Early medical risk and childhood social protection are associated with adult outcomes after preterm birth.

OBJECTIVE: To examine how early medical risk and childhood caregiving environments relate to adult adaptive functioning, executive function, and social competence in a prospective cohort of individuals born preterm. STUDY DESIGN: Participants were drawn from a prospective longitudinal U.S. birth cohort recruited between 1985 and 1989 from a Level III neonatal ICU. Early medical risk was indexed using neonatal health indicators and cumulative medical and neurological complications from birth through age 12 years. Childhood social protection was measured through observations of the home environment and caregiving interactions. At age 35 years, participants completed standardized assessments of adaptive functioning, executive function, and social competence. Linear regression models examined associations between early medical risk, social protection, and adult functional outcomes, adjusting for sex and socioeconomic status. RESULTS: 142 adults (113 preterm, 29 term born) participated in the 35-year assessment. Higher early medical risk was associated with poorer executive functioning on the DKEFS Design Fluency task (β = -0.19; p = .015). Greater childhood social protection was associated with better adaptive functioning (β = 0.60; p = .035), higher Adult Self-Report adaptive scores (β = 0.55; p = .002), stronger Word Context deductive reasoning (β = 0.14; p = .043), and greater social integration (β = 0.22; p = .028). CONCLUSIONS: Early medical risks and childhood caregiving environments are associated with domain-specific functional outcomes in adulthood among individuals born preterm. Supportive early environments may represent modifiable factors that help mitigate long-term functional vulnerability following preterm birth.