Obstetric factors and different causes of special educational need: retrospective cohort study of 407 503 schoolchildren. Issue 3 (27th November 2012)

• Record Type: Journal Article
• Authors: Mackay, DF; Smith, GCS; Dobbie, R; Cooper, S‐A; Pell, JP
• Is Part Of: BJOG. Volume 120:Issue 3(2013:Mar.)
• Page Start: 297
• Page End: 308
• Publication Date: 2012-11-27
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12071
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12071-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12071-sec-0001" sec-type="section"> <title>Objective</title> <p>To determine whether relationships with gestational age and birthweight centile vary between specific causes of special educational need (SEN).</p> </sec> <sec id="bjo12071-sec-0002" sec-type="section"> <title>Design</title> <p>Retrospective cohort study.</p> </sec> <sec id="bjo12071-sec-0003" sec-type="section"> <title>Setting</title> <p>Scotland.</p> </sec> <sec id="bjo12071-sec-0004" sec-type="section"> <title>Population</title> <p>A cohort of 407 503 schoolchildren.</p> </sec> <sec id="bjo12071-sec-0005" sec-type="section"> <title>Methods</title> <p>Polytomous logistic regression was used to examine the risk of each cause of SEN across the spectrum of gestation at delivery and birthweight centile, adjusting for potential confounding factors.</p> </sec> <sec id="bjo12071-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Crude and adjusted odds ratios and confidence intervals.</p> </sec> <sec id="bjo12071-sec-0007" sec-type="section"> <title>Results</title> <p>Of the 19 821 children with SEN, 557 (2.8%) had sensory impairments, 812 (4.1%) had physical or motor disabilities, 876 (4.4%) had language impairments, 2823 (14.2%) had social, emotional, or behavioural problems, 7018 (35.4%) had intellectual disabilities, 4404 (22.2%) had specific learning difficulties, and 1684 (8.5%) autistic spectrum disorder (ASD). Extreme preterm delivery (at 24–27 weeks of gestation) was a strong predictor of sensory (adjusted OR 23.64, 95% CI 12.03–46.45), physical or motor (adjusted OR 29.69, 95% CI 17.49–50.40), and intellectual (adjusted OR 11.67, 95% CI 8.46–16.10) impairments, with dose relationships across the range of gestation. Similarly, birthweight below the third centile was associated with sensory (adjusted OR 2.85, 95% CI 2.04–3.99), physical or motor (adjusted OR 2.47, 95% CI 1.82–3.37), and intellectual (adjusted OR 2.67, 95% CI 2.41–2.96) impairments. Together, gestation and birthweight centile accounted for 24.0% of SEN arising from sensory impairment, 34.3% arising from physical or motor disabilities, and 26.6% arising from intellectual disabilities. Obstetric factors were less strongly associated with specific learning difficulties and social or emotional problems, and there were no significant associations with ASD.</p> </sec> <sec id="bjo12071-sec-0008" sec-type="section"> <title>Conclusions</title> <p>The association between gestation and birthweight centile and overall risk of SEN is largely driven by very strong associations with sensory, physical or motor impairments, and intellectual impairments.</p> </sec> </abstract>