15 Apr Preterm Birth, Especially Before 34 Weeks, Associated With Major Cognitive Challenges

MedicalResearch.com Interview with:

Dr. Nivins

Samson Nivins PhD
Post-doc | Neonatology
Karolinska Institutet
Developmental Neuroscientist
Liggins Institute

Dr. Ådén

Ulrika Ådén PhD
Professor of Neonatology
Department of Women’s and
Children’s Health Karolinska

MedicalResearch.com: What is the background for this study?

Response: Children born preterm are at higher risk of cognitive impairment during childhood and later in life. However, an important unresolved question is whether these impairments primarily reflect genetic susceptibility or are driven by the biological consequences of being born too early. Cognitive development is known to have a strong heritable component (~70 %), and previous studies have attempted to disentangle genetic and environmental contributions, for example through sibling comparison designs. Although informative, such approaches have inherent limitations.

In this study, we aimed to investigate long-term cognitive outcomes across a range of gestational age groups including very preterm, moderately preterm, late preterm, and early term, compared to children born full term. Importantly, we accounted for genetic influences as well as a range of potential confounding factors, including prenatal risks and child-specific factors. This approach provides a more nuanced understanding of the extent to which cognitive outcomes associated with preterm birth reflect biological versus inherited risk.

MedicalResearch.com: What are the main findings?

Response:  In our study involving a large cohort of over 5000 children aged 9 to 10 years, we found that those born before 34 weeks of gestation were at higher risk of cognitive impairments compared to children born full term. This association was independent of genetic influences, prenatal risks, and child-specific factors. Interestingly, the effect estimates for biological risk, such as preterm birth, were larger than those for genetic and other risk factors, highlighting the strong contribution of early gestational age to cognitive outcomes during childhood.

MedicalResearch.com: Did the manner of birth (C-section vs vaginal), make a difference in outcomes?

Response:  In our study, we considered the manner of birth as potential confounder. We found that the association between preterm birth and cognitive impairment remained unchanged by mode of delivery, suggesting that the manner of birth did not significantly influence the cognitive outcomes observed in preterm children.

MedicalResearch.com: What should readers take away from your report?

Response: Cognitive development is a complex interplay of genetic, prenatal, and environmental factors. Through our comprehensive analysis, we inform readers that preterm birth, particularly before 34 weeks, is associated with major cognitive challenges, with effects stronger than those of genetics and other environmental risks. Our results emphasize the need for longer-term follow-up and tailored interventions, as these children may face greater developmental challenges over time.

MedicalResearch.com: What recommendations do you have for future research as a results of this study?

Response: Future research should focus on understanding the neural mechanisms and patterns that contribute to cognitive resilience and susceptibility in preterm children. In particular, identifying neural circuits or structures that support cognitive recovery in some children, while highlighting areas that may be more vulnerable to impairments, would be crucial. Furthermore, long-term studies should track cognitive development from the neonatal period through to later childhood, incorporating genetic factors to better understand how resilience and susceptibility evolve over time and which factors contribute to positive or negative cognitive outcomes in preterm children.

MedicalResearch.com: Is there anything else you would like to add? Any disclosures?

Response: Although not the main focus of our study, we observed some interesting findings. Particularly, girls born preterm tended to reach puberty earlier, whereas boys born preterm were more likely to be obese at ages 9–10 compared to their full-term peers. These findings suggest that preterm birth may have gender-specific effects on physical development, which warrants further investigation in future research.

No disclosures

Citation:

Nivins S, Padilla N, Kvanta H, Ådén U. Gestational Age and Cognitive Development in Childhood. JAMA Netw Open. 2025;8(4):e254580. doi:10.1001/jamanetworkopen.2025.4580

More information:

• March of Dimes

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Last Updated on April 15, 2025 by Marie Benz MD FAAD