Birth weight for gestational age at term and school performance at 12 years of age: linked cohort study

R J Burger* (Corresponding Author), S J Gordijn, B W Mol, W Ganzevoort, A C J Ravelli

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: Birth weight and underlying fetal growth and placental function impact cognitive development. The gradient of these associations is under-studied, especially among those with a birth weight considered appropriate for gestational age. We aim to provide insight in the associations between birth-weight centile and intellectual development across the entire birth-weight spectrum of (near) term infants, serving as a basis for better understanding of the long-term implications of fetal growth restriction and reduced placental function.

METHODS: We conducted a population-based cohort study among liveborn singletons born from uncomplicated pregnancies (N=266,440) from 36 weeks onwards using perinatal data from the Dutch Perinatal Registry (2003-2008) and education data at age 12 from Statistics Netherlands (2016-2019). Regression analyses were conducted investigating the association of birth weight for gestational age with school performance. The main outcome was mean school performance score and higher secondary school level.

RESULTS: Mean school performance score (range 501-550) increased gradually with increasing birth-weight centile from 533.6 (<5 th birth-weight centile) to 536.8 (81-85 th birth-weight centile). Higher secondary school level increased from 42.9% to 56.8% with increasing birth-weight centile. Compared to the 81-85 th birth-weight centile, mean school performance score and the proportion of children that reached higher secondary school level were significantly and gradually lower in all birth-weight centile groups below the 80th centile, adjusted for confounding factors.

CONCLUSIONS: Birth weight for gestational age is positively and gradually associated with school performance at age 12 across the entire spectrum, well beyond the conventional and arbitrary cut-offs for suspected fetal growth restriction. It underlines the importance of better tools to diagnose fetal growth restriction and reduced placental function and to identify those at risk for associated short and long-term consequences. This article is protected by copyright. All rights reserved.

Original languageEnglish
Pages (from-to)458-465
Number of pages7
JournalUltrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
Issue number4
Early online date11 Mar 2023
Publication statusPublished - 3 Apr 2023


  • birth weight
  • Cognitive Development
  • educational achievement
  • fetal growth restriction
  • gestational age
  • placental function
  • Placental Insufficiency


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