Gestational age at term delivery and children’s neurocognitive development

Abstract

Background Preterm birth is associated with lower neurocognitive performance. However, whether children’s neurodevelopment improves with longer gestations within the full-term range (37–41 weeks) is unclear. Given the high rate of obstetric intervention in the USA, it is critical to determine whether long-term outcomes differ for children delivered at each week of term. Methods This secondary analysis included 39 199 live-born singleton children of women who were admitted to the hospital in spontaneous labour from the US Collaborative Perinatal Project (1959–76). At each week of term gestation, we evaluated development at 8 months using the Bayley Scales of Infant Development, 4 years using the Stanford–Binet IQ (SBIQ) domains and 7 years using the Wechsler Intelligence Scales for Children (WISC) and Wide-Range Achievement Tests (WRAT). Results Children’s neurocognitive performance improved with each week of gestation from 37 weeks, peaking at 40 or 41 weeks. Relative to those delivered at 40 weeks, children had lower neurocognitive scores at 37 and 38 weeks for all assessments except SBIQ and WISC Performance IQ. Children delivered at 39 weeks had lower Bayley Mental (β = −1.18; confidence interval −1.77, −0.58) and Psychomotor (β = −1.18; confidence interval −1.90, −0.46) scores. Results were similar for within-family analyses comparing siblings, with the addition of lower WRAT scores at 39 weeks. Conclusions The improvement in development scores across assessment periods indicates that each week up to 40 or 41 weeks of gestation is important for short- and long-term cognitive development, suggesting 40–41 weeks may be the ideal delivery window for optimal neurodevelopmental outcomes.

The COVID-19 Pandemic and Early Child Cognitive Development: A Comparison of Development in Children Born During the Pandemic and Historical References

“…However, even amongst healthy birthweight infants, there is evidence that increased birth weight and later math and language processing (50). Similarly, even within children born full-term, later infant and children neurocognitive outcomes have been shown to improve for each week of gestation past 37 weeks, with a peak at 40-41 weeks (51).…”

Are there sex differences in fetal growth strategies and in the long-term effects of pregnancy complications on cognitive functioning?

“…We do so using a large dataset that allows us to examine birthweights, placental weights as well as cognitive outcomes at 7 years of age in the same population, the National Collaborative Perinatal Project (NCCP).The NCCP collected data from ~60,000 pregnancies, including information about pregnancy outcome, placental pathology, and follow-up psychological exams at various ages, 26 and so provides the opportunity to test hypotheses regarding sex differences in fetal strategies and the long-term effects of early-life environment. Although the NCCP began over 60 years ago, the data are of good quality 26,27 and it forms the basis for many recent studies of placental pathology, [28][29][30][31] cognitive development, [32][33][34][35][36] and other epidemiological questions. [37][38][39][40][41][42] Importantly for the present study, the biology underlying sex differences in fetal growth strategies would not have changed over this time period, and most of the variables used (e.g., birthweight, placental weight, and gestational age at birth) are straightforward to measure.…”

New Markers for Placental Dysfunction at Term – Potential for More

“…In contrast, however, a current epidemiological study of 39 199 viviparous children (singleton pregnancies) between 37 + 0 – 41 + 0 WG examined their neurocognitive development at the age of 8 months, 4 and 7 years – stratified by the WG at delivery. Here, a progress in gestational weeks up until 41 + 0 WG was associated with a significant increase in neurocognitive development scores 22 .…”

“…Demgegenüber steht eine aktuelle epidemiologische Studie von 39 199 lebendgeborenen Kindern (Einlingsschwangerschaften) zwischen 37 + 0 – 41 + 0 SSW, bei denen – stratifiziert nach SSW bei Entbindung – die neurokognitive Entwicklung im Alter von 8 Monaten, 4 und 7 Jahren untersucht wurde. Hier zeigte sich mit fortschreitender SSW eine signifikante Verbesserung in den neurokognitiven Entwicklungs-Scores bis zur 41 + 0 SSW 22 .…”