More than half (57%) of children born before 32 weeks of age were not ready for school at age five, including in areas such as communication, language, and physical and emotional development.
Those born prematurely at 23 to 24 weeks were up to three times more likely to miss expected developmental milestones than those born at 31 weeks.
The study also found that children born in the most deprived areas were up to twice as likely to have low attainment compared to children born in the least deprived areas.
Experts say strategies that reduce social inequalities, promote brain health and increase support for preterm children during the transition to school are essential to improving outcomes.
Advances in neonatal intensive care have improved survival rates for preterm infants. Preterm birth is a major cause of abnormal brain development and cognitive impairment, but little is known about its impact on early educational outcomes.
Scientists led by the University of Edinburgh and Imperial College, London, studied data from around 16,000 children born before 32 weeks of pregnancy in the UK between 2008 and 2012. They used de-identified data from the National Neonatal Research Database and the National Pupil Database to link neonatal clinical data and educational outcomes.
The researchers investigated factors that influence school readiness at age 5 and achievement in reading, mathematics, and science at ages 6 and 7.
The researchers found that half of preterm children do not achieve expected outcomes in writing (51 per cent) and mathematics (48 per cent) by the age of six or seven. Slightly fewer preterm infants were below achievement level in reading (42%) and science (36%).
The study identified several modifiable risk factors associated with differences in achievement, including maternal smoking during pregnancy, nutrition and specific medications during neonatal intensive care, medical difficulties sometimes experienced by preterm infants, and social deprivation.
Boys are at greater risk of having poor academic performance than girls, with those born in the summer entering school a year earlier than those born in the fall. Experts say very preterm babies could benefit from delayed school entry and targeted academic support, depending on when they were born.
The study was funded by the Medical Research Council and the National Institute for Health and Care Excellence and published in the journal JAMA network open: http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2026.23068?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=071426
The data revealed a tremendous burden of poor academic performance in primary school for children born prematurely. Improving the life chances of these vulnerable children will require not only finding new ways to reduce the medical problems associated with preterm birth, but also focusing on social inequalities in early childhood. ”
Professor James Boardman, co-lead author, Center for Reproductive Medicine, University of Edinburgh
Co-lead author Cheryl Battersby, from Imperial College London, said: “One of the most striking findings was that social disadvantage had an impact on achievement comparable to that of severe brain injury. It is unclear which aspects of social disadvantage drive these differences. “We need to better understand what is causing this and identify interventions that can have the greatest impact. Improving outcomes will require a combination of medical advances and targeted social policies that address the broad determinants of child development.”
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Reference magazines:
Haider, S. others. (2026) Health and socio-economic factors in school readiness and achievement of very preterm children. JAMA network open. DOI: 10.1001/jamanetworkopen.2026.23068. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2851613
