Preterm birth, low birth weight, and social relationships

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Functional deficits are known to be associated with preterm birth (PTB) and low birth weight (LBW) but little research exists about socioeconomic outcomes of these medical complications. A systematic review and meta-analysis by UK authors sheds new light on social outcomes in adults who were born preterm or at LBW.

Published in JAMA Network Open, the research looked at 21 prospective longitudinal and registry studies that reported on selected social outcomes in adults born preterm or with LBW compared with control individuals born at term. Pooled analyses were based on odds ratios (ORs) with 95% confidence intervals (Cis) and Hedges g, which were meta-analyzed using random-effects models. 

PTB was defined at < 37 weeks’ gestation and LBW < 2500 g at birth. The studies included were conducted in Germany, Denmark, Norway, Sweden, Finland, UK, Netherlands, Israel, Canada, the United States, New Zealand, and Australia.

Data from more than 4 million adults, nearly 180,000 of whom were preterm or LBW, were analyzed. The authors found that, compared with adults born full term,  individuals with PTB or LBW were less likely to have experienced a romantic partnership (OR 0.17; 95% CI, 0.64-0.81), to have had sexual intercourse (OR, 04.3; 95% CI, 0.31-0.61), or to have become parents (OR 0.77; 95% CI, 0.65-0.91). 

Subgroup analysis of degree of prematurity revealed a dose-response relationship between degree of prematurity and romantic partnership (P< .001) with those who were born extremely premature (EPT) being the least likely to have been in a romantic partnership (ORs for EPT, very preterm [VPT], and moderate to late preterm [MLPT] 0.33, 0.67, and 0.79, respectively). Those in the EPT subgroup were also the least likely to become parents (ORs 0.3, 0.67, and 0.79 for EPT, VPT, and MLPT, respectively). Interestingly, adults born PT/LBW perceived the relationship with their partner as significantly more satisfying or intimate than those born full term. 

The authors said that their findings “are in line with a preterm behavior phenotype that follows into adulthood” but that they do not support the hypothesis that PT/LBW individuals take longer to accomplish normative adult milestones. The researchers’ subgroup analyses included comparisons of participants aged 18 to 25 and 26 or older, which showed no age-associated differences in the life transitions. 

Commenting on the data, the authors said “the findings from the current study should be interpreted with caution and analysis should be repeated when more adulthood data becomes available from the cohort studies. Also, only English publications were considered in this meta-analysis and, therefore, potential language bias should be taken into account.” They recommended additional research “to identify the predictors and promotive factors of social outcomes in PT/LBW individuals to allow for timely interventions in aiding the transition into adulthood.”