Effect of gestational age on special education: a population-based matched cohort analysis.

Abstract

Objective: To investigate the effect of gestational age on special education use at primary school age, and to examine specific groups with elevated risk.

Design, setting and patients: Population-based matched cohort study linking data from the Dutch national perinatal registry (PERINED) of all singleton surviving children without major congenital abnormalities, born between 25⁺⁰ and 42⁺⁶ weeks of gestation between 1999 and 2009, with data of the mandatory special education registry of Statistics Netherlands.

Main outcome measures: Use of special education at primary school age.

Results: 1 814 540 children were included. Overall prevalence of special education was 6.6%, with highest rates in children born at 25 weeks (34.7%) and lowest at 40 weeks (5.7%). Elevated adjusted ORs for special education compared with the reference of 40 weeks were found in all gestational age groups (25-29 weeks, 30-31 weeks, 32-36 weeks, 37-39 weeks and 41-42 weeks), with the highest adjusted OR (3.50 (95% CI, 3.26 to 3.77)) in children born at 25-29 weeks. Comparable ORs were obtained after 1 to 1 exact matching with controls born at 40 weeks. Low maternal education, male sex, small for gestational age and 5-min Apgar score<7 increased special education use at week 25 and above.

Conclusion: There is a strong inverse effect of gestational age on special education use in this complete nationwide, decennium birth cohort. Increased risk of special education use is still present in late preterms and those born at early-term or post-term.