title: Preterm birth, social disadvantage, and cognitive competence in Swedish 18- to 19-year-old men.
abstract: OBJECTIVE
  The aim was to study the impact of a range of gestational ages (GAs) on cognitive competence in late adolescence and how this effect is modified by contextual social adversity in childhood.
  
  
  METHODS
  This was a register study based on a national cohort of 119664 men born in Sweden from 1973 to 1976. Data on GA and other perinatal factors were obtained from the Medical Birth Register, and information on cognitive test scores was extracted from military conscription at the ages of 18 to 19 years. Test scores were analyzed as z scores on a 9-point stanine scale, whereby each unit is equivalent to 0.5 SD. Socioeconomic indicators of the childhood household were obtained from the Population and Housing Census of 1990. The data were analyzed by multivariate linear regression.
  
  
  RESULTS
  The mean cognitive test scores decreased in a stepwise manner with GA. In unadjusted analysis, the test scores were 0.63 stanine unit lower in men who were born after 24 to 32 gestational weeks than in those who were born at term. The difference in global scores between the lowest and highest category of socioeconomic status was 1.57. Adjusting the analysis for the childhood socioeconomic indicators decreased the effect of GA on cognitive test scores by 26% to 33%. There was also a multiplicative interaction effect of social adversity and moderately preterm birth on cognitive test scores.
  
  
  CONCLUSIONS
  This study confirms previous claims of an incremental association of cognitive competence with GA. Socioeconomic indicators in childhood modified this effect at all levels of preterm birth.
authors.affiliation: Department of Women and Children Health, Sachs Children's Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Ekeus
authors.forename: Karolina
authors.initials: K
authors.lastname: Lindström
authors.forename: Frank
authors.initials: F
authors.lastname: Lindblad
authors.forename: Finn
authors.initials: F
authors.lastname: Rasmussen
authors.forename: Anders
authors.initials: A
authors.lastname: Hjern
mesh_terms: D000293:Adolescent; D015984:Causality; D002657:Child Development / Q000502:physiology; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D015897:Comorbidity; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology* / Q000523:psychology; D011336:Probability; D012042:Registries; D018570:Risk Assessment; D012923:Social Class; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult