Published online March 1, 2006
PEDIATRICS Vol. 117 No. 3 March 2006, pp. e460-e467 (doi:10.1542/peds.2005-0737)

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Risks for Low Intellectual Performance Related to Being Born Small for Gestational Age Are Modified by Gestational Age

Niklas Bergvall, MSc^a, Anastasia Iliadou, PhD^a,b, Stefan Johansson, MD^a, Torsten Tuvemo, MD, PhD^c and Sven Cnattingius, MD, PhD^a

^a Department of Medical Epidemiology and Biostatistics
^b Unit of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
^c Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden

OBJECTIVE. We sought to study whether the association between being born small for gestational age and risk for low intellectual performance was modified by gestational age.

METHODS. A population-based cohort study was conducted of 352125 boys who were born between 28 and 43 completed weeks of gestation from 1973 to 1981 in Sweden. Risk for low intellectual performance at military conscription, estimated as odds ratios with 95% confidence intervals was measured.

RESULTS. Compared with men who were born preterm (28–36 weeks) and had normal birth weight for gestational age, men who were born preterm and had a very low birth weight for gestational age were not at increased risk for low intellectual performance. In contrast, men who were born preterm with a very short birth length or a very small head circumference for gestational age faced a near doubled risk for low intellectual performance compared with their appropriate peers. Among men who were born at term (37–41 weeks), risk for low intellectual performance was increased among those with very or moderately small birth weight, birth length, or head circumference for gestational age.

CONCLUSIONS. During early stages of gestation, growth in length and head circumference may be more important for intellectual development than weight increase. Future studies on size at birth and intellectual performance should consider also including anthropometric measurements other than birth weight.

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Key Words: fetal growth • gestational age • intellectual performance

Abbreviations: SDS—SD score • OR—odds ratio • CI—confidence interval

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Accepted Oct 4, 2005.

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