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Preterm birth has been linked to mental health challenges in childhood, but less is known about how these effects continue into adulthood. Advances in neonatal care mean that more preterm infants now reach adulthood, making long-term outcomes increasingly important. This cohort study examined adults born preterm or at term to assess how gestational age and fetal growth relate to depression and anxiety in adulthood. By analyzing mental health outcomes in later life, the researchers aimed to clarify the long-term effects of preterm birth. The findings are especially relevant for parents of preterm infants and neonatal nurses. Results suggest that extreme prematurity is linked to a higher risk of depression and anxiety in adulthood.
Preterm infant care does not end after discharge from neonatal units. Many parents and health professionals ask whether early birth can influence emotional wellbeing later in life. Understanding these long-term outcomes helps families and neonatal teams plan follow-up and support across the lifespan.
The study used data from a retrospective cohort of adults aged 18 to 52 years who were born preterm or at term in Germany. Participants were grouped by gestational age, and mental health outcomes were assessed using standardized questionnaires. The analysis focused on depression and anxiety, while avoiding unnecessary clinical detail. It means keeping the explanation high-level and easy to understand, without including technical terms, statistics, methods, or clinical jargon that are not essential for the audience.
Adults born extremely preterm, defined as at or before 28 weeks of gestation, showed a higher likelihood of major depressive disorder and generalized anxiety disorder compared with those born at term. Each week decrease in gestational age was linked to a higher risk of these mental health conditions. In contrast, fetal growth restriction, measured by birth weight percentiles, was not independently associated with adult mental health outcomes. These findings suggest that gestational age itself plays a key role.
Additional analyses showed that emotional and peer problems in early childhood were associated with adult depression, but only among individuals born preterm. The study also found that adjusting for maternal smoking and alcohol use during pregnancy reduced the strength of the association with depression, while the link with anxiety remained.
For parents of preterm infants, the findings highlight the importance of long-term monitoring of emotional wellbeing. Neonatal nurses and healthcare teams may consider continued psychosocial follow-up, especially for infants born extremely preterm. Early support for emotional and social development may help reduce later mental health risks.
Ongoing dialogue between families and neonatal teams can support early identification of concerns. Sharing this research may also help raise awareness of the lifelong impact of preterm birth.
Paper available at: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00248-2/fulltext
Full list of authors: Fieß, A.; Hartmann, A.; Ernst, M.; Schuster, A.K.; Mildenberger, E.; Brähler, E.; Urschitz, M.S.; Pfeiffer, N.; Beutel, M.E.; Gißler, S.; Tesarz, J.
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