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Gestational age at birth and risk of intellectual disability without a common genetic cause
Journal article   Open access   Peer reviewed

Gestational age at birth and risk of intellectual disability without a common genetic cause

Hein Heuvelman, Kathryn Abel, Susanne Wicks, Renee Gardner, Edward Johnstone, Brian Lee, Cecilia Magnusson, Christina Dalman and Dheeraj Rai
European journal of epidemiology, v 33(7), pp 667-678
06 Dec 2017
DOI: https://doi.org/10.1007/s10654-017-0340-1
PMID: 29214412
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1007/s10654-017-0340-1View
Published, Version of Record (VoR)CC BY V4.0,  Open

Abstract

Gestational age Intellectual disability Perinatal Epidemiology Post-term birth Regression splines Siblings Stockholm Youth Cohort
Preterm birth is linked to intellectual disability and there is evidence to suggest post-term birth may also incur risk. However, these associations have not yet been investigated in the absence of common genetic causes of intellectual disability, where risk associated with late delivery may be preventable. We therefore aimed to examine risk of intellectual disability without a common genetic cause across the entire range of gestation, using a matched-sibling design to account for unmeasured confounding by shared familial factors. We conducted a population-based retrospective study using data from the Stockholm Youth Cohort (n = 499,621) and examined associations in a nested cohort of matched outcome-discordant siblings (n = 8034). Risk of intellectual disability was greatest among those born extremely early (adjusted OR 24 weeks  = 14.54 [95% CI 11.46–18.44]), lessening with advancing gestational age toward term (aOR 32 weeks  = 3.59 [3.22–4.01]; aOR 37 weeks  = 1.50 [1.38–1.63]); aOR 38 weeks  = 1.26 [1.16–1.37]; aOR 39 weeks = 1.10 [1.04–1.17]) and increasing with advancing gestational age post-term (aOR 42 weeks  = 1.16 [1.08–1.25]; aOR 43 weeks  = 1.41 [1.21–1.64]; aOR 44 weeks  = 1.71 [1.34–2.18]; aOR 45 weeks  = 2.07 [1.47–2.92]). Associations persisted in a cohort of matched siblings suggesting they were robust against confounding by shared familial traits. Risk of intellectual disability was greatest among children showing evidence of fetal growth restriction, especially when birth occurred before or after term. Birth at non-optimal gestational duration may be linked causally with greater risk of intellectual disability. The mechanisms underlying these associations need to be elucidated as they are relevant to clinical practice concerning elective delivery around term and mitigation of risk in post-term children.

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