Differential effects of preterm birth and small gestational age on cognitive and motor development

AIMS To determine the differential effects of preterm birth and being small for gestational age on the cognitive and motor ability of the child. METHODS A longitudinal cohort of all infants of gestational age ≤ 32 weeks born to mothers resident in the counties of Cheshire and Merseyside in 1980-1 was studied. The children were assessed at the age of 8 to 9 years using the Wechsler Intelligence Scale for Children, the Neale analysis of reading ability, and the Stott-Moyes-Henderson test of motor impairment. Adequacy of fetal growth was determined by the birthweight ratio—that is, the ratio of the observed birthweight to the expected birthweight for a given gestational age. Children with clinically diagnosed motor, learning or sensory disabilities were excluded. Information on social variables was obtained by a questionnaire completed by the parents. Of the 182 children, 158 were assessed. RESULTS IQ was positively correlated with birthweight ratio but not with birthweight or gestational age. Motor ability was associated with birthweight, gestational age, and birthweight ratio. Reading comprehension was associated with birthweight ratio, but reading rate and accuracy were best explained by social variables and sex. IQ remained associated with birthweight ratio, after adjusting for maternal education, housing status, and number of social service benefits received. Reading ability was related to these social variables but motor ability was not. CONCLUSIONS The effects of SGA and preterm birth differed: SGA was associated with cognitive ability, as measured by IQ and reading comprehension; motor ability was additionally associated with preterm birth. Reading rate and accuracy were not associated with SGA or preterm birth but were socially determined. Key points Preterm birth and being small for gestational age differ in their effects on motor and cognitive development Cognitive ability, as measured by IQ and reading comprehension, was negatively associated with the degree of fetal growth retardation Motor ability was positively associated with gestational age and negatively associated with the degree of fetal growth retardation Reading rate and reading accuracy were not associated with either gestational age or the degree of fetal growth retardation, but were socially determined