Preterm birth refers to a baby born before the completion of 37 weeks of pregnancy. It is a major public health concern globally, with around 15 million preterm births occurring each year.

Preterm birth is the leading cause of neonatal mortality worldwide, and babies who survive are at higher risk of certain health complications. However, preterm birth also has long-term effects on a child’s cognitive development, including lower academic performance.

What is Preterm Birth?

Preterm birth is defined as a baby born before the completion of 37 weeks of pregnancy. It can occur spontaneously, or it can be induced when there are medical reasons to deliver the baby early.

Preterm birth is divided into three categories based on the gestational age of the baby:.

Extremely preterm: Less than 28 weeks
Very preterm: 28 to 32 weeks
Moderate to late preterm: 32 to 37 weeks

Preterm birth is a major public health concern globally. According to the World Health Organization (WHO), around 15 million babies are born preterm each year, accounting for approximately one in 10 births worldwide.

The rates of preterm birth vary across countries and regions, with higher rates in low- and middle-income countries. In the United States, the preterm birth rate is around 10%, which has been relatively stable over the past decade after a long period of increase.

What Are the Causes of Preterm Birth?

The exact causes of preterm birth are not fully understood, but there are several factors that increase the risk of preterm labor and delivery. These include:.

Previous preterm birth
Short cervical length
Uterine or cervical abnormalities
Persistent vaginal bleeding
Infection
Multiple gestation (twins, triplets, etc.)
Pregnancy-induced hypertension
Diabetes
Maternal age (less than 17 or over 35)
Smoking, drug use, or alcohol abuse
Stress

What Are the Health Complications of Preterm Birth?

Preterm birth can lead to a range of health complications for the baby, depending on the gestational age and overall health of the baby. Some common health complications of preterm birth include:.

Respiratory distress syndrome (RDS)
Apnea (periods of stopped breathing)
Jaundice
Anemia
Hypothermia (low body temperature)
Intraventricular hemorrhage (bleeding in the brain)
Poor immune function
Feeding difficulties
Gastrointestinal problems
Speech and language delays
Vision and hearing problems
Cerebral palsy and other neurological disorders

Some of these health complications may resolve with time and medical intervention, while others may have long-term effects on the child’s health and well-being.

What Are the Long-Term Effects of Preterm Birth?

Preterm birth also has long-term effects on a child’s cognitive development and academic performance.

Several studies have found that children born preterm are at higher risk of cognitive and developmental delays, as well as lower academic performance.

One study published in the journal Pediatrics followed a cohort of over 1 million Swedish children born between 1973 and 1994, including over 25,000 born preterm (less than 37 weeks).

The study found that preterm birth was associated with a higher risk of poor academic performance, defined as failing at least one subject in ninth grade. The risk of poor academic performance increased with decreasing gestational age, with extremely preterm infants (less than 28 weeks) having the highest risk.

Another study published in the Journal of Pediatrics followed a cohort of over 1,000 children born preterm and full-term and evaluated their cognitive development at ages 5 and 10 years.

The study found that preterm-born children had lower cognitive scores compared to full-term born children at both ages, and the gap widened over time. The preterm-born children also had a higher risk of having cognitive scores in the clinically impaired range at age 10 years.

Other studies have found that preterm birth is associated with a higher risk of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and other behavioral and emotional problems, which can further impact academic performance and overall well-being.

Why Are Children Born Preterm at Higher Risk of Lower Academic Performance?

The exact mechanisms through which preterm birth affects cognitive development and academic performance are not fully understood, but there are several factors that may contribute to this association:.

Brain development: The last few weeks of pregnancy are critical for brain development, and premature birth may disrupt this process. Children born preterm may have smaller brain volumes, abnormal brain structures, and altered brain connectivity, which can affect cognitive function and academic performance.
Environmental factors: Preterm-born children are often exposed to a stressful and overstimulating neonatal intensive care unit (NICU) environment, which can interfere with their learning and development. They may also have limited opportunities for social interaction and cognitive stimulation during the early years of life, which can delay their cognitive and language development.
Health complications: Preterm birth can lead to a range of health complications that can affect cognitive function and academic performance, such as cerebral palsy, vision and hearing problems, and ADHD.
Socioeconomic factors: Children born preterm are more likely to come from low-income families and have less-educated parents, which can limit their access to educational resources and opportunities.

What Can Be Done to Improve Academic Outcomes for Children Born Preterm?

Although preterm birth is a complex and multifactorial issue, there are several interventions that can improve the cognitive and academic outcomes for children born preterm:.

Early intervention: Early identification and intervention of cognitive and developmental delays can help prevent or mitigate long-term negative effects on academic performance and overall well-being. This can include developmental screenings, early intervention programs, and supportive education services.
Parent training: Parent training programs can help parents of preterm-born children to provide a supportive and stimulating home environment, which can promote cognitive and language development.
Neonatal care: Improving the quality of neonatal care, including reducing the use of unnecessary interventions and optimizing the NICU environment, can improve the health and developmental outcomes for preterm-born children.
Educational support: Providing preterm-born children with educational support and resources, such as tutoring, educational therapy, and access to technology, can improve their academic performance and educational opportunities.
Social and emotional support: Preterm-born children may have higher levels of social and emotional difficulties, such as anxiety and depression, which can affect their academic performance. Providing social and emotional support, such as counseling and peer groups, can improve their overall well-being and academic outcomes.

Conclusion

Preterm birth is a major public health concern globally, with around 15 million preterm births occurring each year.

Several factors may contribute to this association, including brain development, environmental factors, health complications, and socioeconomic factors. Early intervention, parent training, neonatal care, educational support, and social and emotional support can improve the cognitive and academic outcomes for children born preterm.