Cumulative Antenatal Risk and Kindergarten Readiness in Preterm-Born Preschoolers

  • Andrew M. Heitzer
  • Jamie C. Piercy
  • Brittany N. Peters
  • Allyssa M. Mattes
  • Judith M. Klarr
  • Beau Batton
  • Noa Ofen
  • Sarah RazEmail author


A suboptimal intrauterine environment is thought to increase the probability of deviation from the typical neurodevelopmental trajectory, potentially contributing to the etiology of learning disorders. Yet the cumulative influence of individual antenatal risk factors on emergent learning skills has not been sufficiently examined. We sought to determine whether antenatal complications, in aggregate, are a source of variability in preschoolers’ kindergarten readiness, and whether specific classes of antenatal risk play a prominent role. We recruited 160 preschoolers (85 girls; ages 3–4 years), born ≤336/7 weeks’ gestation, and reviewed their hospitalization records. Kindergarten readiness skills were assessed with standardized intellectual, oral-language, prewriting, and prenumeracy tasks. Cumulative antenatal risk was operationalized as the sum of complications identified out of nine common risks. These were also grouped into four classes in follow-up analyses: complications associated with intra-amniotic infection, placental insufficiency, endocrine dysfunction, and uteroplacental bleeding. Linear mixed model analyses, adjusting for sociodemographic and medical background characteristics (socioeconomic status, sex, gestational age, and sum of perinatal complications) revealed an inverse relationship between the sum of antenatal complications and performance in three domains: intelligence, language, and prenumeracy (p = 0.003, 0.002, 0.005, respectively). Each of the four classes of antenatal risk accounted for little variance, yet together they explained 10.5%, 9.8%, and 8.4% of the variance in the cognitive, literacy, and numeracy readiness domains, respectively. We conclude that an increase in the co-occurrence of antenatal complications is moderately linked to poorer kindergarten readiness skills even after statistical adjustment for perinatal risk.


Prenatal Prematurity Preschool Neuropsychology School readiness 



The authors thank Beth Kring and Tammy Swails for their help in data collection. Evaluations and testing materials were funded in part by the Merrill-Palmer Skillman Institute. None of the authors has a known conflict of interest concerning this manuscript.


This work was supported in part by funding from the Merrill Palmer Skillman Institute, Wayne State University, 71 East Ferry, Detroit, MI 48202.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Supplementary material

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyWayne State UniversityDetroitUSA
  2. 2.Department of Newborn MedicineWilliam Beaumont HospitalRoyal OakUSA
  3. 3.Department of PediatricsSouthern Illinois University School of MedicineCarbondaleUSA
  4. 4.The Institute of GerontologyWayne State UniversityDetroitUSA
  5. 5.Developmental Neuropsychology Laboratory, the Merrill-Palmer Skillman InstituteWayne State UniversityDetroitUSA

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