Very preterm birth, social influences and developmental outcomes: alternative developmental mechanisms

• In Event: New insights into the role of environmental factors in the development of individuals born preterm

Abstract

Advances in obstetric and neonatal care have led to infants surviving after being removed from their intrauterine environment many weeks before their expected date and being cared for extra-uterine. The survival of VP in our midst has created a natural experiment of how violation of expected environment, disruption of organ development (e.g. brain) and superimposed complications may affect development in timing and function across the life course.
VP birth has lasting functional and social consequences into adulthood (Wolke et al., 2019). Nevetheless, most VP live adaptive lives without any of the above adversities – how can that be explained?

Most prospective studies of VP use a simple “medical” model investigating the association between perinatal differences at birth and adverse outcomes (see Figure 1, Model 0). However, this approach fails to consider other important influences along the life course. Considering protective and resiliency factors in this field is a major step change.

I will be presenting evidence for the influence of social factors on developmental outcomes into adulthood from our large RECAP-Preterm project that combined more than two dozen VP cohorts (www.recap-preterm.eu). A special focus for longitudinal analysis of VP and parenting will be on our Bavarian Longitudinal Study, a regional study of 682 VP/VLBW born in 1985/86 and survivors and a term control group (original N:916) followed from birth over 34 years. Finally, findings on prenatal risk and effects of trauma across childhood on mental health into adulthood will be demonstrated using the ALSPAC- study of 14.000 women and their children (Liu et al. 2020, 2021).

Firstly, we found that social factors such as SES may have a main effect on VP’s development (see Figure 1, Model 1), i.e. being an additional factor predicting outcome. The effects of low SES are the same for children born VP and at term and are additive. For parenting we found moderation effects VP birth and the outcome of interest (Figure 1, Model 2), i.e. low sensitive parenting significantly larger effect in VP (i.e., they are more vulnerable) than children born at term on academic achievement, consistent with a diathesis-stress model. High sensitive parenting provided protection against the effects of VP birth and VP children reached academic functioning close to those born at term; they are resilient and bounced back after exposure to risk. A third model considers social factors as mediators between VP birth and outcomes (see Figure 1, Model 3). For example, VP children are at higher risk for emotional problems. Similarly, children who are exposed to trauma, such as being bullied by peers, are at higher risk for emotional problems. We showed that those born VP are more often exposed to more adverse environments (e.g. traumatic; more often bullied) and this mediated effects of VP birth to mental health problems.

Our current evidence indicates moderate to large influences of social factors that alter the life trajectories of those born VP. However, not “one size fits all”: the developmental mechanisms seem to differ according to the social factors and the outcomes under consideration.

Author

• Dieter F H Wolke, University of Warwick
  Presenting Author