Born on the Edge: Study Unravels the Cognitive Outcomes of Preterm and Early-Term Births

Preterm and early-term births have established associations with cognitive impairment, yet comprehensive studies accounting for genetic, prenatal, and child-specific factors in these high-risk populations remain sparse. Recently published investigation aimed to assess the long-term cognitive outcomes of children born across various gestational ages—including very preterm (28-31 weeks), moderately preterm (32-33 weeks), late preterm (34-36 weeks), and early term (37-38 weeks)—in comparison with full-term peers (≥39 weeks), while considering genetic influences and other risk factors. Through a prospective, multicenter, longitudinal cross-sectional study involving children aged 9 to 10 years from the Adolescent Brain and Cognitive study, findings indicated significant cognitive differences among gestational age groups. Children born moderately preterm were found to have lower composite cognitive scores (β = -0.39; P < .001) compared to their full-term counterparts after adjusting for age, sex, socioeconomic status (SES), and polygenic scores (cogPGS), which account for genetic contributions to cognitive performance.

Impact of Maternal Influences

In particular, moderating factors such as maternal influences did attenuate this association slightly yet remained significant. Children born moderately preterm scored lower across several cognitive domains: vocabulary (β = -0.36), working memory (β = -0.27), episodic memory (β = -0.32), and recall tasks, affirming their cognitive challenges. Despite adjustments, children born at very preterm and late preterm classifications did not exhibit statistically significant differences in cognitive outcomes relative to full-term peers, suggesting variable risks associated with gestational age.

Cognitive Outcomes by Gestational Age

Furthermore, results indicated that children born at or below 32 weeks gestation scored lower in various cognitive domains, highlighting the critical developmental milestones that are often disrupted by early birth. Notably, the study revealed that despite lower gestational ages being directly correlated to cognitive deficits, the differences were not as pronounced for late preterm or early term births, pointing to the complexity of cognitive outcomes across the gestational spectrum.

Methodological Rigor and Limitations

The study employed rigorous methodologies, including adjusting for genetic influences using cogPGS derived from extensive genome-wide association studies (GWAS). However, limitations exist, such as potential recall bias in maternal reporting and the generalizability of findings due to the demographic composition of the sample. These findings underscore the urgent need for early screening and interventions for children born before 34 weeks gestation due to their heightened risk for cognitive deficits, which may influence academic achievement and quality of life. Future research should aim for longitudinal designs incorporating genetic data to better elucidate the developmental trajectories stemming from preterm birth.

Key Points

- Preterm and early-term births are associated with cognitive impairment; this study examined children born at various gestational ages (very preterm to early term) to assess long-term cognitive outcomes, comparing them with full-term peers (≥39 weeks) while controlling for genetic and child-specific factors.

- Significant cognitive differences were found among gestational age groups, with moderately preterm children (32-33 weeks) exhibiting significantly lower composite cognitive scores than full-term children, after accounting for factors such as age, sex, SES, and genetic influences (polygenic scores).

- Children born moderately preterm showed deficits across multiple cognitive domains, including vocabulary, working memory, and episodic memory, indicating substantial cognitive challenges despite the moderating effects of maternal influences.

- Children born at or below 32 weeks gestation scored lower in various cognitive dimensions, demonstrating critical disruptions in developmental milestones due to early birth; however, late preterm and early term births did not show statistically significant cognitive outcome differences relative to full-term children.

- Methodological rigor was applied through the use of cogPGS for adjusting genetic influences, but limitations such as potential recall bias in maternal reporting and sample demographic considerations may affect the generalizability of the results.

- The study highlights the necessity for early screening and targeted interventions for children born before 34 weeks gestation to mitigate risks for cognitive deficits that can adversely affect academic performance and overall quality of life, with a call for future research to adopt longitudinal designs that incorporate genetic data for deeper insights into developmental trajectories post-preterm birth.

Reference –

Samson Nivins et al. (2025). Gestational Age And Cognitive Development In Childhood. *JAMA Network Open*, 8. https://doi.org/10.1001/jamanetworkopen.2025.4580.