Long-Term Educational Outcomes of Individuals Born Preterm.

Importance: Children born preterm may face neurodevelopmental challenges. Data on how this translates into long-term educational outcomes at the population level are scarce. Objective: To quantify relative contributions of preterm birth and sociodemographic factors to educational achievement and attainment. Design, Setting, and Participants: This case-control study included a birth cohort of all infants born preterm in Quebec, Canada, between 1976 and 1995, matched 1:2 with infants born term. Births before 37 weeks' gestations were considered preterm. The control cohort born between 37 and 42 weeks' gestation were matched by birth year, sex, and pregnancy type (singleton, twins). Administrative database linkages provided objective data for longitudinal follow-up to age 43 years. Individuals who died in 1976 to 2019 or without Quebec Ministry of Education records were excluded. Analyses were performed from February 2, 2023, to June 4, 2025. Exposure: Preterm birth, defined as extremely preterm (under 28 weeks), very preterm (28 to <32 weeks), or moderate-to-late preterm (32 to <37 weeks). Main Outcomes and Measures: Outcomes included high school performance (final high school average), high school graduation by age 22 years, and university degree at any age. Sociodemographic factors were extracted from the Quebec Births and Deaths registry. Socioeconomic status was derived using postal code and the Material and Social Deprivation Index. Results: Of 297 820 participants (160 980 male [54.0%]; 28 040 individuals [9.4%] born to mothers born outside Canada), 1915 (0.6%) were born extremely preterm, 13 225 (4.4%) very preterm, 83 105 (27.9%) moderate-to-late preterm, and 199 575 (67.0%) full term. Associations of preterm birth and final high school average were negligible among those who remained in school. Gestational age was associated with educational attainment in a dose-response pattern wherein individuals born extremely preterm were the most at risk for not graduating high school (OR, 1.80; 99% CI, 1.54-2.09) or not obtaining a university degree (OR, 1.68; 99% CI, 1.39-2.02). The contribution of preterm birth was small compared with male sex, maternal educational level, socioeconomic status, and migration related factors. Conclusions and Relevance: In this case-control study, individuals born preterm were more likely than full-term counterparts to not complete high school, yet sociodemographic factors were more important than preterm status for educational attainment. Our findings substantiate the need for long-term follow-up and support to children born preterm and their families.