Preterm Birth/Low Birth Weight and Markers Reflective of Wealth in Adulthood: A Meta-analysis

CONTEXT: Preterm birth and/or low birth weight (PT/LBW) increases the risk of cognitive deficits, which suggests an association between PT/LBW and lower wealth in adulthood. Nevertheless, studies have revealed inconsistent findings so far. OBJECTIVE: To systematically investigate whether PT/LBW is associated with markers of adulthood wealth. DATA SOURCES: We searched Medline, PubMed, PsycINFO, Web of Science, and Embase. STUDY SELECTION: Prospective longitudinal and registry studies containing reports on selected wealth-related outcomes in PT/LBW-born adults compared with term-born controls. DATA EXTRACTION: Two independent reviewers extracted data on educational qualifications, employment rates, social benefits, and independent living. RESULTS: Of 1347 articles screened, 23 studies met the inclusion criteria. PT/LBW was associated with decreased likelihood of attainment of higher education qualifications (odds ratio [OR] = 0.74; 95% confidence interval [CI] = 0.69-0.80), lower employment rate (OR = 0.83; 95% CI = 0.74-0.92), and increased likelihood of receiving social benefits (OR = 1.25; 95% CI = 1.09-1.42). A dose-response relationship according to gestational age was only found for education qualifications. PT/LBW-born adults did not differ significantly from those born at term in independent living. LIMITATIONS: There was high heterogeneity between studies. There were unequal numbers of studies from different regions in the world. CONCLUSIONS: PT/LBW is associated with lower educational qualifications, decreased rate of employment, and an increased rate of receipt of social benefits in adulthood. Low educational qualifications were most prevalent in those born very preterm and consistent across geographic regions. However, the findings are less clear for independent living.