Born prematurely: what does it mean at 35 and why should doctors and patients themselves know about it

Being born too early is not just about the first weeks of life. A new study in JAMA Network Open shows that the more severe the medical problems in infancy in preemies, the more noticeable the “echoes” in the psyche and metabolism decades later. At age 35, such people are more likely to have internalizing disorders (anxiety/depression), elevated systolic pressure, an unfavorable lipid profile, more abdominal fat, and lower bone density. The authors urge that adult healthcare should systematically take into account the fact of preterm birth - up to adding it to the standard medical history collection by therapists.

The study is a long-term follow-up of one of the oldest American cohorts of preterm infants (RHODE Study, New England). At the tenth visit (2020-2024), the scientists compared 158 adults born prematurely (average gestation 30 weeks, birth weight ~1270 g) and 55 peers born at term. They measured blood pressure, lipids, HbA1c, inflammation markers, fat composition by DXA, and psychological health was assessed by a standardized self-questionnaire in adulthood. Then comes the most interesting part: they did not simply compare the groups, but linked the “severity of early medical risks” (according to the cumulative index) with the health trajectory over time.

Background of the study

Premature birth has long ceased to be an exclusively neonatal problem. Thanks to the successes of intensive care, more and more children born at 24-32 weeks survive, and they enter adulthood - with their "long" consequences of an early start. At the same time, most clinical recommendations in "adult" medicine hardly take into account the fact of prematurity in the anamnesis: therapists rarely ask about it, screening is not adapted to specific risks, and the evidence base on health after 30 years remains fragmented.

There are several reasons to expect delayed effects. The third trimester is a period of intensive organ growth and formation of reserves:

• vascular network and kidneys (final number of nephrons), which affects the “setting” of blood pressure;
• skeletal mineralization (calcium/phosphorus), which determines peak bone mass;
• brain maturation, stress systems (HPA axis) and immune regulation.

Neonatal complications (respiratory support, infections, CNS inflammation), slow growth followed by “catch-up”, parenteral/enteral nutrition and steroid courses add factors of “programming” of metabolism and psyche. As a result, adults born prematurely are more often recorded to have higher systolic blood pressure, unfavorable lipid profile, greater visceral fat mass, lower bone mineral density and more internalizing symptoms (anxiety/depression). But most studies were limited to adolescence and early adulthood; data on the mid-20s are rare.

Another methodological gap is the confusion between biology and environment. The influence of family well-being, education, support, and income can mask or, conversely, “highlight” the links between prematurity and adult health. Therefore, designs are important that take into account not only the fact of prematurity itself, but also the severity of early medical risk (a composite of complications from birth to discharge/early childhood) and, in parallel, indicators of the family environment.

Finally, in the practical field, there is a challenge to “translate” knowledge from neonatology into the therapist’s routine: what screening targets to choose for a 30-year-old patient born prematurely (BP, lipids, body composition, bone mass, mental health), when to start monitoring and how to talk about it without stigma. To answer this, long-term prospective cohorts with repeated visits from adolescence to adulthood and with objective measurements (DXA, laboratory biomarkers, standardized psychoscales) are needed.

This is precisely the gap that the study addresses: it follows the preterm cohort to age 35, links the early medical risk index to mental and somatic outcomes in adulthood, and tests how independent these links are of the social environment. The findings are not so much an argument for alarm as for early, targeted screening and inclusion of preterm birth in the standard adult medical history.

Main findings

• Mental health. Higher early medical risk in preterm infants → greater increase in internalizing problems (anxiety/depression/somatic complaints) from 17 to 35 years: β = 0.85 (SE 0.33; p=0.01). Externalizing problems (aggression/delinquency) did not increase.
• Blood pressure. Association with systolic pressure: +7.15 mm Hg at 35 years (p=0.004); diastolic did not change significantly.
• Lipids and sugar. Lower “good” HDL (−13.07 mg/dL, p=0.003) and higher triglycerides (+53.97 mg/dL, p=0.03). HbA1c and LDL - no significant associations.
• Fat and bones. Higher android/gynoid ratio (i.e. more central fat; β = 0.22, p = 0.006) and lower T-score bone mineral density (β = −1.14, p = 0.004) are factors for future cardio- and osteo-risks.
• Social "cushions". The index of "social support" in the family and the child's SES level almost did not moderate the connections (the exception was slightly lower IL-6 with a higher child SES). In other words, the biological trace of early problems in premature babies appears even against the background of a prosperous childhood.

But this is no reason for fatalism. On the contrary, it is a signal for early and targeted screening. The study is actively cited in university press releases and medical media with one idea: write “premature birth” in the adult patient’s chart and check typical “targets” earlier than usual.

What Doctors and Healthcare Systems Should Do Now

• Introduce a “flag” into the questionnaire. Ask adult patients if they were born prematurely. This is a simple question with great prognostic value.
• Screening “by list”.
  - mental health: anxiety/depression (short validated questionnaires);
  - blood pressure: earlier and more frequent monitoring of SBP;
  - lipids/triglycerides and lifestyle;
  - body composition (waist circumference) and osteoporosis risks (fall factors, nutrition, vitamin D/calcium).
• Communication without stigma. Formulate it as a “developmental factor” and not a “label of a diagnosis for life”: emphasize the possibilities of prevention and control.
• Routing. In case of severe anxiety/depression - quick access to psychotherapy; in case of high SBP - BP control program; in case of risk of osteoporosis - early assessment and correction.

What is important for "prematurely born adult children" to know

• You are not "doomed", but you have a different start. Knowing the risks, it is easier to monitor blood pressure, lipids and mental health in time - and keep everything under control.
• Nutrition and exercise are the first line of treatment. More aerobic activity and strength training (blood pressure/lipids/bone), weight and waist management, protein and calcium/vitamin D - the usual measures work especially well if started early.
• Keep an eye on your bones. Low bone density is not just for the elderly. Talk to your doctor about a personalized prevention plan (including family risk factors).
• The psyche is also health. Regular sleep, stress management, seeking help for anxiety/depression - this is prevention "on an equal footing" with a tonometer.

How the study is structured

• Participants: 158 adults born prematurely (1985-1989, NICU level III, <1850 g; severe defects excluded, extremely low chances of survival) and 55 full-term peers; age at visit - 35 years.
• What was considered "exposure". Composite index of early medical risk (infections, respiratory support, neurological complications, etc.) from birth to 12 years. In parallel - the index of social support (HOME) and children's SES.
• What was measured. Psychological outcomes (internal/external problems), blood pressure, lipids, HbA1c, CRP/IL-6, DXA (regional fat, bone density).
• How we analyzed it. Latent growth curves (17→23→35 years) + path analysis for one-time outcomes; the main “arrow” is from early risk to the state at 35 years.

Limitations that the authors honestly stated

• Sample size and composition: Small cohort, predominantly white participants from one region of the United States - generalizability issues.
• A set of psychometric measurements. In adulthood - self-reports; clinical diagnostics could clarify the scale.
• Observational design. The associations are compelling but do not prove causation in any particular individual.

At the same time, independent news and press releases agree: the signal is replicated in other cohorts and in meta-analyses - the same risk clusters are more common in "prematurely born" people. This is an argument in favor of screening by birth factor - a simple and cheap step.

Summary

Prematurity is a long-term health factor, not just a "neonatal history." If you are a doctor, ask your adult patients about it; if you are a patient, know your early history. The earlier prevention is established, the quieter the "echo" of the first weeks of life will be.

Source: D'Agata AL, Eaton C, Smith T, et al. Psychological and Physical Health of a Preterm Birth Cohort at Age 35 Years. JAMA Network Open. 2025;8(7):e2522599. doi:10.1001/jamanetworkopen.2025.22599.