Childhood Factors and Positive Functioning Among Adults Born Very Preterm or With Very Low Birth Weight

Adults born very preterm and/or with very low birth weight (VP or VLBW; <32 weeks' gestation and/or <1500 g birth weight) are at increased risk of experiencing wealth and social relationship difficulties, yet many achieve positive outcomes in these domains. Following the bioecological framework, early factors relating to person, process, and context may shape long-term positive functioning, but few studies capture this heterogeneity in VP or VLBW individuals, and little is known about the childhood factors promoting positive functioning in adulthood.

To identify distinct positive functioning profiles at 34 years in VP or VLBW and term-born adults across the domains of risk avoidance, wealth, and social relationships with parents, partners, and peers and to investigate whether identified profiles based on objective domains align with subjective life satisfaction at 34 years and are associated with childhood factors.

This longitudinal cohort study was conducted among VP/VLBW and healthy term-born infants born between January 1985 and March 1986 in a geographically defined area (Bavaria, Germany) from birth until 34 years of age. Data were analyzed from February 2025 through April 2026.

Person factors: VP or VLBW, sex at birth, effortful control at 8 years, and IQ at 8 years; process factors: parenting at 6 and 8 years and peer relationship quality at 8 years; and context factors: family socioeconomic status at birth, normative-authoritative family climate at 6 years, and interparental relationship quality at 8 years.

Positive functioning across risk avoidance, wealth, and social relationship domains was assessed with a standard Life Course Interview, and life satisfaction was assessed with the Satisfaction with Life Scale.

Of 715 eligible adults, 416 (214 born VP or VLBW; 217 female [52.2%]) were assessed at age 34 years. Three profiles were distinguished: (1) optimal functioning (261 [63%] in total; 119 [56%] VP or VLBW individuals) across domains; (2) moderate functioning (106 [26%] in total; 56 [26%] VP or VLBW individuals) with low partner relationship scores; and (3) low economic and social functioning (49 [12%] in total; 39 [18%] VP or VLBW individuals), with the lowest wealth, partner, and peer relationship scores. Individuals with the optimal-functioning profile had substantially higher mean scores of life satisfaction than those in the low-functioning profile (mean difference = 7.71; 95% CI, 5.17-10.24; d = 1.46). After adjustment for childhood factors and multiple testing, a 1-SD increase in IQ was associated with decreased odds for low economic and social functioning compared to optimal functioning (odds ratio = 0.21; 95% CI, 0.13-0.34).

Per the results of this cohort study, a substantial subgroup of adults born VP or VLBW are at increased risk for lower positive functioning and lower life satisfaction in adulthood. Improving children's cognitive functioning may help improve adult positive functioning.