Heavy prenatal alcohol exposure is associated with changes to the brain’s white matter, which may underpin attention problems observed in this population. Less is known about the effect of low to moderate exposure. This study investigated white matter correlates of attention in children with low to moderate levels of prenatal alcohol exposure and controls whose mothers abstained from alcohol. We also examined whether associations differed between alcohol exposure in trimester one only or throughout pregnancy. A total of 129 children aged 6-7-years from the prospective Asking Questions about Alcohol in pregnancy (AQUA) cohort (trimester one alcohol exposure n = 47; exposure throughout pregnancy n = 45; controls n = 37) participated in a brain magnetic resonance imaging study. Fixel-based analysis was performed on diffusion weighted images to investigate associations between whole brain white matter micro- and macro-structure and attention (focus, shift, sustain, hyperactivity and inattention). In controls, better focused attention and less hyperactivity were associated with greater macrostructural cross-sectional area of the corticospinal tract and cerebellar white matter, respectively. Greater microstructural fiber density in the splenium of the corpus callosum was associated with more inattention in the children with trimester one alcohol exposure, which persisted when adjusted for any binge drinking episodes prior to pregnancy recognition. Subtle differences in the association between white matter and attention were found between controls and prenatal exposure groups, where associations were stronger in controls. While further exploration is needed, preliminary findings in 6-7-year-old children suggest that low to moderate prenatal alcohol exposure affects white matter fibers that subserve attention skills.

Objective: To describe associations between executive function (EF) domains (attentional control, information processing, cognitive flexibility, and goal setting) and concurrent math computation performance at age 7 and 13 years in children born <30 weeks' gestation or weighing <1,250 g, and second, to examine the impact of 7-year EF on math performance at 13 years. Method: In a prospective, longitudinal cohort of children born <30 weeks' gestation or with a birthweight <1,250 g, assessment of EF and math performance was undertaken at 7 (n = 187) and 13 years (n = 174). Linear regression models were used to describe associations between EF domains with math performance at both time points, as well as to examine the impact of EF at 7 years on math performance at 13 years. Results: At 7 and 13 years, all EF domains were positively and strongly associated with concurrent math performance (beta = 11.35, 95% CI [9.28, 13.41] to beta = 13.79, 95% CI [11.59, 15.98]). All EF domains at age 7 years were positively associated with math performance at 13 years, with the strongest associations observed for cognitive flexibility (beta = 10.79 [8.64, 12.94]) and goal setting (beta = 10.37 [8.08, 12.67]). Conclusions: This study provides evidence that EF is strongly associated with math performance in children born <30 weeks' gestation or with a birthweight <1,250 g and highlights the importance of early cognitive flexibility and goal setting performance for future math performance.

AbstractObjective:To examine associations between executive function (EF) domains (attentional control, information processing, cognitive flexibility, and goal setting) and math computation performance at 7 and 13 years in children born very preterm (VP; <30 weeks' gestation), and secondly, to investigate the associations of 7-year EF with change in math performance from 7 to 13 years.Participants and Methods:In the prospective, longitudinal Victorian Infant Brain Studies (VIBeS) cohort of children born VP, assessment of EF and math performance was undertaken at 7 (n = 187) and 13 years (n = 174). Univariable and multivariable regression models (including all domains of EF) were used to examine associations between EF domains at both timepoints with math performance, as well as associations between EF at 7 years with change in math from 7 to 13 years.Results:At 7 and 13 years, all EF domains were positively associated with concurrent math performance, with multivariable models finding information processing, cognitive flexibility and goal setting independently contributed to math performance at both ages. All EF domains were positively associated with improvement in math performance from 7 to 13 years, with multivariable models finding that goal setting contributed unique variance to improvement in math over this period.Conclusions:This study provides evidence for a strong, consistent association between EF and math performance in children born VP and emphasizes the importance of goal setting capacity for later improvement in math performance.

Individuals born very preterm (VPT; <32 weeks' gestational age) are at increased risk of impaired mathematics and word reading performance, as well as widespread white matter microstructural alterations compared with individuals born full term (FT; ≥37 weeks' gestational age). To date, the link between academic performance and white matter microstructure is not well understood. This study aimed to investigate the associations between mathematics and reading performance with white matter microstructure in 114 VPT and 36 FT 13-year-old children. Additionally, we aimed to investigate whether the association of mathematics and reading performance with white matter microstructure in VPT children varied as a function of impairment. To do this, we used diffusion tensor imaging and advanced diffusion modelling techniques (Neurite Orientation Dispersion and Density Imaging and the Spherical Mean Technique), combined with a whole-brain analysis approach (Tract-Based Spatial Statistics). Mathematics performance across VPT and FT groups was positively associated with white matter microstructural measurements of fractional anisotropy and neurite density, and negatively associated with radial and mean diffusivities in widespread, bilateral regions. Furthermore, VPT children with a mathematics impairment (>1 standard deviation below FT mean) had significantly reduced neurite density compared with VPT children without an impairment. Reading performance was not significantly associated with any of the white matter microstructure parameters. Additionally, the associations between white matter microstructure and mathematics and reading performance did not differ significantly between VPT and FT groups. Our findings suggest that alterations in white matter microstructure, and more specifically lower neurite density, are associated with poorer mathematics performance in 13-year-old VPT and FT children. More research is required to understand the association between reading performance and white matter microstructure in 13-year-old children.