Born preterm or low weight? What could that mean for your relationships and wellbeing later on?

In Episode 4 of Series 3 of the DIAL Podcast, Ayten Bilgin and Marina Mendonça from DIAL’s PremLife project discuss their research looking at the romantic and sexual relationships of adults who were born pre-term or with a low birth weight and the potential knock on effects of that on their physical and mental wellbeing.

Association of Preterm Birth and Low Birth Weight With Romantic Partnership, Sexual Intercourse, and Parenthood in Adulthood: A Systematic Review and Meta-analysis is research by Marina Mendonça, Ayten Bilgin and Dieter Wolke and is published in the Journal of the American Medical Association (JAMA Open)

Transcript

Christine Garrington  0:00 

Welcome to DIAL, a podcast where we tune into evidence on inequality over the life course. In this series we are discussing emerging findings from DIAL research. Our guests today are Ayten Bilgin and Marina Mendonça from the PremLife project. They've been investigating the romantic and sexual relationships of adults who were born preterm or with a low birth weight, and the potential knock on effects of that on their physical and mental wellbeing.

Ayten Bilgin  0:27

So preterm birth is being born before 37 weeks of pregnancy, and low birth weight is being born weighing less than 2500 grammes. And research shows that these individuals are at a higher risk of having emotional problems in adulthood, such as depression and anxiety. They are more likely to be introverts, they are more likely to be shy and socially withdrawn, and they are less prone to risky behaviour, such as drug use from our own previous study, we also know that adults born preterm, tend to have lower educational qualifications, they are less likely to be employed, and they are more likely to receive social benefits in comparison to those born at term. In other words, being born preterm seems to contribute to having economic disadvantages to adulthood.what aspects of preterm or low weight baby's life

Christine Garrington  1:25  

What aspects of a preterm or low weight baby's life did you specifically want to look at? And why? And who was the focus of your research?

Ayten Bilgin  1:34

So in general, we were interested in how being born preterm or low birth weight influences their transition into adulthood, regarding their economic independence and social relationships, and in a previous study these child, these child I just briefly described, we showed that adults born preterm are more likely to have economy problems. But we were not sure if they were also likely to have more problems in their social relationships as well. So, this is important because having a close and intimate relationships, having found to increase wellbeing as well as good physical and mental health, and from previous research we know that preterm children struggle more to establish relationships with their peers. They're more likely to be shy and more likely to be victims of bullying, but it wasn't clear whether adults born preterm also face difficulties in establishing social relationships that are normative of adulthood. Such as initiating their sexual life, finding a partner and having children. 

Christine Garrington  2:45

And where did you get all your information from?

Ayten Bilgin  2:49

So what we did in the study is was a meta-analysis which is bringing together data from previous studies. We first started doing an expansive research looking into previous studies, which reported on adult and social relationships, after being born preterm or low birth rates. We found 21 studies from 12 different countries, and we then combined the results of these different studies.

Christine Garrington  3:20  

And can you talk us through a little more exactly what you what you did with that information?

Ayten Bilgin  3:24

Yeah, so to assess the level of social relationships we looked at having a romantic partner, having sexual intercourse, and becoming a parent and we were also interested in assessing the quality of the relationship with romantic partners and friends. And overall their information for up to 4.4 million participants in the study, and we overall compared the scores of adults born preterm on these outcomes to those born at term.

Christine Garrington  3:58  

And Marina now I wonder if you can just talk us through them some of your, your principal findings.

Marina Mendonça 4:02

So previous research on the social lives of adults born preterm was quite inconsistent. And as Ayten mentioned in the study we brought together data from these previous studies, which allowed us to have a greater understanding about the effect of preterm birth on social relationships later in adulthood. And what we found was that those who are born preterm were less likely to form romantic partnerships, have initiated their sexual life, and to experience parenthood than those born full term. The point of these associations was in general small for romantic partnership and for parenthood. For example, those born preterm, were about 20%, less likely to form romantic partnerships and 22% less likely to become parents when compared with full time terms. However, the association was stronger for sexual intercourse, because we found that adults one preterms were about 2.3 times - which is more or less 57% less likely to ever had had sexual intercourse. We also found that these associations became stronger the more premature one was born. So this means that those who were born extremely preterm so this is less than 28 weeks of gestation, were at the highest risk of not finding a romantic partner, having sexual relations and having children.

Christine Garrington  5:43 

And was the picture different for men and women? And I wonder also whether age mattered at all? 

Marina Mendonça  5:48

Well, these associations were similar for both men and women so this means that both men and women born preterm are less likely to experience these social milestones, and one of our most surprising findings was that this pattern of associations also did not differ between the younger age group of those between 18 and 25 years, and the older age group of those with more than 25 years. So previous studies have suggested that people born preterm would take longer to make these social transitions, but then catch up. However, our findings suggest that rather than a delay. There was a persistent difficulty in making these social transitions, which could be associated with negative outcomes later in life, such as being more socially isolated, and also having poor physical and mental health, which Ayten also already mentioned that these social relationships are very important for your wellbeing.

Christine Garrington  6:56  

Absolutely, that's really interesting. Now Marina you also looked at the quality of the relationships that people were in, was there anything that was interesting that emerged there?

Marina Mendonça  7:06

Yes, so we found that despite having fewer close relationships. What we found in this meta-analysis was that when preterm adults have friends, or had a romantic partner, the quality of these relationships, was at least as good in preterms, compared to those born full term. So this is a very positive message, and it also highlights the importance of further research on this area as we still know very little about the characteristics of these social relationship.

Christine Garrington  7:42

Ayten, what would you say are the implications of all this? Are there any lessons for how we can better and best support these, these groups as they become adults?

Ayten Bilgin  7:53

Yes, our findings suggest that preterm born individuals could struggle more later on in their lives, regarding their social relationships, they may be more lonely - socially isolated while also facing economical difficulties, and could be a challenge for them later on as adults. When preterm get older their parents may not be around anymore to give them support, and overall, the most important lesson is to intervene and start promoting their social skills, as soon as possible. As specifically when they go in school because these social relationship problems tend to develop early, and those caring for preterm children. This includes parents., health professionals and teachers, they should be more aware of the important role of social development and social integration for preterm children and supporting them to make new friends, that will help them later in life, and help them to enhance their wellbeing.

Christine Garrington  9:02  

Some really clear messages there, now how will this work, feed into the wider Premlife project which is obviously seeking to ensure that preterm and low weight babies do go on and thrive and do have those fulfilling lives.

Ayten Bilgin  9:16

This study is about inequalities in social relationships caused by preterm birth and our previous study from the same project was about economic inequalities, caused by preterm births, both of which are in line with the focus of PremLife. PremLife project investigates which factors provides protection, and increased resilience for preterm children's life course outcomes to help them achieve better outcomes. Findings of this study feeds into PremLife project by highlighting the importance of focusing on the social relationships in childhood so it also does, and investigation of the factors which could explain the difference in social skills in preterm individuals.

Christine Garrington  10:06  

Ayten Bilgin and Marina Mendonça from the PremLife project, were talking to Chris Garrington, for this episode of the DIAL podcast. Association of Preterm Birth and Low Birth Weight With Romantic Partnership, Sexual Intercourse, and Parenthood in Adulthood: A Systematic Review and Meta-analysis is research published by the Journal of the American Medical Association. You can find out more about the DIAL research programme at dynamicsofinequality.org. And don't forget to subscribe to the DIAL podcast, to access earlier and forthcoming episodes.