Adult Functional Outcome of Those Born Small for Gestational Age

TLDR

Studies of children born small for gestational age (SGA) have reported cognitive impairment, though some have found no differences in IQ or other cognitive scores. This study aimed to evaluate the long‑term functional outcomes of SGA infants. A prospective cohort of 14,189 UK infants born in 1970, including 1,064 SGA cases, was followed at ages 5, 10, 16, and 26 years. SGA adults showed modest academic deficits during childhood, were less likely to hold professional or managerial positions and earned lower income, yet had similar education levels, employment rates, marital status, and life satisfaction compared with normal‑birth‑weight peers, and displayed shorter stature.

Abstract

ContextAlthough studies have documented cognitive impairment in children who were born small for gestational age (SGA), other studies have not demonstrated differences in IQ or other cognitive scores. The need exists for long-term studies of such children to assess functional outcomes not measurable with standardized testing.ObjectiveTo determine the long-term functional outcome of SGA infants.DesignProspective cohort study.Setting and ParticipantsA total of 14,189 full-term infants born in the United Kingdom on April 5 through 11, 1970, were studied as part of the 1970 British Birth Cohort; 1064 were SGA (birth weight less than the fifth percentile for age at term). Follow-up at 5, 10, 16, and 26 years was 93%, 80%, 72%, and 53%, respectively.Main Outcome MeasuresSchool performance and achievement, assessed at 5, 10, and 16 years; and years of education, occupational status, income, marital status, life satisfaction, disability, and height, assessed at 26 years, comparing persons born SGA with those who were not.ResultsAt 5, 10, and 16 years of age, those born SGA demonstrated small but significant deficits in academic achievement. In addition, teachers were less likely to rate those born SGA in the top 15th percentile of the class at 16 years (13% vs 20%; P<.01) and more likely to recommend special education (4.9% vs 2.3%; P<.01) compared with those born at normal birth weight (NBW). At age 26 years, adults who were SGA did not demonstrate any differences in years of education, employment, hours of work per week, marital status, or satisfaction with life. However, adults who were SGA were less likely to have professional or managerial jobs (8.7% vs 16.4%; P<.01) and reported significantly lower levels of weekly income (mean [SD], 185 [91] vs 206 [102] £; P<.01) than adults who were NBW. Adults who were SGA also reported significant height deficits compared with those who were NBW (mean [SD] z score, −0.55 [0.98] vs 0.08 [1.02]; P<.001). Similar results were also obtained after adjusting for social class, sex, region of birth, and the presence of fetal or neonatal distress.ConclusionsIn this cohort, adults who were born SGA had significant differences in academic achievement and professional attainment compared with adults who were NBW. However, there were no long-term social or emotional consequences of being SGA: these adults were as likely to be employed, married, and satisfied with life.