Attention problems in relation to gestational age at birth and smallness for gestational age

Background: While it is well established that very preterm birth (gestational age at birth<32 weeks) is related to increased attention problems, there is still considerable uncertainty of the effects of moderate or late preterm birth or smallness for gestational age (SGA) on attention regulation. Aims: To investigate the impact of gestational age at birth and SGA, birth on child attention problems. Study design: Prospective longitudinal cohort study. Subjects: A total of 1435 children sampled from the Bavarian Longitudinal Study (BLS). Outcome measures: Main outcome variables were parent-reported attention problems and examiner-reported attention skills at 6 and 8 years. Predictors were linked to attention outcomes using hierarchical regression analyses. Results: Gestational age at birth ranged from 25 weeks to 41 weeks. We found a quadratic effect of gestational age on attention problems (β6years=0.161, 95% CI= 0.085; 0.236; β8years= 0.211, 95% CI= 0.135; 0.287), and attention skills at 6 and 8 years (β6years= -0.178, 95% CI= -0.252; -0.104; β8years= -0.169, 95% CI= -0.243; -0.094). Elective caesarean birth did not predict child attention. In adjusted models, SGA was an additional risk factor for attention problems ((β=0.080, 95% CI= 0.026; 0.134), and attention skills (β= -0.091, 95% CI=-0.143; -0.039) at 6 years but not at 8 years after adjusting for child sex and family SES. Conclusion: Adverse effects on attention are disproportionately higher at early gestations. In contrast, the impact of SGA status was found to be similar at all gestational ages but disappeared by 8 years. Keywords: child attention, preterm, gestational age at birth, elective caesarean birth, small for gestational age