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Adults born preterm less likely to have sexual partnerships
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Adults who were born preterm or with low birth weight are less likely to have sexual intercourse, romantic partnerships or to become parents than adults who were born full term, according to study results published in JAMA Network Open.
“Close and intimate relationships have been shown to increase happiness and well-being both physically and mentally,” study author Marina Mendonca, PhD, a researcher in the department of psychology at the University of Warwick in the United Kingdom, told Infectious Diseases in Children. “Our findings suggest that people born preterm might be at greater risk of social isolation, lower wealth and poorer physical and mental health due to lack of sexual activity and lack of support from a romantic partner.”
According to the researchers, findings from previous studies have associated preterm birth and low birth weight (PT/LBW) with challenges in social relationships for children born with these conditions. Prematurity has also been associated with “a behavioral phenotype and personality profile that includes being timid, socially withdrawn, overcontrolling, and disinclined toward risk-taking or fun seeking,” they wrote.
However, research on social outcomes of adults born PT is inconclusive and scarce, they added.
To address this unmet research need, Mendonca and colleagues conducted a meta-analysis of 21 prospective longitudinal and registry studies that reported on selected social outcomes in adults who were born PT/LBW compared with controls who were born at term. The mean sample age was 18 years or older.
The studies were conducted in 12 high-income countries and included approximately 4.4 million adult participants, of whom 179,724 were PT/LBW.
Adults born PT/LBW were less likely than adults born full term to have had sexual intercourse (OR = 0.43; 95% CI, 0.31-0.61), have ever experienced a romantic partnership (OR = 0.72; 95% CI, 0.64-0.81) or to have become parents (OR = 0.77; 95% CI, 0.65-0.91).
The researchers reported a dose-response association according to degree of prematurity for romantic partnerships and parenthood.
“Overall, effect sizes did not differ with age and sex,” they noted.
Although the likelihood of experiencing these three social outcomes was lower in adults born PT/LBW, Mendonca and colleagues found that adults born PT/LBW did not experience impaired quality of relationships with partners and friends.
“Previous research has shown that children born preterm had poorer social interactions,” Mendonca said. “These social characteristics may persist into adulthood, making it harder for people born preterm to form relationships normative of adulthood, such as finding a partner. Future studies need now to investigate what contributes to these differences between people born preterm and full term in terms of social relationships. This requires studies from early childhood, and we are currently working on this.”– by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Deborah E. Campbell, MD
As you explore studies in detail, it becomes clear that very PT/very LBW adults are more vulnerable to the continuing effects of their PT/LBW birth. There are differences based on decreasing gestational age and associated chronic health sequelae and neurosensory impairments among survivors, as well as heterogeneity in the behavioral patterns exhibited by survivors based on their sex. The child’s environment (social advantage, attachment, maternal education, socioeconomic status, social support) can also moderate these risks.
It is important to recognize the vulnerability and persistent difficulties that many PT/LBW individuals experience as they transition into adulthood, and it is equally important to appreciate the resiliency of preterm adults, most of whom are living independent, productive, fulfilled lives despite the health, behavioral and academic challenges they have navigated.
Prematurity is a life-long journey that includes increased risks for chronic health conditions affecting pulmonary, central nervous system, renal and ophthalmological function and a constellation of neurodevelopmental effects that encompass motor-neurologic function, visual-motor integrative skills and auditory processing, IQ, academic achievement, language, executive function (problem-solving and completion of goal-directed activities) and ADHD and behavioral issues. Language difficulties may also impact social pragmatics (how language is used socially and understanding social nuances), use and understanding of complex language, phonological processing (use of letter sounds to identify/distinguish words) and syntax.
Predicting long-term outcomes can be challenging because even preterm infants who do not have evidence of early brain injury or atypical brain development can experience the same neurodevelopmental issues. An area of particular interest has been described as the preterm behavioral phenotype that comprises difficulties with emotions, attention and peer relationships. Behavioral functioning is important for individual well-being, and although the majority (approximately 55%) of preterm children have minimal behavioral problems, approximately 20% exhibit a behavioral profile that includes subclinical emotional symptoms, hyperactivity and inattention, and peer problems that lead to social difficulties. A similar percentage of preterm children also exhibit conduct disorders and more severe emotional difficulties yet have normal peer relationships. It is important to note that among very PT/very LBW adults engaged in relationships, there were no overall differences in their experiences and satisfaction with peer relationships in comparison with their term-born peers, despite having poorer self-esteem and fewer reported friends.
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