A University of Rhode Island-led cohort study links preterm index of cumulative medical risk from birth to year 12 to adult disorders at age 35.

Premature birth affects about one in 10 U.S. infants annually, and survival rates have improved dramatically since the 1980s. In the US, adult medical care rarely includes birth history and much of what is known about long-term outcomes for those born preterm has come from international cohorts.

In the study, “Psychological and Physical Health of a Preterm Birth Cohort at Age 35 Years,” published in JAMA Network Open, researchers designed a prospective longitudinal cohort study to examine how early life medical risk affects adult psychological and physiological health outcomes.

A total of 213 individuals originally recruited from a Level III neonatal intensive care unit in New England between 1985 and 1989 were followed through 2024. The sample included 158 adults born preterm (under 1,850 g) and 55 full-term counterparts. Data were collected during a single clinical visit and through at-home surveys, with assessments covering biospecimens, imaging, and psychological self-reports.

Medical risk was quantified from birth to age 12 using a composite index incorporating birth weight, gestational age, duration of oxygen therapy, and neurological and medical health status across multiple timepoints. Health outcomes at age 35 included blood pressure, lipid levels, body composition via DEXA scan, and psychological function measured by ASEBA Adult Self-Report.

Each one-point increase in early life medical risk was associated with a 7-point rise in systolic blood pressure, a 13 mg/dL decrease in HDL cholesterol, and a 54 mg/dL increase in triglycerides. Fat was more likely to accumulate in the abdominal region than in the lower body, and bone mineral density was lower. Internalizing problems such as anxiety and depression also increased with higher early life risk.

No associations were found for diastolic blood pressure, LDL cholesterol, hemoglobin A1c, or inflammatory markers. Childhood SES and social protection did not significantly alter these outcomes, though higher SES was linked to lower IL-6 levels.

Researchers conclude that preterm birth and the severity of early medical complications are associated with lifelong health consequences, including mental health and cardiometabolic vulnerabilities.

Without clinical guidelines for screening adults born preterm, many clinicians may overlook risk factors rooted in early life. As the preterm-born population continues to age, long-term monitoring and tailored preventive care could help address the needs of this growing segment of the population.

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