Article Text

other Versions

Download PDFPDF
Gestational age at birth and child special educational needs: a UK representative birth cohort study
  1. Neora Alterman1,
  2. Samantha Johnson2,
  3. Claire Carson1,
  4. Stavros Petrou3,
  5. Oliver Rivero-Arias1,
  6. Jennifer J Kurinczuk1,
  7. Alison Macfarlane4,
  8. Elaine Boyle2,
  9. Maria A Quigley1
  1. 1National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2Department of Health Sciences, University of Leicester, Leicester, UK
  3. 3Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  4. 4Department of Health Sciences, City University, London, UK
  1. Correspondence to Dr Neora Alterman, National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK; neora.alterman{at}


Objective To examine the association between gestational age at birth across the entire gestational age spectrum and special educational needs (SENs) in UK children at 11 years of age.

Methods The Millennium Cohort Study is a nationally representative longitudinal sample of children born in the UK during 2000–2002. Information about the child’s birth, health and sociodemographic factors was collected when children were 9 months old. Information about presence and reasons for SEN was collected from parents at age 11. Adjusted relative risks (aRRs) were estimated using modified Poisson regression, accounting for confounders.

Results The sample included 12 081 children with data at both time points. The overall prevalence of SEN was 11.2%, and it was inversely associated with gestational age. Among children born <32 weeks of gestation, the prevalence of SEN was 27.4%, three times higher than among those born at 40 weeks (aRR=2.89; 95% CI 2.02 to 4.13). Children born early term (37–38 weeks) were also at increased risk for SEN (aRR=1.33; 95% CI 1.11 to 1.59); this was the same when the analysis was restricted to births after labour with spontaneous onset. Birth before full term was more strongly associated with having a formal statement of SEN or SEN for multiple reasons.

Conclusion Children born at earlier gestational ages are more likely to experience SEN, have more complex SEN and require support in multiple facets of learning. This association was observed even among children born early-term and when labour began spontaneously.

  • epidemiology
  • neonatology
  • adolescent health

Statistics from


  • Contributors MAQ, NA, CC and SJ designed the study with input from EB, JJK, AM, SP and OR-A. Statistical analysis was performed by NA, while MAQ, CC, SJ, EB, JJK, AM, SP, OR-A and NA were all involved in the interpretation of the findings. NA wrote the initial draft of the manuscript and all authors contributed to draft of the manuscript and reviewed the final version.

  • Funding The TIGAR study was funded by a research grant from the Medical Research Council (MR/M01228X/1).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Data availability statement Data from the Millennium Cohort Study surveys are available from the Centre for Longitudinal Studies and can be accessed through the UK Data Service (

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles