Preterm Birth and Adult Wealth

Abstract

Each year, 15 million babies worldwide are born preterm. Preterm birth is associated with adverse neurodevelopmental outcomes across the life span. Recent registry-based studies suggest that preterm birth is associated with decreased wealth in adulthood, but the mediating mechanisms are unknown. This study investigated whether the relationship between preterm birth and low adult wealth is mediated by poor academic abilities and educational qualifications. Participants were members of two British population-based birth cohorts born in 1958 and 1970, respectively. Results showed that preterm birth was associated with decreased wealth at 42 years of age. This association was mediated by decreased intelligence, reading, and, in particular, mathematics attainment in middle childhood, as well as decreased educational qualifications in young adulthood. Findings were similar in both cohorts, which suggests that these mechanisms may be time invariant. Special educational support in childhood may prevent preterm children from becoming less wealthy as adults. Keywordspreterm birth, wealth, mathematics, reading, intelligence, adulthood outcomes Received 1/7/15; Revision accepted 6/24/15 Worldwide, 11% of infants are born preterm (< 37 weeks gestation), which amounts to around 15 million births per year (Blencowe et al., 2012;Goldenberg, Culhane, Iams, & Romero, 2008). Rates of preterm birth are increasing globally, rising from 7.2% to 8.6% between 1990 and 2010 in developed countries alone (Blencowe et al., 2012). Preterm birth is a syndrome resulting from multiple causes (Goldenberg et al., 2008) and is associated with widespread brain alterations (Volpe, 2009). Prematurity is associated with adverse developmental and psychological outcomes across the life span (Johnson & Wolke, 2013;Moster, Lie, & Markestad, 2008;Saigal, 2014).Recent registry-based studies have documented decreased wealth in adulthood following preterm birth (Heinonen et al., 2013;Lindstrom, Winbladh, Haglund, & Hjern, 2007;Moster et al., 2008). In a Scandinavian sample, adults born preterm had, on average, lower job-related incomes and were found to be more likely to receive social security benefits at the ages of 20 to 36 years than adults born at term (Moster et al., 2008). These negative outcomes do not apply only to high-risk groups, such as those born very preterm (< 32 weeks gestation); they have also been found for adults born moderately preterm (32-33 weeks gestation) and late preterm (34-36 weeks gestation; Heinonen et al., 2013;Lindstrom et al., 2007), who together comprise up to 84% of all preterm births (Shapiro-Mendoza & Lackritz, 2012). These registry-based studies have important strengths, including unbiased measures and the use of large, unselected samples. However, they do not provide information on potential mechanisms leading to decreased wealth in adulthood that could aid the development of intervention strategies.Mediators that may explain decreased wealth in preterm adults include poor abilities in several academic fields. P...

Academic performance of children born preterm: a meta-analysis and meta-regression

“…5 6 Despite influential advances in neonatal healthcare, preterm children show considerable academic difficulties. Given the increasing number of preterm children and the substantial individual, social and economic consequences of academic difficulties in these children, 7 29 there is a need to develop strategies that will improve outcomes after preterm birth. These interventions may target perinatal factors associated with adverse outcomes.…”

“…5 6 Preterm birth is associated with lower incomes and increased reliance on social security in adulthood, which was predicted by decreased academic abilities. 7 More insight into academic difficulties of preterm children may help prevent academic failure and thereby reduce long-term individual burden and societal costs. In a meta-analysis on reading abilities in preterm children at school-age, Kovachy and colleagues 8 found worse decoding and reading comprehension abilities in preterm children compared with controls.…”

Academic Outcomes of School-Aged Children Born Preterm

“…For example, the association between preterm birth and adult wealth is particularly mediated by low achievement in the mathematics domain during the formative school years. 5 Despite the clear importance of reading and mathematics skills, the problem as it relates to the preterm population has been defined broadly, with little known of how component subskills are affected. 6 Furthermore, educational professionals underappreciate the potential challenges faced by students with preterm birth histories and may be ill-prepared to address their needs.…”

Automated quantitative evaluation of brain MRI may be more accurate for discriminating preterm born adults

“…Brain abnormalities are well documented in newborns, infants and children and persist into the adult life [12]. VLBW adults have a higher incidence of neurosensory deficits, a greater burden of illness, lower IQ scores, and poorer educational achievement than their peers born with normal birth weight [12,[24][25][26] and lower quality of life [27]. However, few studies describe the adult preterm brain from a neuroradiological perspective [28][29][30][31].…”