Outcomes in Early Adulthood for Individuals Born Very Preterm and/or with Very Low Birth Weight: Evidence from Multinational Cohorts

TL;DR

Individuals born very preterm or with very low birth weight face higher mortality and educational challenges in early adulthood compared to those born at term.

Contribution

This study provides multinational evidence on long-term outcomes of very preterm or very low birth weight individuals into early adulthood.

Findings

VP/VLBW individuals had 16.7 percentage points higher mortality before adulthood compared to term-born controls.

VP/VLBW survivors were more likely to attain less than secondary education.

Each additional week of gestational age reduced mortality by 6.8 percentage points within the VP/VLBW group.

Abstract

Advances in neonatal care have improved survival rates for infants born very preterm (VP) and/or with very low birth weight (VLBW), yet their long-term outcomes into adulthood remain understudied.

To assess the impact of VP/VLBW status on mortality, educational attainment, and labor market outcomes in early adulthood using data from the RECAP Preterm Project.

We used harmonized data from 5 nationally representative cohort studies in high-income countries (Canada, Germany, the Netherlands, New Zealand, and Norway) participating in the RECAP Preterm Project. Our sample included 2493 individuals born VP/VLBW and 496 control patients born at term. We used coarsened exact matching to compare adult outcomes between infants who were VP/VLBW and those born at term and an instrumental variable approach—using maternal nulliparity—to estimate the marginal effect of gestational age within the VP/VLBW group.

Mortality before adulthood was 16.7 percentage points greater among individuals who were VP/VLBW compared with control infants born at term (95% CI 13.2-20.2). Among survivors, the likelihood of attaining less than secondary education was 4.3 percentage points greater (95% CI −0.8 to 9.4). Differences in economic activity and working hours were small and uncertain. Within the VP/VLBW group, each additional week of gestational age was associated with a 6.8 percentage point reduction in mortality (95% CI −12.7 to −1.0), with weaker associations for educational and labor market outcomes.

VP/VLBW birth is associated with elevated mortality and educational disadvantage in early adulthood. These findings highlight the importance of long-term support for this population beyond neonatal survival, particularly in education and development policy.