Carol R. Hogue, MPH, Ph.D., Michael Kramer, Ph.D., Anne Lang Dunlop, MPH M.D. , and Lucky Jain, M.D.
What is the value added by a healthy mother and child?
The adverse consequences of prematurity (< 37 weeks) and low birth weight (< 2500 grams) on the child and family are well-documented (Agarwal and Lim, 2003; Davis, et al., 2003; Goldani, et al., 2004; Kilbride, et al., 2004; Pleacher, et al., 2004; Brown, et al., 2003). Prematurity and low birth weight are leading causes of infant death and long-term cognitive and developmental disabilities (Reichman,2005).Jain (2008) points out, “Needless to say, the growing brain and body are deceptively capable of keeping adverse effects masked until cognitive and motor functions can be meaningfully tested”. Prematurity and low birth weight are leading causes of infant death and long-term cognitive and developmental disabilities (Reichman,2005).
Infantswhose birthweight is below the 10th percentile for gestational age (small for gestational age, SGA) birthweight between the 10th and 90th percentiles (appropriate for gestationalage, AGA).
Notes:ANCOVAMaternal Age, Race, and Education originally used as covariates (e.g., interactions) but only age was significant. No information on maternal ethnicity.
Covariates included:maternal age at birth, maternal education, maternal race/ethnicity, child race/ethnicity, sex of child, and year of birth
Ran 3 logistic models. Only significant interaction between SGA and prematurity was on ELA failure.
In sufficient evidence to conclude SGA increase risk of failure on other two tests.
Prematurity and Academic Achievement
Bryan L. Williams, Ph.D., Associate Professor
What is it? Who or what is responsible for it? What are the consequences of poor achievement?
• Wide-spread attention to teacher quality in the education literature (Borman & Kimball, 2005; Darling-Hammond, 2006; Hopkins & Stern, 1996; Newton et al., 2010).• Value-Added Modeling (VAM) of the effect of teacher quality: some evidence that teacher quality and effectiveness are positively related to changes in performance over course of an academic year (Newton et al., 2010; Wayne & Youngs, 2003).
• Maybe we should consider maternal and child health…• Maybe prematurity, low birth weight, and maternal risk factors account for a significant proportion of unexplained, within-classroom variance in student achievement.
Being born too early increases the risk of: • Neonatal morbidity and mortality • Early and long term neurological impairment • Lower quality of life Ourability to decrease prematurity is increasing • Prenatal care • Reexamination of standard clinical practice • Interpregnancy and pre-conception care
Jain (2008) points out, “Needless to say, thegrowing brain and body are deceptivelycapable of keeping adverse effects maskeduntil cognitive and motor functions can bemeaningfully tested”.
What is the longer term consequences of prematurity on children across the gestational age spectrum?
What is the relationship between prematurity, birthweight for gestational age, and performance on the standardized test among children born in Georgia?
Electronic Birth Record Mother- (1998-2003) Infant HospitalDischarge Data Linked Georgia Birth- Education Data Set CRCT Test (2004-2010) Grades 1-3
Criterion-Referenced Competency Tests (CRCT) • Designed to measure how well students acquire the skills and knowledge described in the Georgia Performance Standards • Administered in Grades 1-8 • Domains of interest: English Language Arts Reading Source: http://www.doe.k12.ga.us/ci_testing.aspx?PageReq=CI_TESTING_CRCT
Inherent truncated variability of minimal competency tests Inability to obtain non-resident births Incomplete or inaccurate maternal and infant records Lack of earlier outcome measure (i.e., Pre-K) Inability to assess longitudinal changes in achievement
Maternal Ethnicity Child Ethnicity Hispanic 10% Hispanic 11%NH Black NH White NH White 36% 54% NH Black 52% 37%
• Births that have matching student information• Singleton births• Infants with birth weight 400 g to 5000 g• Infants of gestational age 20 to 43 weeks• Infants without recorded congenital anomalies and chromosomal defects
70% 60% 60% 60% 59%60% 55%50%40%30%20% 25% 24% 22% 31% 18%10% 13% 22% 19% 16% 17%0% Extreme Moderately Late Term (37-41) Post Term Premature Premature Premature (>41) (<28) (29-33) (34-36) X2=972.95;df=8; p. Does Not Meet Meets Exceeds < .0001 N=354,781
60% 53% 55% 52% 50% 50% 50% 40% 41% 39% 37% 30% 31% 20% 24% 10% 23% 14% 11% 10% 9% 0% Extreme Moderately Late Term (37-41) Post Term Premature Premature Premature (>41) (<28) (29-33) (34-36) X2=1092.2df=8; Does Not Meet Meets Exceeds p. < .0001N=354,815
60% 55% 52% 51% 50% 50%50%40% 37% 37%30% 33% 26%20% 32% 18%10% 19% 15% 12% 13%0% Extreme Moderately Late Term (37-41) Post Term Premature Premature Premature (>41) (<28) (29-33) (34-36) X2=1587.5;df=8; N=354,764 Does Not Meet Meets Exceeds p. < .0001
345.0Standardized Scale CRCT Score 340.0 R2=.045 (p. < .05) R2=.055 (p. < .05) 335.0 330.0 R2=.045 (p. < .05) 325.0 320.0 315.0 310.0 READING ELA MATH AGA 340.0 329.0 338.5 SGA 333.3 323.2 330.6 Covariates appearing in the model are evaluated at the following values: Mothers Age In Years = 26.11.
Standardized Scale Scores by Gestational Age 345.0 340.0 339.0 338.3 335.7 337.3 336.9 CRCT Scaled Score 1st Grade 335.0 331.7 333.3 330.0 327.9 328.2 327.8 325.0 323.4 325.0 317.5 321.6 320.0 315.0 315.1 Reading SS (n=354,815) 310.0 ELA SS (n=354,781) 305.0 MATH SS (n=354,764) 300.0 Extreme Moderate Late (34-36) Term (37-41) Post Term (> (<28) (29-33) 41) Gestational Age Category
Prematurity and Risk (odds) of CRCT Failure aOR for Association Of Gestational Age With Child’s 1st Grade CRCT Failure 10 English Language ArtsAdjusted Odds Ratio Reading Math 2.85 2.72 2.44 1.47 1.36 1.38 1.17 1.15 1.12 1.06 1.07 1.09 1 Post… Extreme… Moderat… Late… Gestational Age Adjusted for maternal age at birth, maternal education, maternal race/ethnicity, child race/ethnicity, sex of child, and year of birth
Prematurity and Birthweight by Gestational Age on ELA Failure aOR for Association of the Interaction Between Birthweight for Gestational Age and Prematurity on Failure of the ELA Test Only 10.00 SGA 5.43 Adjusted Odds Ratios AGA 2.45 SGA AGA 1.61 SGA AGA 1.35 1.17 AGA 1.15 1.09 SGA 1.00 0.98 0.10 Extreme Moderate Late Post Term (20-28) (29-33) Preterm (>42) (34-36) Gestational Age Adjusted for maternal age at birth, maternal education, maternal race/ethnicity, child race/ethnicity, sex of child, and year of birth
Summary• Being born ‘preterm’ versus ‘term’ increases a first-grade child’s risk of failure of all three components of the CRCT.• Small for gestational age infants scored significantly lower on all three components of the CRCT.• Being small for gestational age significantly increases a first- grade child’s risk of failure on the English Language Arts test among those born extremely, moderately, and late preterm.
Prematurity is an injury that can hurt a child for a very long time Not all premature infants are injured in the same way Likemost injuries many forms of prematurity can be prevented
• Teacher/school variables vs. maternal/infant variables as predictor of school performance• Factors under schools’ control• Fairness of high stakes testing
Next Steps• Link hospital discharge, Pregnancy Risk Assessment Monitoring System (PRAMS), and spatial data to existing data set• Examine the impact of the neighborhood on maternal child health and academic achievement• Obtain earlier and more relevant measures of development