Abstract
Background
Early measures of cognitive function are of great public health interest. We aimed to estimate the association between head circumference at birth, a measure of cerebral size, and school performance.
Methods
We conducted a nationwide cohort study of all liveborn singletons in Denmark, 1997–2005. The association between birth head circumference z score and test scores in reading and mathematics from a nationwide mandatory computer-based school test program (7–16 years) was estimated by multivariable linear regression adjusted for potential confounders.
Results
The cohort included 536,921 children. Compared to normocephalic children, children with microcephaly [<−2 standard deviations (SD)] had lower mean reading scores: second grade: −0.08 SD (95% CI −0.10 to −0.06), eighth grade: −0.07 SD (95% CI −0.10 to −0.04). Macrocephaly (>+2 SD) was associated with higher scores. In normocephalic children, each SD increase in head circumference was associated with a 0.03 SD (95% CI 0.03 to 0.04) increase in mean reading scores. The results were similar across grades within both reading and mathematics.
Conclusion
Prenatal brain growth may be causally related to childhood school performance. The demonstrated differences are unlikely to be clinically relevant at the individual level but may be important at a public health level.
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Acknowledgements
Financial support covering salaries and purchase of data was provided by the Perinatal Epidemiology Research Unit, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University.
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N.B.M. was the main author responsible for the acquisition of the data, contributed to the conception and the design of the study, the implementation of epidemiological methods, the performance and the interpretation of data analyses, and drafted the initial manuscript and revised the manuscript. C.C.B. contributed to the conception and the design of the study, the implementation of epidemiological methods, the performance and the interpretation of data analyses, and drafted the initial manuscript and revised the manuscript. T.B.H. contributed to the conception of the study, the interpretation of the analyses, secured the funding for the study, and reviewed and revised the manuscript. R.T.L. contributed to the design of the study, the data analyses, and the interpretation of the results, drafted the initial manuscript, and revised the manuscript. K.A. contributed to the design of the study, the data analyses, the interpretation of the results, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Bach, C.C., Henriksen, T.B., Larsen, R.T. et al. Head circumference at birth and school performance: a nationwide cohort study of 536,921 children. Pediatr Res 87, 1112–1118 (2020). https://doi.org/10.1038/s41390-019-0683-2
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DOI: https://doi.org/10.1038/s41390-019-0683-2
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