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Gestational age on trajectories of social competence difficulties into adolescence
  1. Mariko Hosozawa1,2,
  2. Noriko Cable3,
  3. Yvonne Kelly3,
  4. Amanda Sacker3
  1. 1Institute for Global Health Policy Research, Bureau of International Health, National Center for Global Health and Medicine, Tokyo, Japan
  2. 2Department of Epidemiology and Public Health, University College London, London, UK
  3. 3ESRC International Centre for Lifecourse Studies in Society and Health, Department of Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to Dr Mariko Hosozawa, Institute for Global Health Policy Research, National Center for Global Health and Medicine, Tokyo 162-8655, Japan; mhosozawa{at}


Objectives To examine if gestational age groups predict the development of social competence difficulties (SCDs) from childhood into mid-adolescence and to assess the mediation by maternal psychological distress during infancy on these trajectories.

Design Nationally representative population-based birth cohort (UK Millennium Cohort Study).

Participants 15 821 children born in 2000–2002.

Outcome measures SCDs (derived from peer and prosocial subscales of Strengths and Difficulties Questionnaire) were assessed by parent report when the participants were aged 3, 5, 7, 11 and 14 years. Maternal psychological distress was self-rated using Rutter Malaise Inventory when the children were 9 months of age. Data were modelled using latent growth curve analysis.

Results Developmental trajectories of SCDs were U-shaped in all groups. Very preterm (VP) children (<32 weeks, n=173) showed pronounced difficulties throughout, with the coefficient difference from the full term at age 14 being 0.94 (95% CI 0.23 to 1.66, equivalent to 0.32 SD of the population average SCDs). Moderate-to-late preterm children (32–36 weeks, n=1130) and early-term children (37–38 weeks, n=3232) showed greater difficulties compared with the full-term peers around age 7 years, which resolved by age 14 years (b=0.20, 95% CI –0.05 to 0.44; b=0.03, 95% CI –0.12 to 0.17, respectively). Maternal psychological distress during infancy mediated 20% of the aforementioned association at age 14 years for the VP.

Conclusion There was a dose–response association between gestational age and the trajectories of SCDs. Monitoring and providing support on social development throughout childhood and adolescence and treating early maternal psychological distress may help children who were born earlier than ideal, particularly those born VP.

  • epidemiology
  • neonatology
  • child psychiatry

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  • Correction notice This paper has been updated since it was published online. The authors' affiliations have been reordered.

  • Contributors MH designed the study, carried out the analysis and drafted the initial manuscript. NC, YK and AS provided support on the design of the study and interpretation of the results and revised the manuscript.

  • Funding This work was supported by the UK Economic and Social Research Council (ES/R008930/1) and the Japan Foundation for Paediatric Research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The data collection of Millennium Cohort Study (MCS) is approved by the UK National Health Service Research Ethics Committee and written consent was obtained from all participating parents at each survey; MCS1: South West MREC (MREC/01/6/19); MCS2 and MCS3: London MREC (MREC/03/2/022, 05/MRE02/46); MCS4: Yorkshire MREC (07/MRE03/32); MCS5: Yorkshire and The Humber-Leeds East (11/YH/0203); MCS6: London MREC(13/LO/1786). The use of anonymised data for academic purposes did not require additional ethical approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Millennium Cohort Study is available via the UK Data Archive. Further information about the study is found at

  • 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.

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