School difficulties in 20-year-olds who were born small for gestational age at term in a regional cohort study

Objective. To investigate the relation between school difficulties and being born small for gestational age (SGA) at full term in adolescents and young adults. Methods. A total of 236 full-term singletons who were born SGA (birth weight and/or length below the third percentile) from 1971 through 1978 and 281 full-term singletons who were born appropriate for gestational age (AGA; between the 25th and 75th percentiles) from the maternity registry of Haguenau, France. Participants were evaluated at a mean age of 20.6 (+/-2.1) years. The outcomes measured were late entry into secondary school (normal age: 11 years) and failure to take or pass the baccalaureate examination at the end of secondary school (normal age: 18 years). Results. Late entry into secondary school was more frequent for the SGA than the AGA children (odds ratio: 2.3) after adjustment for maternal age and educational level, parental socioeconomic status, family size, and gender. A significantly higher proportion of term SGA adolescents failed to take or pass the baccalaureate examination than AGA adolescents (odds ratio: 1.6). SGA participants with a smaller head circumference entered secondary school late more often than SGA participants with a larger head circumference, but the association was not significant after adjustment. Conclusion. Being born SGA at term is associated with poorer school performance at 12 and 18 years. Fetal adaptation to conditions that retard growth during gestation may not be successful in maintaining brain development.