Preterm birth, social disadvantage, and cognitive competence in Swedish 18- to 19-year-old men

• OBJECTIVE: The aim was to study the impact of a range of gestationalages (GAs) on cognitive competence in late adolescence and howthis effect is modified by contextual social adversity in childhood. METHODS: This was a register study based on a national cohortof 119664 men born in Sweden from 1973 to 1976. Data on GA andother perinatal factors were obtained from the Medical BirthRegister, and information on cognitive test scores was extractedfrom military conscription at the ages of 18 to 19 years. Testscores were analyzed as z scores on a 9-point stanine scale,whereby each unit is equivalent to 0.5 SD. Socioeconomic indicatorsof the childhood household were obtained from the Populationand Housing Census of 1990. The data were analyzed by multivariatelinear regression. RESULTS: The mean cognitive test scores decreased in a stepwisemanner with GA. In unadjusted analysis, the test scores were0.63 stanine unit lower in men who were born after 24 to 32gestational weeks than in those who were born at term. The differencein global scores between the lowest and highest category ofsocioeconomic status was 1.57. Adjusting the analysis for thechildhood socioeconomic indicators decreased the effect of GAon cognitive test scores by 26% to 33%. There was also a multiplicativeinteraction effect of social adversity and moderately pretermbirth on cognitive test scores. CONCLUSIONS: This study confirms previous claims of an incrementalassociation of cognitive competence with GA. Socioeconomic indicatorsin childhood modified this effect at all levels of preterm birth.

Nyckelord

preterm

IQ

socioeconomic

inequity

follow-up

MEDICINE

MEDICIN

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