Abstract
Background: Advances in neonatal care have improved survival rates for very preterm (VP) and very low birth weight (VLBW) infants, yet their long-term outcomes into adulthood remain understudied.
Objectives: To assess the impact of VP/VLBW status on mortality, educational attainment, and labour market outcomes in early adulthood using data from the RECAP Preterm Project.
Methods: We used harmonised data from five nationally representative cohort studies in high-income countries (Canada, Germany, the Netherlands, New Zealand, and Norway) participating in the RECAP Preterm Project. Our sample included 2,493 individuals born VP/VLBW and 496 term-born controls. We employed coarsened exact matching (CEM) to compare adult outcomes between VP/VLBW and term-born individuals, and an instrumental variable (IV) approach—using maternal nulliparity—to estimate the marginal effect of gestational age within the VP/VLBW group.
Results: Mortality before adulthood was 16.7 percentage points higher among VP/VLBW individuals compared to term-born controls (95% CI: 13.2, 20.2). Among survivors, the likelihood of attaining less than secondary education was 4.3 percentage points higher (95% CI: −0.8, 9.4). Differences in economic activity and working hours were small and uncertain. Within the VP/VLBW group, each additional week of gestational age was associated with a 6.8 percentage point reduction in mortality (95% CI: −12.7, −1.0), with weaker associations for educational and labour market outcomes.
Conclusions: VP/VLBW birth is associated with elevated mortality and educational disadvantage in early adulthood. These findings highlight the importance of long-term support for this population beyond neonatal survival, particularly in education and development policy.