Birth weight and adult earnings: a systematic review and meta-analysis

Birth weight and school absences and attainment: a longitudinal linked cohort study of compulsory schooling in England

OBJECTIVE

To explore how birth weight and size-for-gestation may contribute to school absences and educational attainment and whether there are different associations across sex and income groups.

DESIGN

Longitudinal linked cohort study.

METHODS

Data were drawn from the Millennium Cohort Study, a nationally representative cohort of children born in 2000-2001; percentage of authorised and unauthorised absences from Year 1 to Year 11, and Key Stage test scores at ages 7, 11 and 16 in English and Maths were linked from the National Pupil Database. Birth outcomes and covariates were derived from the 9-month survey, and linear regressions with complex survey weights were fitted.

RESULTS

Being born small-for-gestational-age (vs average-for-gestational-age) was associated with an increase of 0.47%, 0.55% and 0.40% in authorised absences in Years 1, 3 and 4 (n=6659) and with a reduction of 0.16-0.26 SD in all English and Maths test scores (n=6204). Similar associations were found for birth weight. After adjusting for prior test scores, English (b=0.07) and Maths (b=0.05) performance at age 11 remained associated with birth weight. Socioeconomic status modified the associations: there were larger disparities in test scores among higher-income families, suggesting that higher income did not compensate for being born small-for-gestational-age.

CONCLUSION

Children born smaller missed slightly more classes (~1 day per year) during primary school and had lower English and Maths performance across compulsory education. Exploring specific health conditions and understanding how education and health systems can work together to support children may help to reduce the burden.

Socioeconomic outcomes in very preterm/very low birth weight adults: individual participant data meta-analysis

BACKGROUND

Very preterm (VPT; <32 weeks) or very low birth weight (VLBW; <1500 g) birth is associated with socioeconomic disadvantages in adulthood; however, the predictors of these outcomes remain underexplored. This study examined socioeconomic disparities and identified neonatal and sociodemographic risk factors among VPT/VLBW individuals.

METHODS

A one-stage individual participant data meta-analysis was conducted using 11 birth cohorts from eight countries, comprising 1695 VPT/VLBW and 1620 term-born adults aged 18-30 years.

RESULTS

VPT/VLBW adults had lower odds of higher educational attainment (0.40[0.26-0.59]), remaining in education (0.63[0.47-0.84]) or paid work (0.76[0.59-0.97]), and higher odds of receiving social benefits (3.93[2.63-5.68]) than term-borns. Disparities in education and social benefits persisted after adjusting for age, sex, and maternal education, even among those without neurosensory impairments (NSI). Among VPT/VLBW adults, NSI significantly impacted all socioeconomic outcomes, increasing the odds of receiving social benefits 6.7-fold. Additional risk factors included medical complications, lower gestational age and birth weight, lower maternal education, younger maternal age, and non-white ethnicity.

CONCLUSIONS

NSI is the strongest risk factor for adulthood socioeconomic challenges in the VPT/VLBW population. Mitigating these disparities may require improved neonatal care to reduce NSI prevalence and targeted social and educational support for VPT/VLBW individuals.

IMPACT

Very preterm or very low birth weight (VPT/VLBW) birth is associated with socioeconomic disadvantages in adulthood, including lower educational attainment, lower employment rates, and a higher need for social benefits compared with individuals born at term. Neurosensory impairments are strongly associated with adverse socioeconomic outcomes among VPT/VLBW adults, while lower gestational age, lower birth weight, and sociodemographic disadvantages serve as additional risk factors. Early interventions in the NICU that reduce medical complications, along with enhanced educational support throughout childhood, may help mitigate long-term socioeconomic disparities for individuals born VPT/VLBW.

Voting Restrictions and Increased Odds of Adverse Birth Outcomes in the US

BACKGROUND

Disparities persist in adverse birth outcomes - preterm birth and small-for-gestational age (SGA) among racialized populations. Previous studies have indicated that voting restrictions are associated with health outcomes, such as access to health insurance and teenage birth rates. This paper examines whether the association between voting restrictions and adverse birth outcomes varies according to birthing individuals' race/ethnicity.

METHODS

These analyses merged individual-level 2019-2020 Pregnancy Risk Assessment Monitoring System (PRAMS, 8th edition) data with state-level exposure information. The exposure, the Cost of Voting Index (COVI), is a 2020 state-level measure of voting restrictions, and the outcomes were preterm birth and SGA. Multilevel logistic regression, survey-weighted models adjusted for sociodemographic and geographically-based characteristics. Subanalyses examined if the association differed by race (non-Hispanic White, non-Hispanic Black, Hispanic, API, Other).

RESULTS

In the unadjusted model, a standard deviation increase in COVI was associated with increased odds of preterm birth (OR = 1.11, 95% CI = 0.98, 1.25) and SGA (OR = 1.12, 95% CI = 1.02, 1.22). The association for SGA was still significant in the fully adjusted models. Results differed by race/ethnicity with the largest effects among API (OR = 1.20, 95% CI = 0.95, 1.52) for preterm birth and OR = 1.27, 95% CI = 1.01, 1.59) for SGA respectively).

CONCLUSION

Our results suggest structural voting barriers disproportionately increase the odds of adverse birth outcomes, especially for API-birthing individuals. Increasing voting restrictions may amplify existing birth inequities.

Prenatal exposure to particulate matter and infant birth outcomes: Evidence from a population-wide database

There are growing concerns about the impact of pollution on maternal and infant health. Despite an extensive correlational literature, observational studies which adopt methods that seek to address potential biases due to unmeasured confounders draw mixed conclusions. Using a population database of births in Northern Ireland (NI) linked to localized geographic information on pollution in mothers' postcodes (zipcodes) of residence during pregnancy, we examine whether prenatal exposure to PM2.5 is associated with a comprehensive range of birth outcomes, including placental health. Overall, we find little evidence that particulate matter is related to infant outcomes at the pollution levels experienced in NI, once we implement a mother fixed effects approach that accounts for time-invariant factors. This contrasts with strong associations in models that adjust for observed confounders but without fixed effects. While reducing ambient air pollution remains an urgent public health priority globally, our results imply that further improvements in short-run levels of prenatal PM2.5 exposure in a relatively low-pollution, higher-income country context, are unlikely to impact on birth outcomes at the population level.

Poor housing quality and the health of newborns and young children

This study uses linked administrative data on live births, hospital stays, and census records for children born in Hungary between 2006 and 2011 to examine the relationship between poor housing quality and the health of newborns and children aged 1-2 years. We show that poor housing quality, defined as lack of access to basic sanitation and exposure to polluting heating, is not a negligible problem even in a high-income EU country like Hungary. This is particularly the case for disadvantaged children, 20-25% of whom live in extremely poor-quality homes. Next, we provide evidence that poor housing quality is strongly associated with lower health at birth and a higher number of days spent in inpatient care at the age of 1-2 years. These results indicate that lack of access to basic sanitation, hygiene, and non-polluting heating and their health impacts cannot be considered as the exclusive problem for low- and middle-income countries. In high-income countries, there is also a need for public policy programs that identify those affected by poor housing quality and offer them potential solutions to reduce the adverse effects on their health.

Low and very low birthweight disadvantage in compulsory education achievement and the transition to upper secondary education in the Finnish birth cohorts of 1987 to 1997

BACKGROUND

We compared the educational achievements of very low-birthweight (VLBW) and low-birthweight (LBW) adolescents (ages 16 to 19) to those of their normal-birthweight (NBW) peers in the complete Finnish birth cohorts of 1987 to 1997. We focused on three key phases of the education process: the end of compulsory education (9th-grade completion), and the transition to and the completion of upper secondary-level education.

METHODS

We used register data on grades, educational transitions and completed education. We employed multiple indicators on the progression of the education process and estimated population-level and within-families linear probability (LPM) models with robustness checks at the population level using logistic regression. We tested whether parental education and the child's sex modify the association between (V)LBW and educational achievement.

RESULTS

Results of both descriptive analysis and the population-level and within-family LPM models indicate that (V)LBW is associated with an increased risk of not being able to keep up with the normative education process and to compete for upper secondary education study places at the end of compulsory education. The modifying effect of parental education was robust, whereas that of the child's sex was not. Among (V)LBW students who were able to keep up with the normative education process, (V)LBW was not associated with a lower grade point average or with a meaningfully lower probability of completing upper secondary education by the normative age.

CONCLUSIONS

The upper secondary-level educational choices and achievements of the children born with (V)LBW who managed to complete the standard compulsory education curriculum and complete the transition to upper secondary-level education within the expected time did not, in essence, differ from those of the NBW children. Some specific characteristics of the Finnish education system likely contributed to these results, such as the grading at compulsory education being only relatively loosely standardized.

Small for Gestational Age Newborns in French Guiana: The Importance of Health Insurance for Prevention

Objectives: Small for gestational age (SGA) newborns have a higher risk of poor outcomes. French Guiana (FG) is a territory in South America with poor living conditions. The objectives of this study were to describe risk factors associated with SGA newborns in FG. Methods: We used the birth cohort that compiles data from all pregnancies that ended in FG from 2013 to 2021. We analysed data of newborns born after 22 weeks of gestation and/or weighing more than 500 g and their mothers. Results: 67,962 newborns were included. SGA newborns represented 11.7% of all newborns. Lack of health insurance was associated with SGA newborns (p < 0.001) whereas no difference was found between different types of health insurance and the proportion of SGA newborns (p = 0.86). Mothers aged less than 20 years (aOR = 1.65 [1.55-1.77]), from Haiti (aOR = 1.24 [1.11-1.39]) or Guyana (aOR = 1.30 [1.01-1.68]) and lack of health insurance (aOR = 1.24 [1.10-1.40]) were associated with SGA newborns. Conclusion: Immigration and precariousness appear to be determinants of SGA newborns in FG. Other studies are needed to refine these results.

A cost-effectiveness analysis of a South African pregnancy support grant

Poverty among expectant mothers often results in sub-optimal maternal nutrition and inadequate antenatal care, with negative consequences on child health outcomes. South Africa has a child support grant that is available from birth to those in need. This study aims to determine whether a pregnancy support grant, administered through the extension of the child support grant, would be cost-effective compared to the existing child support grant alone. A cost-utility analysis was performed using a decision-tree model to predict the incremental costs (ZAR) and disability-adjusted life years (DALYs) averted by the pregnancy support grant over a 2-year time horizon. An ingredients-based approach to costing was completed from a governmental perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were performed. The intervention resulted in a cost saving of R13.8 billion ($930 million, 95% CI: ZAR3.91 billion - ZAR23.2 billion/ $1.57 billion - $264 million) and averted 59,000 DALYs (95% CI: -6,400-110,000), indicating that the intervention is highly cost-effective. The primary cost driver was low birthweight requiring neonatal intensive care, with a disaggregated incremental cost of R31,800 ($2,149) per pregnancy. Mortality contributed most significantly to the DALYs accrued in the comparator (0.68 DALYs). The intervention remained the dominant strategy in the sensitivity analyses. The pregnancy support grant is a highly cost-effective solution for supporting expecting mothers and ensuring healthy pregnancies. With its positive impact on child health outcomes, there is a clear imperative for government to implement this grant. By investing in this program, cost savings could be leveraged. The implementation of this grant should be given high priority in public health and social policies.

Birth size, school performance and family social position: a study of 650,000 children

BACKGROUND

Low birth weight (BW) is associated with lower cognitive functioning, but less is known of these associations across the full range of the BW distribution and its components. We analyzed how BW, birth length (BL) and birth ponderal index (BPI, kg/m3) are associated with school performance and how childhood family social position modifies these associations.

METHODS

Medical birth records of all Finnish children born in 1987-1997 were linked to school performance records at 16 years of age (N = 642,425). We used population averaged and within-siblings fixed-effects linear regression models.

RESULTS

BL showed a linear and BW a curvilinear association with school performance whereas for BPI the association was weak. The strongest association was found for BL explaining 0.08% of the variation in school performance in boys and 0.14% in girls. Demographic, gestational and social factors partly explained these associations. Similar but weaker associations were found within sibships. The association of BL with school performance was stronger at lower levels of family social position.

CONCLUSION

BL shows a linear association with school performance and can explain more school performance variation than BW. At the population level, BL can offer useful information on intrauterine environmental factors relevant for cognitive performance.

IMPACT

Birth length is linearly associated with school performance in late adolescence and explains a larger proportion of school performance variation than birth weight. The association between birth length and school performance is stronger in families with lower socio-economic position. At the population level, birth length can offer information on the intrauterine environment relevant for later cognitive performance.

Racialized police use of force and birth outcomes

OBJECTIVE

To estimate associations between police use of force (PUOF) in local jurisdictions and birth outcomes of Black women compared to White women.

METHODS

Using birth records linked to municipal police department data on PUOF incidents, we estimated associations between overall and racialized PUOF and birth outcomes of 75,461 Black women and 278,372 White women across 430 municipalities in New Jersey (2012-2016).

RESULTS

Overall PUOF was not associated with birth outcomes of Black or White women. A 1% increase in racialized PUOF was associated with a 0.06% increase in the odds of low birth weight (β: 0.06; 95% CI: 0.03-0.09) and preterm birth (β: 0.06; 95% CI: 0.03-0.10) among Black women but had no associations with birth outcomes of White women.

CONCLUSIONS

Lack of associations between overall PUOF and birth outcomes coupled with significant associations between racialized PUOF and birth outcomes, among Black women only, is consistent with mounting evidence that structural racism adversely affects the health of Black people in the U.S.

POLICY IMPLICATIONS

The findings point to the need to address health inequalities at the structural level.