This document discusses the relationship between prematurity, birthweight, and student performance on standardized tests among children born in Georgia. It finds that being born preterm increases the risk of failing all parts of Georgia's CRCT test in 1st grade compared to term births. Children who were small for gestational age scored significantly lower and had a higher risk of failing the English Language Arts section of the test. Being both preterm and small for gestational age further increased the risk of failing the ELA test. The document calls for linking additional data like hospital and neighborhood records to examine how social factors influence academic achievement.

1. Bryan L. Williams, Ph.D.,
Associate Professor

2.  What is it?
 Who or what is responsible for it?
 What are the consequences of poor achievement?

3. • Wide-spread attention to teacher quality in the education literature
(Borman & Kimball, 2005; Darling-Hammond, 2006; Hopkins & Stern,
1996; Newton et al., 2010).
• Value-Added Modeling (VAM) of the effect of teacher quality: some
evidence that teacher quality and effectiveness are positively related to
changes in performance over course of an academic year (Newton et
al., 2010; Wayne & Youngs, 2003).

4. • Maybe we should consider maternal and child
health…
• Maybe prematurity, low birth weight, and maternal
risk factors account for a significant proportion of
unexplained, within-classroom variance in student
achievement.

5.  Being born too early increases the risk of:
• Neonatal morbidity and mortality
• Early and long term neurological impairment
• Lower quality of life
 Ourability to decrease prematurity is
increasing
• Prenatal care
• Reexamination of standard clinical practice
• Interpregnancy and pre-conception care

6. Jain (2008) points out, “Needless to say, the
growing brain and body are deceptively
capable of keeping adverse effects masked
until cognitive and motor functions can be
meaningfully tested”.

7.  What is the longer term consequences of
prematurity on children across the
gestational age spectrum?

8.  What is the relationship
between prematurity,
birthweight for gestational age,
and performance on the
standardized test among
children born in Georgia?

9. Electronic
Birth Record
Mother- (1998-2003)
Infant
Hospital
Discharge
Data
Linked Georgia
Birth-
Education
Data Set
CRCT Test
(2004-2010)
Grades 1-3

10.  Criterion-Referenced Competency Tests (CRCT)
• Designed to measure how well students acquire the skills and
knowledge described in the Georgia Performance Standards
• Administered in Grades 1-8
• Domains of interest:
 English Language Arts
 Reading
Source: http://www.doe.k12.ga.us/ci_testing.aspx?PageReq=CI_TESTING_CRCT

11.  Inherent truncated variability of minimal competency
tests
 Inability to obtain non-resident births
 Incomplete or inaccurate maternal and infant records
 Lack of earlier outcome measure (i.e., Pre-K)
 Inability to assess longitudinal changes in achievement

12. Maternal Ethnicity Child Ethnicity
Hispanic
10%
Hispanic
11%
NH Black NH White NH White
36% 54% NH Black 52%
37%

13. • Births that have matching student
information
• Singleton births
• Infants with birth weight 400 g to 5000 g
• Infants of gestational age 20 to 43 weeks
• Infants without recorded congenital
anomalies and chromosomal defects

15. 70%
60% 60% 60% 59%
60% 55%
50%
40%
30%
20% 25% 24%
22%
31% 18%
10% 13% 22% 19% 16% 17%
0%
Extreme Moderately Late Term (37-41) Post Term
Premature Premature Premature (>41)
(<28) (29-33) (34-36)
X2=972.95;df=8; p.
Does Not Meet Meets Exceeds < .0001
N=354,781

16. 60%
53% 55%
52%
50% 50%
50%
40%
41% 39%
37%
30% 31%
20% 24%
10% 23%
14% 11% 10%
9%
0%
Extreme Moderately Late Term (37-41) Post Term
Premature Premature Premature (>41)
(<28) (29-33) (34-36)
X2=1092.2df=8;
Does Not Meet Meets Exceeds p. < .0001
N=354,815

17. 60%
55%
52% 51%
50% 50%
50%
40%
37% 37%
30% 33%
26%
20%
32% 18%
10% 19%
15% 12% 13%
0%
Extreme Moderately Late Term (37-41) Post Term
Premature Premature Premature (>41)
(<28) (29-33) (34-36)
X2=1587.5;df=8;
N=354,764 Does Not Meet Meets Exceeds p. < .0001

18. 345.0
Standardized Scale CRCT Score
340.0
R2=.045 (p. < .05) R2=.055 (p. < .05)
335.0
330.0
R2=.045 (p. < .05)
325.0
320.0
315.0
310.0
READING ELA MATH
AGA 340.0 329.0 338.5
SGA 333.3 323.2 330.6
Covariates appearing in the model are evaluated at the following values: Mothers Age In Years = 26.11.

19. Standardized Scale Scores by Gestational Age
345.0
340.0 339.0 338.3
335.7 337.3 336.9
CRCT Scaled Score 1st Grade
335.0
331.7 333.3
330.0
327.9 328.2 327.8
325.0 323.4 325.0
317.5 321.6
320.0
315.0 315.1
Reading SS (n=354,815)
310.0
ELA SS (n=354,781)
305.0
MATH SS (n=354,764)
300.0
Extreme Moderate Late (34-36) Term (37-41) Post Term (>
(<28) (29-33) 41)
Gestational Age Category

20. Prematurity and Risk (odds) of CRCT Failure
aOR for Association Of Gestational Age With Child’s 1st Grade CRCT Failure
10
English Language Arts
Adjusted Odds Ratio
Reading
Math
2.85 2.72
2.44
1.47
1.36 1.38
1.17 1.15 1.12 1.06 1.07 1.09
1
Post…
Extreme…
Moderat…
Late…
Gestational Age
Adjusted for maternal age at birth, maternal education, maternal race/ethnicity, child
race/ethnicity, sex of child, and year of birth

21. Prematurity and Birthweight by Gestational Age on ELA Failure
aOR for Association of the Interaction Between Birthweight for
Gestational Age and Prematurity on Failure of the ELA Test Only
10.00
SGA
5.43
Adjusted Odds Ratios
AGA
2.45 SGA
AGA
1.61
SGA
AGA
1.35 1.17
AGA
1.15 1.09
SGA
1.00 0.98
0.10
Extreme Moderate Late Post Term
(20-28) (29-33) Preterm (>42)
(34-36)
Gestational Age
Adjusted for maternal age at birth, maternal education, maternal race/ethnicity, child race/ethnicity, sex
of child, and year of birth

22. Summary
• Being born ‘preterm’ versus ‘term’ increases a first-grade child’s
risk of failure of all three components of the CRCT.
• Small for gestational age infants scored significantly lower on all
three components of the CRCT.
• Being small for gestational age significantly increases a first-
grade child’s risk of failure on the English Language Arts test
among those born extremely, moderately, and late preterm.

23.  Prematurity is an injury that can hurt a child for a
very long time
 Not all premature infants are injured in the same
way
 Likemost injuries many forms of prematurity can
be prevented

24. • Teacher/school variables vs. maternal/infant
variables as predictor of school performance
• Factors under schools’ control
• Fairness of high stakes testing

25. Next Steps
• Link hospital discharge, Pregnancy Risk Assessment
Monitoring System (PRAMS), and spatial data to existing
data set
• Examine the impact of the neighborhood on maternal
child health and academic achievement
• Obtain earlier and more relevant measures of
development

26. Attention Cornhusker Nation