Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Preterm birth and early life environmental factors: neuropsychological profiles at adolescence and young adulthood

Journal of Perinatology volume 43, pages 1429–1436 (2023)Cite this article

Subjects

Abstract

Objectives

To establish neuropsychological profiles after high- and low-risk preterm birth (i.e., with and without neonatal brain injury) during adolescence and young adulthood and to assess the potential role of early life environmental factors in cognition.

Study design

Participants (N = 177; Mage = 20.11 years) of both sexes were evaluated when adolescent or in young adulthood. They were grouped according to their birth status: 30 high-risk preterm, 83 low-risk preterm and 64 born at full term.

Results

Significant differences were found in several cognitive domains between groups. Furthermore, familial socioeconomic status (SES) moderated the relation between the degree of maturity/immaturity at birth and cognition (F(5,171) = 11.94, p < 0.001, R2 = 0.26).

Discussion

The findings showed different neuropsychological profiles during adolescence and young adulthood, with the high-risk preterm sample evidencing lower cognitive values. In addition, higher scores in the familial SES score in this study seem to have a protective effect on cognition.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Moderation Models between the Degree of Maturity/Immaturity at Birth and General Cognitive Functioning Score.
Fig. 2: Moderating Effect of Familial SES between the Degree of Maturity/Immaturity at Birth and General Cognitive Functioning Score.

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed in the current study are available from the corresponding author on reasonable request.

References

  1. World Health Organization. Recommended definition, terminology and format for statistical tables related to the perinatal period. Acta Obstet Gynecol Scand. 1997;56:247–53.

    Google Scholar 

  2. Raju TNK, Pemberton VL, Saigal S, Blaisdell CJ, Moxey-Mims M, Buist S. Long-Term Healthcare Outcomes of Preterm Birth: An Executive Summary of a Conference Sponsored by the National Institutes of Health. J Pediatr. 2017;181:309–318.e1.

    PubMed  Google Scholar 

  3. Rees P, Callan C, Chadda KR, Vaal M, Diviney J, Sabti S, et al. Preterm Brain Injury and Neurodevelopmental Outcomes: A Meta-analysis. Pediatrics 2022;150:e2022057442.

    PubMed  Google Scholar 

  4. Volpe JJ. The Encephalopathy of Prematurity-Brain Injury and Impaired Brain Development Inextricably Intertwined. Semin Pediatr Neurol. 2009;16:167–78.

    PubMed  PubMed Central  Google Scholar 

  5. Caravale B, Tozzi C, Albino G, Vicari S. Cognitive development in low risk preterm infants at 3-4 years of life. Arch Dis Child Fetal Neonatal Ed. 2005;90:474–79.

    Google Scholar 

  6. Hart AR, Whitby EW, Griffiths PD, Smith MF. Magnetic resonance imaging and developmental outcome following preterm birth: Review of current evidence. Dev Med Child Neurol. 2008;50:655–63.

    PubMed  Google Scholar 

  7. Walsh JM, Doyle LW, Anderson PJ, Lee KJ, Cheong JLY. Moderate and late preterm birth: Effect on Brain size and maturation at term-equivalent age. Radiology 2014;273:232–40.

    PubMed  Google Scholar 

  8. Arpi E, D’Amico R, Lucaccioni L, Bedetti L, Berardi A, Ferrari F. Worse global intellectual and worse neuropsychological functioning in preterm-born children at preschool age: a meta-analysis. Acta Paediatr Int J Paediatr. 2019;108:1567–79.

    Google Scholar 

  9. Chan E, Leong P, Malouf R, Quigley MA. Long-term cognitive and school outcomes of late-preterm and early-term births: A systematic review. Child Care Health Dev. 2016;42:297–312.

    CAS  PubMed  Google Scholar 

  10. McBryde M, Fitzallen GC, Liley HG, Taylor HG, Bora S. Academic Outcomes of School-Aged Children Born Preterm: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3:e202027.

    PubMed  PubMed Central  Google Scholar 

  11. Allotey J, Zamora J, Cheong-See F, Kalidindi M, Arroyo-Manzano D, Asztalos E, et al. Cognitive, motor, behavioural and academic performances of children born preterm: a meta-analysis and systematic review involving 64 061 children. BJOG An. Int J Obstet Gynaecol. 2018;125:16–25.

    CAS  Google Scholar 

  12. Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJS. Cognitive and behavioral outcomes of school-aged children who were born preterm: A meta-analysis. Jama 2002;288:728–37.

    PubMed  Google Scholar 

  13. Hadaya L, Nosarti C. The neurobiological correlates of cognitive outcomes in adolescence and adulthood following very preterm birth. Semin Fetal Neonatal Med. 2020;25:101117.

    PubMed  Google Scholar 

  14. O’Reilly H, Johnson S, Ni Y, Wolke D, Marlow N. Neuropsychological outcomes at 19 years of age following extremely preterm birth. Pediatrics 2020;145:e20192087.

    PubMed  Google Scholar 

  15. Brydges CR, Landes JK, Reid CL, Campbell C, French N, Anderson M. Cognitive outcomes in children and adolescents born very preterm: a meta-analysis. Dev Med Child Neurol. 2018;60:452–68.

    PubMed  Google Scholar 

  16. Raju TNK, Buist AS, Blaisdell CJ, Moxey-Mims M, Saigal S. Adults born preterm: a review of general health and system-specific outcomes. Acta Paediatr Int J Paediatr. 2017;106:1409–37.

    Google Scholar 

  17. Truttmann AC, Ginet V, Puyal J. Current Evidence on Cell Death in Preterm Brain Injury in Human and Preclinical Models. Front Cell Dev Biol. 2020;8:1–26.

    Google Scholar 

  18. de Jong M, Verhoeven M, van Baar AL. School outcome, cognitive functioning, and behaviour problems in moderate and late preterm children and adults: A review. Semin Fetal Neonatal Med. 2012;17:163–9.

    PubMed  Google Scholar 

  19. Yaari M, Mankuta D, Harel-Gadassi A, Friedlander E, Bar-Oz B, Eventov-Friedman S, et al. Early developmental trajectories of preterm infants. Res Dev Disabil. 2018;81:12–23.

    PubMed  Google Scholar 

  20. Linsell L, Johnson S, Wolke D, O’Reilly H, Morris JK, Kurinczuk JJ, et al. Cognitive trajectories from infancy to early adulthood following birth before 26 weeks of gestation: A prospective, population-based cohort study. Arch Dis Child. 2018;103:363–70.

    PubMed  Google Scholar 

  21. Wong HS, Edwards P. Nature or nurture: A systematic review of the effect of socio-economic status on the developmental and cognitive outcomes of children born preterm. Matern Child Health J. 2013;17:1689–1700.

    PubMed  Google Scholar 

  22. Pérez-Pereira M, Fernández MP, Gómez-Taibo ML, Martínez-López Z, Arce C. A follow-up study of cognitive development in low risk preterm children. Int J Environ Res Public Health. 2020;17:2380.

    PubMed  PubMed Central  Google Scholar 

  23. Sansavini A, Guarini A, Caselli MC. Preterm birth: Neuropsychological profiles and atypical developmental pathways. Dev Disabil Res. Rev. 2011;17:102–13.

    PubMed  Google Scholar 

  24. Fernández de Gamarra-Oca L, Zubiaurre-Elorza L, Junqué C, Solana E, Soria-Pastor S, Vázquez É, et al. Reduced hippocampal subfield volumes and memory performance in preterm children with and without germinal matrix-intraventricular hemorrhage. Sci Rep. 2021;11:1–11.

    Google Scholar 

  25. Zubiaurre-Elorza L, Soria-Pastor S, Junqué C, Fernandez-Espejo D, Segarra D, Bargalló N, et al. Thalamic changes in a preterm sample with periventricular leukomalacia: Correlation with white-matter integrity and cognitive outcome at school age. Pediatr Res. 2012;71:354–60.

    PubMed  Google Scholar 

  26. Zubiaurre-Elorza L, Soria-Pastor S, Junque C, Segarra D, Bargalló N, Mayolas N, et al. Gray matter volume decrements in preterm children with periventricular leukomalacia. Pediatr Res. 2011;69:554–60.

    PubMed  Google Scholar 

  27. Raven J, Raven JC, Court JH. Raven Manual: Section 4, Advanced Progressive Matrices. Oxford Psychologists Press Ltd; 1998.

  28. Dunn LM, Dunn LM. Peabody picture vocabulary test-revised. American guidance service, Incorporated; 1981.

  29. Lezak MD, Howieson DB, Loring DW, Fischer JS. Neuropsychological assessment. Oxford University Press, USA; 2004.

  30. Kaufman AS, Raiford SE, Coalson DL. Intelligent testing with the WISC-V. John Wiley & Sons; 2015.

  31. Wechsler D. Wechsler adult intelligence scale–Fourth Edition(WAIS–IV), Vol. 22. NCS Pearson; 2008:1.

  32. Reitan RM. Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills. 1958;8:271–6.

    Google Scholar 

  33. Schretlen DJ. Modified Wisconsin Card Sorting Test®: M-WCST; Professional Manual. PAR; 2010.

  34. Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol: Gen. 1992;121:15.

    Google Scholar 

  35. Happé FG. An advanced test of theory of mind: Understanding of story characters’ thoughts and feelings by able autistic, mentally handicapped, and normal children and adults. J Autism Dev Disord. 1994;24:129–154.

    PubMed  Google Scholar 

  36. Lind G. Wie misst man moralisches Urteil?: Probleme u. alternative Moeglichkeiten d. Messung e. komplexen Konstrukts.Beltz; 1978.

  37. Kirby KN, Maraković NN. Delay-discounting probabilistic rewards: Rates decrease as amounts increase. Psychon Bull Rev. 1996;3:100–4.

    CAS  PubMed  Google Scholar 

  38. Hollingshead AB. Four factor index of social status. NewHaven, CT: Department of Sociology, Yale University. 1975.

  39. Achenbach TM, Dumenci L, Rescorla LA. Ratings of relations between DSM-IV diagnostic categories and items of the Adult Self-Report (ASR) and Adult Behavior Checklist (ABCL). Research Center for Children, Youth and Families. 2003:1–11.

  40. Achenbach TM, Edelbrock CS. Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington, VT: University of Vermont. Psychiatry Department; 1983.

    Google Scholar 

  41. Parker G, Tupling H, Brown LB. A parental bonding instrument. Br J Med Psychol. 1979;52:1–10.

  42. World Health Organization (WHO). Adverse childhood experiences international questionnaire. Adverse childhood experiences international questionnaire (ACE-IQ). 2018. Retrieved from: https://www.who.int/publications/m/item/adverse-childhood-experiences-international-questionnaire-(ace-iq).

  43. Hack M, Flannery DJ, Schluchter M, Cartar L, Borawski E, Klein N. Outcomes in Young Adulthood for Very-Low-Birth-Weight Infants. Obstet Gynecol Surv. 2002;57:342–4.

    Google Scholar 

  44. Hack M. Adult outcomes of preterm children. J Dev Behav Pediatr. 2009;30:460–70.

    PubMed  Google Scholar 

  45. Allen MC, Cristofalo E, Kim C. Preterm birth: Transition to adulthood. Dev Disabil Res Rev. 2010;16:323–35.

    PubMed  Google Scholar 

  46. Vollmer B, Lundequist A, Mårtensson G, Nagy Z, Lagercrantz H, Smedler AC, et al. Correlation between white matter microstructure and executive functions suggests early developmental influence on long fibre tracts in preterm born adolescents. PLoS ONE. 2017;12:1–16.

    Google Scholar 

  47. Ross GS, Perlman JM. Relationships of biological and environmental factors to cognition of preterm infants in the toddler and preschool periods. Dev Psychobiol. 2019;61:1100–6.

    PubMed  Google Scholar 

  48. Wolke D. Is Social Inequality in Cognitive Outcomes Increased by Preterm Birth-Related Complications? JAMA Netw Open. 2019;2:e192902.

    PubMed  Google Scholar 

  49. Potijk MR, Kerstjens JM, Bos AF, Reijneveld SA, De Winter AF. Developmental delay in moderately preterm-born children with low socioeconomic status: Risks multiply. J Pediatr. 2013;163:1289–95.

    PubMed  Google Scholar 

  50. Beauregard JL, Drews-Botsch C, Sales JM, Flanders WD, Kramer MR. Preterm birth, poverty, and cognitive development. Pediatrics 2018;141:e20170509.

    PubMed  Google Scholar 

  51. Ekeus C, Lindström K, Lindblad F, Rasmussen F, Hjern A. Preterm birth, social disadvantage, and cognitive competence in Swedish 18-to 19-year-old men. Pediatrics 2010;125:e67–73.

    PubMed  Google Scholar 

  52. Benavente-Fernández I, Synnes A, Grunau RE, Chau V, Ramraj C, Glass T, et al. Association of Socioeconomic Status and Brain Injury With Neurodevelopmental Outcomes of Very Preterm Children. JAMA Netw Open. 2019;2:e192914.

    PubMed  PubMed Central  Google Scholar 

  53. Joseph RM, O’Shea TM, Allred EN, Heeren T, Kuban KK. Maternal educational status at birth, maternal educational advancement, and neurocognitive outcomes at age 10 years among children born extremely preterm. Pediatr Res. 2018;83:767–77.

    PubMed  Google Scholar 

  54. Flodmark O, Roland EH, Hill A, Whitfield MF. Periventricular leukomalacia: Radiologic diagnosis. Radiology 1987;162:119–24.

    CAS  PubMed  Google Scholar 

  55. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92:529–34.

    CAS  PubMed  Google Scholar 

  56. Bilgin A, Mendonca M, Wolke D. Preterm birth/low birth eight and markers reflective of wealth in adulthood: A meta-analysis. Pediatrics 2018;142:e20173625.

    PubMed  Google Scholar 

  57. Jaekel J, Anderson PJ, Bartmann P, Cheong JLY, Doyle LW, Hack M, et al. Mathematical performance in childhood and early adult outcomes after very preterm birth: an individual participant data meta-analysis. Dev Med Child Neurol. 2022;64:421–8.

    PubMed  Google Scholar 

Download references

Acknowledgements

This research was supported by the Spanish Ministry of Science, Innovation and Universities [L. Zubiaurre-Elorza (PSI2017-83657-P)]; Aristos Campus Mundus [L. Zubiaurre-Elorza (ACM2018_17)]; the Department of Education and Science of the Basque Government [N. Ojeda (IT1545-22)]; and the Department of Education of the Basque Government [L. Fernández de Gamarra-Oca (PRE_2019_1_0105)]. We would like to give special thanks to the adolescents and young adults who participated in this study.

Author information

Authors and Affiliations

  1. Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Vizcaya, Spain

    Lexuri Fernández de Gamarra-Oca, Leire Zubiaurre-Elorza, Javier Peña, M. Acebo García-Guerrero, Naroa Ibarretxe-Bilbao & Natalia Ojeda

  2. Department of Basic Psychological Processes and Development, Faculty of Psychology, University of the Basque Country, Donostia, Gipuzkoa, Spain

    Ainara Gómez-Gastiasoro

  3. School of Psychology, Education and Sport Science Blanquerna, Ramon Llull University, Barcelona, Catalonia, Spain

    Marta Molins-Sauri & Olga Bruna

  4. Neonatal Intensive Care Unit, Cruces University Hospital, Biocruces Health Research Institute, Barakaldo, Vizcaya, Spain

    Begoña Loureiro

  5. Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Catalonia, Spain

    Carme Junqué

  6. Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain

    Carme Junqué

  7. Pediatric Neurology Research Group, Vall d’Hebron Research Institute, Vall d’Hebron University Hospital, Barcelona, Catalonia, Spain

    Alfons Macaya

  8. Department of Neurosurgery and Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Catalonia, Spain

    Maria A. Poca

Authors
  1. Lexuri Fernández de Gamarra-Oca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leire Zubiaurre-Elorza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ainara Gómez-Gastiasoro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marta Molins-Sauri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Begoña Loureiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Javier Peña
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Acebo García-Guerrero
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Naroa Ibarretxe-Bilbao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Olga Bruna
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Carme Junqué
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alfons Macaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Maria A. Poca
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Natalia Ojeda
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LZ-E, BL, OB, CJ, AM, MAP, and NO made substantial contributions to the conception and design of the work. LF-O, LZ-E, AG-G, MM-S, BL, OB, CJ, AM, MAP, and NO played a part in the acquisition, analysis, and interpretation of data for the work. All the authors worked on the draft and revised it critically for important intellectual content. Besides, all of them gave the final approval of the version to be published. Lastly, all authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Leire Zubiaurre-Elorza.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fernández de Gamarra-Oca, L., Zubiaurre-Elorza, L., Gómez-Gastiasoro, A. et al. Preterm birth and early life environmental factors: neuropsychological profiles at adolescence and young adulthood. J Perinatol 43, 1429–1436 (2023). https://doi.org/10.1038/s41372-023-01727-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-023-01727-z

Search

Advanced search

Quick links