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Eur J Epidemiol. 2019 Dec 2. doi: 10.1007/s10654-019-00590-7. [Epub ahead of print]

Risk of intellectual disability in children born appropriate-for-gestational-age at term or post-term: impact of birth weight for gestational age and gestational age.

Author information

1
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, 171 76, Stockholm, Sweden. ruoqing.chen@ki.se.
2
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
3
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
4
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
5
Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
6
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
7
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, 171 76, Stockholm, Sweden.

Abstract

Children born small for gestational age have a higher risk of intellectual disability. We investigated associations of birth weight for gestational age percentile and gestational age with risk of intellectual disability in appropriate-for-gestational-age (AGA) children. We included 828,948 non-malformed term or post-term AGA singleton children (including 429,379 full siblings) born between 1998 and 2009 based on data from the Swedish Medical Birth Register. Diagnosis of intellectual disability after 3 years of age was identified through the Patient Register. Using Cox regression models, we calculated hazard ratios (HRs) with 95% confidence intervals (CIs) of intellectual disability among children with different birth weight percentiles and gestational age in the whole population and in a subpopulation of full siblings. A total of 1688 children were diagnosed with intellectual disability during follow-up. HRs (95% CIs) of intellectual disability for the low birth weight percentile groups (10th-24th and 25th-39th percentiles, respectively) versus the reference group (40th-59th percentiles) were 1.43 (1.22-1.67) and 1.28 (1.10-1.50) in population analysis and 1.52 (1.00-2.31) and 1.44 (1.00-2.09) in sibling comparison analysis. The increased risk for low birth weight percentiles in population analysis was stable irrespective of gestational age. A weak U-shaped association between gestational age and intellectual disability was observed in population analysis, although not in sibling comparison analysis. These findings suggest that among AGA children born at term or post-term, lower birth weight percentiles within the normal range are associated with increased risk of intellectual disability, regardless of gestational age.

KEYWORDS:

Birth weight for gestational age; Cohort studies; Gestational age; Intellectual disability; Siblings

PMID:
31788734
DOI:
10.1007/s10654-019-00590-7

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