Long-term Impact of Poor Birth Condition on Social and Economic Outcomes in Early Adulthood

OBJECTIVE: The goal of this study was to investigate the association of poor birth condition with long-term social and economic outcomes at 25 to 31 years of age.

METHODS: This was a population-based cohort study using data derived from linkage of routinely collected Swedish data. All term infants born in Sweden between 1973 and 1979 identified from the Swedish birth registry (n = 651 615) were included in the study. Infants were categorized into 3 groups: (1) infants with a normal (>7) Apgar score at 1 or 5 minutes of age without encephalopathy; (2) infants with a low (<7) Apgar score at 1 and 5 minutes of age without encephalopathy; and (3) infants with a low (<7) Apgar score at 1 and 5 minutes with evidence of encephalopathy. The main outcome measures were achievement of a university education and participant's income in early adulthood.

RESULTS: Infants with low Apgar scores who did not develop encephalopathy were less likely to have attended university (odds ratio [OR]: 1.14 [95% confidence interval (CI): 1.05–1.23]) and were more likely to have no income from work (OR: 1.19 [95% CI: 1.07–1.32]) than those born in good condition. Infants who developed encephalopathy also had greater risks of these adverse outcomes (not attended university, OR: 1.94 [95% CI: 1.13–3.33]); no income from work, OR: 3.08 [95% CI: 1.89–5.01]).

CONCLUSIONS: Infants born in poor condition had worse measures of social performance than their peers, and this association was not restricted to those infants who developed obvious neurologic symptoms in the neonatal period. However, even in infants with likely encephalopathy, more than half obtained employment and one third attended university.