The long-term effects of fetal growth retardation, if any, on intellectual and educational outcomes remain incompletely understood. Some but not all studies indicate cognitive impairment in children born small for gestational age (SGA). The present prospective cohort study reviewed school performance and achievement at ages 5, 10, and 16 years in 14,189 full-term infants born in the United Kingdom during 1 week in 1970. The group included 1064 SGA infants with a birth weightless than the fifth percentile for age at term. About half of the participants were followed up for 26 years for occupational status, income, marital status, life satisfaction, and disability. SGA children were significantly deficient in their performance on a wide range of standard tests from ages 5 to 16 years, but typically the deficits were not large. Reading scores at age 10 and spelling and word recognition at age 16 were not significantly abnormal. Teachers rated the 10-year-old SGA children significantly lower than children in the comparison group. SGA adolescents earned lower math grades. In addition, SGA children were more likely to be enrolled in special education classes. The two groups were similar in their emotional and social development. Adjusted years of education and weekly hours of work did not differ significantly. SGA adults were significantly less tall than their peers with an appropriate-for-gestational-age (AGA) birthweight (25 and 10 percent, respectively, had a height <168 cm). SGA status also correlated with a smaller head size at age 5 years. Controlling for social class did not alter the relationship between SGA and long-term achievements. Even in families with one or two professional parents, SGA subjects were less than half as likely as AGA subjects to become professionals or managers. None of the findings could be explained by fetal or neonatal distress. Significant functional impairment in childhood, adolescence, and early adult life is not uncommon in those who were SGA infants, suggesting that every effort should be made to enrich the environment for these children. JAMA 2000;283:625–632
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Richard Strauß (2000) studied this question.