Preterm birth linked to reduced odds of high school graduation

The odds of completing high school are reduced among children born preterm vs full-term, according to a recent study published in JAMA Network Open.¹

Approximately 10% of infants are born preterm, which may cause early exposure to noxious factors and influence brain development, challenging neurodevelopment and mental well-being. Additionally, socioeconomic factors often prevent children from accessing support systems that can mitigate disabilities.

“Few researchers have conducted studies on long-term educational outcomes across the full spectrum of preterm birth using large population-based cohorts that account for other health-related determinants and socioeconomic factors,” wrote investigators.

Assessing preterm birth and education

The birth cohort case-control study was conducted to assess the impacts of preterm birth and sociodemographic factors on educational outcomes. Live preterm births in Quebec, Canada, between January 1, 1976, and December 31, 1995, were included in the analysis.

Each preterm individual was matched with 2 full-term patients, defined as 37- to 42-weeks gestation. Exclusion criteria included multiple pregnancies, triplet births, and death between 1976 and 2019 without Quebec Ministry of Education records.

Extremely preterm birth was defined as under 28 weeks, very preterm as 28 to under 32 weeks, and moderate-to-late preterm as 32 to 37 weeks. Forty-three years of follow-up data was obtained from administrative databases.

High school performance was measured using the final high school average recorded in the Quebec Ministry of Education database, using marks obtained in grades 10 and 11. Covariates included year of birth, birth order, sex, stillbirth history, primary language, matrimonial status at birth, maternal education, and neighborhood socioeconomic status.

Participant characteristics and academic performance

There were 297,820 participants included in the final analysis, 0.6% of whom were born extremely preterm, 4.4% very preterm, 27.9% moderate-to-late preterm, and 67% full-term. Under 11 years of maternal school were reported in 20.6%, 24%, 23%, and 20.3%, respectively.

Preterm birth groups also more often reported primary languages other than French or English, and more recent birth years were reported in those born extremely preterm. Overall, the rate of preterm births in Quebec rose from 4.6% between 1976 and 1980 to 6.1% between 1991 and 1995.

Significant differences were not reported in high school performance based on preterm birth, with final mean scores of 69.4, 70.2, 70.7, and 71 for extremely preterm, very preterm, moderately preterm, and term births, respectively. However, rates of not graduating from high school were 40.2%, 34.4%, 31.1%, and 27.1%, respectively.

This data indicated significantly reduced odds of high school graduation from preterm birth. These patients were also more likely not to graduate from university. Rates included:

• 83.3% for extremely preterm
• 80.2% for very preterm
• 78.2% for moderately preterm
• 75.8% for full-term

Socioeconomic and demographic influences

In regression analyses, a B coefficient range of 0.15 to 1.45 was reported for the link between preterm status and final high school average. Low maternal education, male sex, low neighborhood socioeconomic status, not being first-born, and mother not married had the most significant B coefficients for low average marks of 4.43, 2.84, 2.30, 2.30, and 1.98, respectively.

These results indicated reduced odds of graduating from high school or university among children born preterm vs their full-term counterparts. Investigators concluded long-term follow-up is needed in both health care and education among individuals born preterm.

This data highlights the importance of preterm birth prediction. Identifying individuals at an increased risk of preterm birth may be more accurate through the use of neighborhood-level indices, according to Daniel L. Kuhr, MD, third-year fellow in maternal fetal medicine at the Icahn School of Medicine at Mount Sinai.²

According to Kuhr, an increase in prediction was only noticeable when including individual patient characteristics. This highlights a need to evaluate other social determinants of health that may influence preterm birth risk.

“The best thing that you can do is take a really good history when you meet a patient at the beginning of pregnancy, and really make sure you can get accurate gestational ages of delivery when possible, because we do know that history of a prior spontaneous preterm birth is also a risk factor,” said Kuhr.

References

1. Loose T, Collet O, Nuyt AM, et al. Long-term educational outcomes of individuals born preterm. JAMA Netw Open. 2025;8(10):e2534918. doi:10.1001/jamanetworkopen.2025.34918
2. Krewson C. Study explores the limits of neighborhood data in predicting preterm birth. Contemporary OB/GYN. January 31, 2025. Accessed October 6, 2025. https://www.contemporaryobgyn.net/view/study-explores-the-limits-of-neighborhood-data-in-predicting-preterm-birth.