Obstetric factors and different causes of special educational need: retrospective cohort study of 407 503 schoolchildren
Obstetric factors and different causes of special educational need: retrospective cohort study of 407 503 schoolchildren
复制标题
DOI：
10.1111/1471-0528.12071
复制
发表时间：
2013-02-01
影响因子：
5.8
通讯作者：
Pell, J. P.
中科院分区：
文献类型：
--
作者：
Mackay, D. F.;Smith, G. C. S.;Pell, J. P.
目的 确定特殊教育需要 (SEN) 的具体原因与胎龄和出生体重百分位数的关系是否有所不同。设计回顾性队列研究。设置苏格兰。人口 407 503 名学童。方法 使用多层次逻辑回归来检查不同妊娠期和出生体重百分位范围内每种 SEN 原因的风险，并调整潜在的混杂因素。主要结果衡量粗略和调整后的优势比和置信区间。结果 19 821 名特殊教育需要儿童中，557 名（2.8%）有感觉障碍，812 名（4.1%）有身体或运动障碍，876 名（4.4%）有语言障碍，2823 名（14.2%）有社交、情绪或行为问题，7018 名（35.4%）有智力障碍，4404 名（22.2%）有特定学习困难， 1684 (8.5%) 自闭症谱系障碍 (ASD)。极端早产（妊娠 2427 周）是感觉（调整后 OR 23.64，95% CI 12.0346.45）、身体或运动（调整后 OR 29.69，95% CI 17.4950.40）和智力（调整后 OR 11.67，95% CI 8.4616.10）的有力预测因子损害，与整个妊娠范围内的剂量关系。同样，低于第三百分位的出生体重与感觉（调整后 OR 2.85，95% CI 2.043.99）、身体或运动（调整后 OR 2.47，95% CI 1.823.37）和智力（调整后 OR 2.67，95% CI 2.412.96）障碍相关。妊娠和出生体重百分位合计占因感觉障碍引起的特殊教育需要的 24.0%、因身体或运动残疾引起的 34.3%、因智力障碍引起的 26.6%。产科因素与特定学习困难和社交或情感问题的相关性较小，并且与自闭症谱系障碍（ASD）没有显着关联。结论 妊娠和出生体重百分位数与 SEN 总体风险之间的关联很大程度上是由与感觉、身体或运动损伤以及智力损伤的密切相关性驱动的。
Objective To determine whether relationships with gestational age and birthweight centile vary between specific causes of special educational need (SEN). Design Retrospective cohort study. Setting Scotland. Population A cohort of 407 503 schoolchildren. Methods Polytomous logistic regression was used to examine the risk of each cause of SEN across the spectrum of gestation at delivery and birthweight centile, adjusting for potential confounding factors. Main outcome measures Crude and adjusted odds ratios and confidence intervals. Results Of the 19 821 children with SEN, 557 (2.8%) had sensory impairments, 812 (4.1%) had physical or motor disabilities, 876 (4.4%) had language impairments, 2823 (14.2%) had social, emotional, or behavioural problems, 7018 (35.4%) had intellectual disabilities, 4404 (22.2%) had specific learning difficulties, and 1684 (8.5%) autistic spectrum disorder (ASD). Extreme preterm delivery (at 2427 weeks of gestation) was a strong predictor of sensory (adjusted OR 23.64, 95% CI 12.0346.45), physical or motor (adjusted OR 29.69, 95% CI 17.4950.40), and intellectual (adjusted OR 11.67, 95% CI 8.4616.10) impairments, with dose relationships across the range of gestation. Similarly, birthweight below the third centile was associated with sensory (adjusted OR 2.85, 95% CI 2.043.99), physical or motor (adjusted OR 2.47, 95% CI 1.823.37), and intellectual (adjusted OR 2.67, 95% CI 2.412.96) impairments. Together, gestation and birthweight centile accounted for 24.0% of SEN arising from sensory impairment, 34.3% arising from physical or motor disabilities, and 26.6% arising from intellectual disabilities. Obstetric factors were less strongly associated with specific learning difficulties and social or emotional problems, and there were no significant associations with ASD. Conclusions The association between gestation and birthweight centile and overall risk of SEN is largely driven by very strong associations with sensory, physical or motor impairments, and intellectual impairments.