The intersection of neuroscience, socioeconomic status, and preterm birth

Preterm birth is a leading cause of brain dysmaturation and neurocognitive impairment in childhood. While both dysmaturation and adverse outcomes are often attributed to low gestational age and PTB-associated risk factors such as chorioamnionitis, immune dysregulation, suboptimal nutrition, and common co-morbidities, recent studies suggest socioeconomic inequalities also play an important role. In this review, we summarize current etiological evidence linking socioeconomic status with i) brain injury/dysmaturation defined using magnetic resonance imaging, and ii) cognitive and behavioral outcomes, in very preterm children from birth to five years. We consider the mechanisms that may embed socioeconomic status in the development of children who were born preterm, including in response to prevalent brain injuries. We discuss the potential role of access to cognitive, social, and economic resources for attenuating the effects of social disadvantage and suggest targets for future research and policy change. IMPACT: Social gradients are strong determinants of neurodevelopmental outcomes after preterm birth. Social disadvantage is associated with brain structure and connectivity in preterm infants. Improving outcomes after preterm birth is likely to require mitigating social disadvantage in the perinatal period and early childhood, as well as reducing medical risks linked to atypical development.