{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T03:07:32Z","timestamp":1789182452014,"version":"build-2803163510"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001537","name":"University of Auckland","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001537","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Small for gestational age (SGA) birthweight is an important predictor of childhood intelligence, yet longitudinal evidence on its association with school achievement is scarce. We aimed to explore the association between SGA birthweight and educational achievement in secondary school in a national linked data study of New Zealand adolescents. This population study included children born in New Zealand with gestational age, birthweight and sex information available between 1998 and 2005. This cohort was followed until July 31, 2024. Exclusion criteria were children born overseas, multiple births, and children who moved overseas prior to secondary school examinations. SGA birthweight was defined using the New Zealand Sex-Specific Population Birthweight Standard. Educational achievement was defined as the highest qualification attained in secondary school. The analysis included 372,519 children (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200925,341 [6.8%] small-for-gestational-age [SGA] and\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009347,178 appropriate-for-gestational-age [AGA]). Compared with infants born AGA, in multivariable analysis, children born SGA were at an elevated risk of achieving no formal school qualification (aRR 1.36, 95% CI: 1.25\u20131.47) compared to finishing secondary school with the maximum qualification available. This risk was greater for those with severe-SGA birthweight (aRR 1.48, 95% CI: 1.29\u20131.70). There was a statistically significant interaction with very preterm and preterm birth, indicating that SGA birthweight has a differential association with achievement across gestational ages. Crude estimates were larger, suggesting large contributions from confounders.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    :\u00a0Children born SGA had a slightly lower risk of achieving higher secondary school qualifications than their AGA peers. This risk is higher for those not achieving any formal qualification and increases with the severity of SGA. The interaction with preterm birth suggests that the relationship between SGA birthweight and education may differ for very preterm and preterm infants. Adjustment for confounders decreased the associations between SGA birthweight and educational achievement in secondary school, indicating the importance of familial and societal factors.\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              <jats:italic>\u2022 Few studies have looked at the association between SGA birthweight and achievement in school.<\/jats:italic>\n                              <jats:italic>\u2022 The relationship between SGA birthweight and achievement remains unclear, as studies seldom adjust for confounding variables.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              <jats:italic>\u2022 This study used administrative data to explore the association between SGA birthweight and educational achievement in secondary school.<\/jats:italic>\n                              <jats:italic>\u2022 There appeared to be a small but statistically significant association between SGA birthweight and education in secondary school. The effect size is small and confounded by social determinants, but the number of children affected is not inconsequential at the population level, with SGA having a prevalence of 10%.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-07372-w","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T14:04:30Z","timestamp":1788357870000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A large national cohort study exploring the association between small for gestational age birthweight and educational achievement in secondary school"],"prefix":"10.1007","volume":"185","author":[{"given":"Alexia K.","family":"Searchfield","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Milne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M. D.","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"7372_CR1","first-page":"1","volume":"107","author":"JM Thompson","year":"1994","unstructured":"Thompson JM, Mitchell EA, Borman B (1994) Sex specific birthweight percentiles by gestational age for New Zealand. N Z Med J 107:1\u20133","journal-title":"N Z Med J"},{"key":"7372_CR2","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.reprotox.2020.10.005","volume":"99","author":"JB Armengaud","year":"2021","unstructured":"Armengaud JB, Yzydorczyk C, Siddeek B, Peyter AC, Simeoni U (2021) Intrauterine growth restriction: clinical consequences on health and disease at adulthood. Reprod Toxicol 99:168\u2013176","journal-title":"Reprod Toxicol"},{"key":"7372_CR3","doi-asserted-by":"publisher","unstructured":"Strauss RS (2000) Adult functional outcome of those born small for gestational age twenty-six-year follow-up of the 1970 British birth cohort. JAMA 283(5):625-632. https:\/\/doi.org\/10.1001\/jama.283.5.625","DOI":"10.1001\/jama.283.5.625"},{"key":"7372_CR4","doi-asserted-by":"publisher","unstructured":"Sommerfelt K, Andersson HW, Sonnander K, Ahlsten G, Ellertsen B, Markestad T et al (2000) Cognitive development of term small for gestational age children at five years of age.\u00a0Arch Dis Child 83(1):25-30. https:\/\/doi.org\/10.1136\/adc.83.1.25","DOI":"10.1136\/adc.83.1.25"},{"key":"7372_CR5","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1111\/apa.17037","volume":"113","author":"A Gustafsson","year":"1973","unstructured":"Gustafsson A, Bonnevier A, K\u00e4ll\u00e9n K (1973) Association between small-for-gestational age and poor school performance in 2 500 000 children born 1973\u20132002. Acta Paediatr 113:221\u2013228. https:\/\/doi.org\/10.1111\/apa.17037","journal-title":"Acta Paediatr"},{"key":"7372_CR6","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1542\/peds.108.1.111","volume":"108","author":"B Larroque","year":"2001","unstructured":"Larroque B, Bertrais S, Czernichow P, L\u00e9ger J (2001) School difficulties in 20-year-olds who were born small for gestational age at term in a regional cohort study. Pediatrics 108:111\u20135","journal-title":"Pediatrics"},{"key":"7372_CR7","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/0378-3782(80)90031-6","volume":"4","author":"I Leijon","year":"1980","unstructured":"Leijon I, Billstr\u00f6m G, Lind I (1980) An 18-month follow-up study of growth-retarded neonates. Relation to biochemical tests of placental function in late pregnancy and neurobehavioural condition in the newborn period. Early Hum Dev 4:271\u201385","journal-title":"Early Hum Dev"},{"key":"7372_CR8","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1177\/088307389901401107","volume":"14","author":"A Fattal-Valevski","year":"1999","unstructured":"Fattal-Valevski A, Leitner Y, Kutai M, Tal-Posener E, Tomer A, Lieberman D et al (1999) Neurodevelopmental outcome in children with intrauterine growth retardation: a 3-year follow-up. J Child Neurol 14:724\u2013727","journal-title":"J Child Neurol"},{"key":"7372_CR9","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.1111\/1471-0528.16341","volume":"127","author":"R Eves","year":"2020","unstructured":"Eves R, Mendon\u00e7a M, Bartmann P, Wolke D (2020) Small for gestational age\u2014cognitive performance from infancy to adulthood: an observational study. BJOG 127:1598\u20131606","journal-title":"BJOG"},{"key":"7372_CR10","doi-asserted-by":"crossref","unstructured":"McCarton CM, Wallace ma F, Divon M, Vaughan HC (1996) Cognitive and neurologic development of the premature, small for gestational age infant through age 6: comparison by birth weight and gestational age.\u00a0Pediatrics 98:1167-1178","DOI":"10.1542\/peds.98.6.1167"},{"key":"7372_CR11","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1159\/000477905","volume":"88","author":"L Lindstr\u00f6m","year":"2017","unstructured":"Lindstr\u00f6m L, Wikstr\u00f6m AK, Bergman E, Lundgren M (2017) Born small for gestational age and poor school performance-how small is too small? Horm Res Paediatr 88:215\u201323. https:\/\/doi.org\/10.1159\/000477905","journal-title":"Horm Res Paediatr"},{"key":"7372_CR12","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/S0022-3476(05)81639-7","volume":"116","author":"CMT Robertson","year":"1990","unstructured":"Robertson CMT, Etches PC, Kyle JM (1990) Eight-year school performance and growth of preterm, small for gestational age infants: a comparative study with subjects matched for birth weight or for gestational age. J Pediatr 116:19\u201326","journal-title":"J Pediatr"},{"key":"7372_CR13","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/j.jpeds.2013.01.060","volume":"163","author":"GCC L\u00f8haugen","year":"2013","unstructured":"L\u00f8haugen GCC, \u00d8stg\u00e5rd HF, Andreassen S, Jacobsen GW, Vik T, Brubakk A-M et al (2013) Small for gestational age and intrauterine growth restriction decreases cognitive function in young adults. J Pediatr 163:447\u2013453","journal-title":"J Pediatr"},{"key":"7372_CR14","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1080\/03036758.2022.2072905","volume":"52","author":"BJ Milne","year":"2022","unstructured":"Milne BJ (2022) Longitudinal research in Aotearoa New Zealand using the integrated data infrastructure: a review. J R Soc N Z 52:301\u2013312","journal-title":"J R Soc N Z"},{"key":"7372_CR15","first-page":"489","volume":"106","author":"PG Tuohy","year":"1993","unstructured":"Tuohy PG, Counsell AM, Geddis DC (1993) The Plunket National Child Health Study: birth defects and sociodemographic factors. N Z Med J 106:489\u2013492","journal-title":"N Z Med J"},{"key":"7372_CR16","unstructured":"Li E (2024) Investigating linkage bias in the integrated data infrastructure (IDI) using census and education data. Doctoral dissertation, University of Auckland"},{"key":"7372_CR17","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1111\/j.1479-828X.2004.00272.x","volume":"44","author":"L McCOWAN","year":"2004","unstructured":"McCOWAN L, Stewart AW, Francis A, Gardosi J (2004) A customised birthweight centile calculator developed for a New Zealand population. Aust N Z J Obstet Gynaecol 44:428\u2013431","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"7372_CR18","unstructured":"Smithers A (1997) The New Zealand Qualifications Framework. Education Forum, Auckland"},{"key":"7372_CR19","unstructured":"Ministry of Social Development (2021) Improving how we report ethnicity. https:\/\/www.msd.govt.nz\/about-msd-and-our-work\/tools\/how-we-report-ethnicity.html"},{"key":"7372_CR20","unstructured":"Salmond C, Crampton P (2002) NZDep2001 index of deprivation. Department of Public Health, Wellington School of Medicine and Health Sciences, Wellington"},{"key":"7372_CR21","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1016\/j.earlhumdev.2009.09.004","volume":"85","author":"CV Ananth","year":"2009","unstructured":"Ananth CV, Vintzileos AM (2009) Distinguishing pathological from constitutional small for gestational age births in population-based studies. Early Hum Dev 85:653\u20138","journal-title":"Early Hum Dev"},{"key":"7372_CR22","doi-asserted-by":"publisher","first-page":"F12","DOI":"10.1136\/archdischild-2013-304705","volume":"99","author":"D Wong","year":"2014","unstructured":"Wong D, Abdel-Latif ME, Kent AL (2014) Antenatal steroid exposure and outcomes of very premature infants: a regional cohort study. Arch Dis Child Fetal Neonatal Ed 99:F12-20","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"7372_CR23","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1001\/jamapediatrics.2016.1936","volume":"170","author":"S Chawla","year":"2016","unstructured":"Chawla S, Natarajan G, Shankaran S, Pappas A, Stoll BJ, Carlo WA et al (2016) Association of neurodevelopmental outcomes and neonatal morbidities of extremely premature infants with differential exposure to antenatal steroids. JAMA Pediatr 170:1164\u20131172","journal-title":"JAMA Pediatr"},{"key":"7372_CR24","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1016\/S0002-9378(96)70099-6","volume":"175","author":"RL Goldenberg","year":"1996","unstructured":"Goldenberg RL, DuBard MB, Cliver SP, Nelson KG, Blanksona K, Ramey SL et al (1996) Pregnancy outcome and intelligence at age five years. Am J Obstet Gynecol 175:1511\u20131515","journal-title":"Am J Obstet Gynecol"},{"key":"7372_CR25","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1530\/ROR.0.0020105","volume":"2","author":"DJP Barker","year":"1997","unstructured":"Barker DJP, Clark PM (1997) Fetal undernutrition and disease in later life. Rev Reprod 2:105\u2013112. https:\/\/doi.org\/10.1530\/ROR.0.0020105","journal-title":"Rev Reprod"},{"key":"7372_CR26","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1016\/S0140-6736(86)91340-1","volume":"327","author":"DJP Barker","year":"1986","unstructured":"Barker DJP, Osmond C (1986) Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. The Lancet 327:1077\u20131081","journal-title":"The Lancet"},{"key":"7372_CR27","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1017\/S2040174417000733","volume":"8","author":"T Bianco-Miotto","year":"2017","unstructured":"Bianco-Miotto T, Craig JM, Gasser YP, Van Dijk SJ, Ozanne SE (2017) Epigenetics and DOHaD: from basics to birth and beyond. J Dev Orig Health Dis 8:513\u20139","journal-title":"J Dev Orig Health Dis"},{"key":"7372_CR28","unstructured":"Te Whatu Ora \u2013 Health New Zealand (2023) Small for gestational age and fetal growth restriction in Aotearoa New Zealand He Aratohu Ritenga Haumanu m\u014d te T\u014dhuatanga K\u014dpiri me te Pakupaku Rawa. A clinical practice guideline: summary of recommendations. Te Whatu Ora \u2013 Health New Zealand, Wellington"},{"key":"7372_CR29","volume-title":"Statewide exit exams, governance, and school development: An international comparison","author":"ED Klein","year":"2013","unstructured":"Klein ED (2013) Statewide exit exams, governance, and school development: An international comparison. Waxmann Verlag"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07372-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-026-07372-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07372-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T02:55:07Z","timestamp":1789181707000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-026-07372-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,2]]},"references-count":29,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["7372"],"URL":"https:\/\/doi.org\/10.1007\/s00431-026-07372-w","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-9109142\/v1","asserted-by":"object"}]},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,2]]},"assertion":[{"value":"13 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 August 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 August 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"712"}}