Lower gestational age is associated with lower cortical volume and cognitive and educational performance in adolescence

Qing Ma; Hui Wang; Edmund T Rolls; Shitong Xiang; Jiong Li; Yuzhu Li; Qiongjie Zhou; Wei Cheng; Fei Li

doi:10.1186/s12916-022-02627-3

Lower gestational age is associated with lower cortical volume and cognitive and educational performance in adolescence

BMC Med. 2022 Nov 3;20(1):424. doi: 10.1186/s12916-022-02627-3.

Authors

Qing Ma^#^{1

2}, Hui Wang^#³, Edmund T Rolls^#^{1

4

5}, Shitong Xiang^{1

2}, Jiong Li⁶, Yuzhu Li^{1

2}, Qiongjie Zhou^{7

8}, Wei Cheng^{9

10

11

12}, Fei Li¹³

Affiliations

¹ Department of Neurology, Huashan Hospital, Institute of Science and Technology for Brain-Inspired Intelligence, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433, China.
² Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, 200433, China.
³ Department of Developmental and Behavioral Pediatric & Child Primary Care/MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200082, China.
⁴ Department of Computer Science, University of Warwick, Coventry CV4 7AL, Conventry, UK.
⁵ Oxford Centre for Computational Neuroscience, Oxford, UK.
⁶ Department of Clinical Medicine, Aarhus University, Aarhus, 8000, Denmark.
⁷ Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China.
⁸ Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China.
⁹ Department of Neurology, Huashan Hospital, Institute of Science and Technology for Brain-Inspired Intelligence, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433, China. wcheng@fudan.edu.cn.
¹⁰ Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, 200433, China. wcheng@fudan.edu.cn.
¹¹ Fudan ISTBI-ZJNU Algorithm Centre for Brain-inspired Intelligence, Zhejiang Normal University, Jinhua, 321004, China. wcheng@fudan.edu.cn.
¹² Shanghai Medical College and Zhongshan Hospital Immunotherapy Technology Transfer Center, Shanghai, 200032, China. wcheng@fudan.edu.cn.
¹³ Department of Developmental and Behavioral Pediatric & Child Primary Care/MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200082, China. lifei5861_cn@163.com.

^# Contributed equally.

Abstract

Background: Gestational age (GA) is associated with later cognition and behavior. However, it is unclear how specific cognitive domains and brain structural development varies with the stepwise change of gestational duration.

Methods: This large-scale longitudinal cohort study analyzed 11,878 early adolescents' brain volume maps at 9-10 years (baseline) and 5685 at 11-12 years (a 2-year follow-up) from the Adolescent Brain Cognitive Development (ABCD) study. According to gestational age, adolescents were divided into five categorical groups: ≤ 33 weeks, 34-35 weeks, 36 weeks, 37-39 weeks, and ≥ 40 weeks. The NIH Toolbox was used to estimate neurocognitive performance, including crystallized and fluid intelligence, which was measured for 11,878 adolescents at baseline with crystallized intelligence and relevant subscales obtained at 2-year follow-up (with participant numbers ranging from 6185 to 6310 depending on the cognitive domain). An additional large population-based cohort of 618,070 middle adolescents at ninth-grade (15-16 years) from the Danish national register was utilized to validate the association between gestational age and academic achievements. A linear mixed model was used to examine the group differences between gestational age and neurocognitive performance, school achievements, and grey matter volume. A mediation analysis was performed to examine whether brain structural volumes mediated the association between GA and neurocognition, followed with a longitudinal analysis to track the changes.

Results: Significant group differences were found in all neurocognitive scores, school achievements, and twenty-five cortical regional volumes (P < 0.05, Bonferroni corrected). Specifically, lower gestational ages were associated with graded lower cognition and school achievements and with smaller brain volumes of the fronto-parieto-temporal, fusiform, cingulate, insula, postcentral, hippocampal, thalamic, and pallidal regions. These lower brain volumes mediated the association between gestational age and cognitive function (P = 1 × 10^-8, β = 0.017, 95% CI: 0.007-0.028). Longitudinal analysis showed that compared to full term adolescents, preterm adolescents still had smaller brain volumes and crystallized intelligence scores at 11-12 years.

Conclusions: These results emphasize the relationships between gestational age at birth and adolescents' lower brain volume, and lower cognitive and educational performance, measured many years later when 9-10 and 11-12 years old. The study indicates the importance of early screening and close follow-up for neurocognitive and behavioral development for children and adolescents born with gestational ages that are even a little lower than full term.

Keywords: Cognitive performance; Cortical structure; Gestational age; Longitudinal development; Neuroimaging.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Brain* / diagnostic imaging
Child
Cognition
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Premature*
Longitudinal Studies
Magnetic Resonance Imaging / methods