Perinatal Origins of First-Grade Academic Failure: Role of Prematurity and Maternal Factors

OBJECTIVE: We examined the relationships among gestational age at birth, maternal characteristics, and standardized test performance in Georgia first-grade students.

METHODS: Live births to Georgia-resident mothers aged 11 to 53 years from 1998 through 2003 were deterministically linked with standardized test results for first-grade attendees of Georgia public schools from 2005 through 2009. Logistic models were used to estimate the odds of failure of the 3 components of the first-grade Criterion-Referenced Competency Test (CRCT).

RESULTS: The strongest risk factor for failure of each of the 3 components of the first-grade CRCT was level of maternal education. Child race/ethnicity and maternal age at birth were also associated with first-grade CRCT failure irrespective of the severity of preterm birth, but these factors were more important among children born moderately preterm than for those born on the margins of the prematurity distribution. Adjusting for maternal and child characteristics, there was an increased odds of failure of each component of the CRCT for children born late preterm versus term, including for math (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.13–1.22), reading (aOR: 1.13, 95% CI: 1.08–1.18), and English/language arts, for which there was an important interaction with being born small for gestational age (aOR: 1.17, 95% CI: 1.07–1.29).

CONCLUSIONS: Preterm birth and low maternal education increase children’s risk of failure of first-grade standardized tests. Promoting women’s academic achievement and reduce rates of preterm birth may be important to achieving gains in elementary school performance.