Born pre-term: How early adversity and social environment affect life course development

Professor Dieter Wolke, Department of Psychology 

The €2.8 million ERC Advanced Grant PRETERM-LIFECOURSE project (underwritten by UKRI), led by Professor Dieter Wolke studies how early adversity affects development into adulthood and whether age related function, disease and the time we may die is already determined in the womb and at birth.

Early adversity refers to a huge deviation from an expected environment that requires many adaptations. Professor Wolke and team will look at very preterm birth (VPT, less than 32 weeks gestation) as a natural experiment of how early deviation from an expected (intrauterine) environment is related to trade-offs affecting individuals themselves and even the next generation.

Professor Wolke and team and others have previously shown that very pre-term (VPT) is associated with increased risk of cognitive, behavioural and social development. The team now wants to investigate alternative developmental models of how other factors across the life course operate to increase or dampen the effect of very pre-term birth on social relationships, employment and wealth and health into middle adulthood. Does VPT lead to pathology or alternatively, to living faster? To assess potential trade-offs and changes in the pace of development, we will be looking at functional ageing, brain ageing, physiological aging and cell aging with the epigenetic clock.

Finally, what and how do conditions or experiences after VPT affect reproductive success (having children), the sex ratio and the “quality” of the offspring.

Professor Wolke will investigate these question utilising the Bavarian Longitudinal Study (BEST) that he has directed over three decades, preterm cohorts around the world (www.recap-preterm.eu) and the Nordic registries.

Insight in how early adversity affects the speed of development (ageing), what protective factors dampen adverse outcomes and how early adversity may affect the offspring is not just of scientific interest, but is also likely to inform long term follow-up care.

Impact

Healthcare organisations, including NICE have already updated their guidance to include PARCA-R as a screen for cognitive and language problems in the follow-up of very preterm children at 2 years. More than 1,200 people, mainly healthcare and education professionals globally, have used the PARCA-R screening test in their follow-up work, which is available in 14 different languages, to identify children at all stages of gestation who need follow up care. The PARCA-R became a major follow-up tool internationally when face-to-face assessment was not possible during the COVID-19 crisis.

Professor Wolke’s findings have also influenced the European Foundation of the Care of Newborns and Infants’s new standards on follow-up care of preterm children. These have now been endorsed by over 50 European societies and healthcare organisations. In addition, as a result of Professor Wolke’s findings the Department for Education requires that admission authorities consider the age group the child would have fallen into if born on time when commencing primary education. Each year 6,500 parents in England and Wales ask for postponed school entry due to the effects of preterm birth.

Read more about the research.