Normal pregnancy is intended to last 40 weeks. However, every year around the world 11% of births, or 15m children, are preterm – before 37 weeks gestation. Being born too soon is associated with increased costs of care in infancy and childhood. But recently, there has been growing concern that premature birth may throw a long shadow over a child’s life chances as they grow up.
Large studies have found that being born preterm is related to having less wealth – including research that has shown them as more likely to earn less or receive more social benefits in adulthood. This may be due to long lasting alterations in brain development that affect learning, academic achievement and by extension, a person’s ability to earn. Others have suggested that preterm birth is related to social inequality because mothers who are socio-economically deprived are more likely to give birth preterm.
In recent research I investigated the impact of being born preterm on a person’s wealth through two large longitudinal studies: the National Child Development Study (NCDS), started in 1958 and the British Cohort Study (BCS) which began in 1970. Both of the studies recruited all children born in a single week in England, Scotland and Wales, and followed them from birth through to adulthood. My colleagues and I assessed the participants’ wealth at age 42, using a combination of their family income and social class, housing and employment status, and their own perceptions of their financial situation. Most of those people in the study who were premature had been born after 32 weeks, and the average was around 35 weeks.
The results were consistent in both of the two cohorts: people who had been born prematurely tended to be less well-off at age 42 and have lower educational qualifications in adulthood than those who had been born full-term. By looking at the NCDS study, we found that people born preterm were more likely to be manual workers, to be unemployed and to report financial difficulties than those born full-term. They were also more likely to have below average family income and were less likely to own a house.
The effects we saw on wealth were not as a direct result of being born preterm, but also depended on a person having lower mathematics and reading achievement and lower intelligence in primary school compared with their full-term peers. This means the fact that prematurely born children had on average lower academic abilities, meant that they were more likely to have lower educational qualifications and subsequently lower wealth in adulthood. And these indirect effects continued despite controlling for the effects of socio-economic status at birth.
Mathematics achievement in primary school was, however, directly associated with wealth in adulthood – whether or not a person had a high level of education qualification.
Where to intervene
These new findings suggest that premature birth does not inevitably lead to poor wealth but that being born preterm sets children on a different trajectory. You can think of this trajectory in terms of “developmental cascades” that may be altered at certain junctions. Some of these junctions are the transition into primary school and then navigation through to successful educational qualifications.
Educational interventions that address the special needs of preterm children and in particular their progress in mathematics may provide an avenue to alter the long-term effects on individuals’ and nations’ wealth. Improving support for preterm children’s education will require better understanding of their specific problems and needs by teachers and parents.
However, recent research has shown that teachers have most likely not received any training about the specific difficulties in mathematics, learning and attention that preterm children more often face. Most teachers would be open to learning more about the special needs of prematurely born children and how to support their education – but this is currently not provided in their training or in school.
Such support may include more individualised mathematics teaching, interventions to improve attention, offering teaching material in smaller chunks, and interventions aimed at improving working memory.
Giving parents support
Parents also have an important role in supporting the education of children who are born preterm. Mothers of pre-term children are, on average, as attuned or sensitive in their parenting as mothers of full-term children. However, preterm children are more vulnerable to poor or average parenting. They are often compared to “orchids” who need the right conditions to grow while healthy full-term children are compared to “dandelions” who may grow well in all but the most adverse conditions.
So interventions that help parents of school-age children who were born prematurely to meet their special needs and vulnerabilities may be another avenue to improve these children’s academic success.
Preterm birth is frequent and rates are increasing. To improve the wealth and life chances of individuals born preterm we need to bridge the current divide from intensive medical care in infancy and early childhood to more appropriate and adaptive educational provisions for preterm children and their parents.
Dieter Wolke receives funding from Nuffield Foundation, ESRC, EU, BMBF, MRC
Authors: The Conversation