Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. e62-e72 (doi:10.1542/peds.2007-3858)
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ARTICLE

Young Adults With Very Low Birth Weight: Leaving the Parental Home and Sexual Relationships—Helsinki Study of Very Low Birth Weight Adults

Eero Kajantie, MD, PhDa,b, Petteri Hovi, MDa,b, Katri Räikkönen, PhDc, Anu-Katriina Pesonen, PhDc, Kati Heinonen, PhDc, Anna-Liisa Järvenpää, MD, PhDb, Johan G Eriksson, MD, PhDa,d, Sonja Strang-Karlsson, MDa,b and Sture Andersson, MD, PhDb

a National Public Health Institute, Helsinki, Finland
b Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
c Departments of Psychology
d Public Health, University of Helsinki, Helsinki, Finland


   ABSTRACT
TOP
 ABSTRACT
METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 
OBJECTIVE. Although most children and adults who are born very preterm live healthy lives, they have, on average, lower cognitive scores, more internalizing behaviors, and deficits in social skills. This could well affect their transition to adulthood. We studied the tempo of first leaving the parental home and starting cohabitation with an intimate partner and sexual experience of young adults with very low birth weight (<1500 g).

METHODS. In conjunction with the Helsinki Study of Very Low Birth Weight Adults, 162 very low birth weight individuals and 188 individuals who were born at term (mean age: 22.3 years [range: 18.5–27.1]) and did not have any major disability filled out a questionnaire. For analysis of their ages at events which had not occurred in all subjects, we used survival analysis (Cox regression), adjusted for gender, current height, parents' ages at the birth, maternal smoking during pregnancy, parental educational attainment, number of siblings, and parental divorce/death.

RESULTS. During their late teens and early adulthood, these very low birth weight adults were less likely to leave the parental home and to start cohabiting with an intimate partner. In gender-stratified analyses, these hazard ratios were similar between genders, but the latter was statistically significant for women only. These very low birth weight adults were also less likely to experience sexual intercourse. This relationship was statistically significant for women but not for men; however, very low birth weight women and men both reported a smaller lifetime number of sex partners than did control subjects.

CONCLUSIONS. Healthy young adults with very low birth weight show a delay in leaving the parental home and starting sexual activity and partnerships.

Key Words: adolescent sexual behavior • epidemiology • follow-up studies • prematurity • sexual activity

Abbreviations: VLBW—very low birth weight • ELBW—extremely low birth weight • SDS—SD score • HR—hazard ratio • OR—odds ratio • CI—confidence interval • SGA—small for gestational age • AGA—appropriate for gestational age

Advances in perinatal therapies and neonatal intensive care from the 1970s onward have produced dramatic improvements in the prognosis of very preterm infants. The first generations of infants who have benefited from these advances are now young adults. Although the prevalence of major disabilities such as cerebral palsy, developmental delay, and vision impairments is higher in this group, most adults who were born very preterm live normal, healthy lives.1–5

Recent research has suggested, however, that even in the absence of major disabilities, children and adults who were born very small or very preterm often exhibit disadvantages that are more subtle. Although groups under study vary—some studies focusing on very low birth weight (VLBW) (<1500 g),1,3,5–14 some on extremely low birth weight (ELBW) (<1000 g),4,15–19 others using different upper limits for birth weight20 or gestational age,21,22 or both23,24—common findings include lower cognitive scores*; learning difficulties and poorer school performance{dagger}; higher degrees of inattention, hyperactivity,6,10,12,17,20,25,26 and internalizing behavior2,9,12,20,23; and deficits in social skills,10,12,17 as compared with control subjects who were born at term. We and others showed that these differences extend into temperamental and personality characteristics, young adults with VLBW displaying fewer negative emotions and being more dutiful, cautious, and behaviorally inhibited11,13,22 than their peers who were born at term.

These differences may have a considerable effect on an individual's transition to adulthood. Key components of this transition include leaving the parental home, beginning sexual activity, and starting a family. These choices have enduring ramifications for adult health and quality of life.27–30 In VLBW adults, these choices have gained little attention, and existing data are inconclusive. Whereas Hack et al1 found VLBW women aged 20 years to be considerably less likely to have experienced sexual intercourse or pregnancy or given birth than their counterparts who were born at term, Saigal et al19 found no difference between ELBW adults aged 22 to 25 years and control subjects in leaving the parental home, cohabiting/marrying, or being a parent, except that a higher proportion of VLBW men were living with their parents. Cooke3 showed that 19- to 22-year-old VLBW survivors were more likely to reside in the parental home but observed no difference in sexual activity. With this background, we studied whether VLBW adults who were free of any major impairment differed from their term-born counterparts in key aspects and timing of their transition to adulthood: leaving the parental home, sexual activity, and starting a family.


   METHODS
TOP
 ABSTRACT
 METHODS
RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 
Study Participants
The original study cohort consisted of 335 consecutive VLBW infants who were born between January 1978 and December 1985 and were discharged alive (29.3% of the 474 VLBW infants who were admitted to the NICU during that period died before discharge) from the NICU of Children's Hospital at Helsinki University Central Hospital, the only tertiary neonatal care center in the province of Uusimaa, Finland. We selected a comparison group from the charts of all consecutive births at their birth hospitals. For each VLBW survivor, we selected the next available singleton term infant (gestational age ≥37 weeks) who was of the same gender and was not small for gestational age (birth weight more than –2 SD).31

Details of the subject recruitment have been described.32 Briefly, we traced the subjects through the Population Register and invited the 255 VLBW individuals and 314 individuals who were born at term and were then residing in the greater Helsinki area to a clinical examination32 that included completing a detailed questionnaire that covered medical history, education, current and previous family structure, and close relationships. A total of 185 (72.5%) VLBW individuals and 190 (60.5%) individuals who were born at term completed the questionnaire; of these, 166 and 172, respectively, did so in conjunction with the clinical examination, and the remaining 19 and 18 returned the questionnaire by mail. Because our focus in this study was on healthy adults, we excluded 25 individuals who reported a diagnosis of cerebral palsy (n = 18), blindness (n = 3), developmental delay (n = 5; 1 of whom had cerebral palsy and 1 of whom was blind), or severe hearing deficit (n = 1), leaving 162 VLBW individuals and 188 comparison individuals who were born at term for analysis. As compared with the remaining VLBW and term members of the original cohort, those included in the analysis had similar birth weight, birth weight SD score (SDS), and gestational age at birth (all P > .07). Individuals who were included in the analysis were, however, more likely to be women (P = .003).

Perinatal, Neonatal, and Current Data
We obtained perinatal and neonatal data from hospital charts. Birth weight SDS was calculated on the basis of Finnish standards.31 Standard criteria defined preeclampsia.33

Study Outcomes and Covariates
The 3 main outcome measures of the study were leaving the parental home, cohabiting with an intimate partner (including marriage and cohabitation outside marriage), and experiencing sexual intercourse. As secondary outcomes, we considered the individual's lifetime-to-date number of sex partners, the individual's perception of her or his own sexual attractiveness, and preferred number of children and ideal age at having the first child. These were assessed by a detailed structured questionnaire, which also included questions about current pregnancy and current number of children. Leaving the parental home and cohabiting/marriage were assessed by asking whether the individual had left home, and this served as a dichotomous variable in logistic regression analysis. Data as to whether the individual had lived (1) alone or with a roommate and (2) with an intimate partner or a spouse and during which years allowed calculation of age at leaving home or starting cohabitation, which were used in Cox regression as described in "Data analysis." Similar variables for sexual history were obtained by asking the age at first sexual intercourse and the lifetime number of sex partners (how many people with whom the individual has had sexual intercourse, the choices being 0, 1, 2, 3 or 4, or ≥5). Each individual also evaluated on a visual analog scale (scored from 0 to 100) how sexually attractive she or he considered herself or himself.

As potential confounding or mediating factors, we considered family factors (parental education, parents' ages at the individual's birth, maternal smoking during pregnancy, number of siblings, parental divorce/death), and participant characteristics (academic performance, height, and timing of puberty). Parental education was defined as the highest level of education achieved by either parent. For 3 participants, father's date of birth was unknown, and the median was substituted in the analyses. Maternal smoking data came from hospital charts. The questionnaire included questions about possible parental divorce or death during the time the participant was living at home and numbers and birth dates of siblings. It also included a question about age at menarche in women and age at voice break in men, which we used as proxies of pubertal development, and the grade point average for all school subjects on finishing comprehensive school (at 15–16 years; the end of compulsory education in Finland), a proxy of academic performance. We did not consider other data to be valid indicators of educational attainment in these young adults, a large proportion of whom were currently students, were having a year off, or were applying for additional education. Participants' heights and weights were measured at the clinical examination,32 or, for the 37 participants who did not attend the examination, they came from the questionnaire.

Data Analysis
We used linear regression for continuous and logistic regression for binary outcome variables. As a set of outcomes, we studied ages at which an event first occurred (leaving home, moving in together with an intimate partner, first sexual intercourse). Because these events had not occurred for all participants, we used Cox regression and coded as survival time the age at the event or, if the event had not occurred (censored cases), age at examination. The proportionality assumption of the Cox model was confirmed by models that included VLBW status and a time-varying indicator variable (determining whether the hazard ratio [HR] between VLBW and term-born adults was the same at different ages), none of which was statistically significant (P > .08). We present the data as unstandardized regression coefficients, odds ratios (ORs), or HRs, with 95% confidence intervals (CIs). All linear and logistic regression models were adjusted for age at examination. We performed additional adjustments for a set of covariates (parental education, parents' ages, maternal smoking during pregnancy, number of siblings, and parental divorce/death) and additional adjustments for school grades, timing of puberty, and current height and BMI. Because the study outcomes may have different implications for women and men, we report the data separately by gender unless otherwise stated.

Ethics
The study protocol was approved by the ethics committee for Children's and Adolescents' Diseases and Psychiatry of the Helsinki and Uusimaa Hospital District. Each participant signed an informed consent.


   RESULTS
TOP
 ABSTRACT
 METHODS
 RESULTS
DISCUSSION
 CONCLUSIONS
 REFERENCES
 
Participant Characteristics
In the VLBW and term comparison groups, respective birth weights ranged from 600 to 1500 g and from 2560 to 4930 g; gestational ages from 24.1 to 35.7 weeks and 37.0 to 42.9 weeks; and birth weight SDSs from –5.08 to 1.92 SD and –1.98 to 3.36 SD. Of the VLBW participants, 88.9% were born before 32 and 24.7% before 28 weeks of gestation; 26.5% had ELBW (<1000 g), and 30.9% were born small for gestational age (SGA) (less than –2 SD). At examination, the age of the participants ranged from 18.5 to 27.1 year (Table 1). Potential confounding factors and other covariates used in the analyses are also shown in Table 1 and their relationships in Table 4, which is published as supporting information on www.pediatrics.org/content/full/122/1/e62. Between young adults with VLBW and those born at term, parents' ages, number of siblings, frequency of parental divorce/death and maternal smoking during pregnancy, and timing of puberty were similar. VLBW adults were, however, more likely to come from families with a lower parental education, had lower school grades, and were shorter as adults. Comparisons of the VLBW and term participants' status at examination (living in the parental home, having ever been cohabiting/married, not having experienced sexual intercourse) in relation to data from published Finnish34,35 and US36–39 population surveys are shown in Table 2.


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  		TABLE 1 Characteristics of the Study Participants

 

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  		TABLE 4 Associations Between Covariates and Study Outcomes

 

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  		TABLE 2 Living Arrangements, Sexual Experience, and Preference of Having Own Children Among Young Adults With VLBW and Those Born at Term

 
Leaving the Parental Home
At examination, VLBW adults were 1.75-fold more likely still to live in the parental home (95% CI: 1.01–3.05; P = .05, adjusted for age and gender); but when analyzed for women and men separately, this association was statistically significant only for men (Table 2). We then analyzed the relationship between VLBW and age at leaving the parental home. Because not all participants had left home, we used Cox regression to calculate the HRs shown in Table 3, with corresponding survival plots in Fig 1. For both genders, VLBW was associated with a lower likelihood of leaving the parental home. Table 3 shows also that this association was little affected by adjustment for the covariates.


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  		TABLE 3 Cox Regression Models Showing HRs (95% CIs) for Leaving Parental Home, Starting Cohabiting With an Intimate Partner, and Having Sexual Intercourse

 

Figure 1
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  		FIGURE 1 Survival plots showing the likelihood of A, leaving the parental home, B, starting cohabitation (including marriage), and C, experiencing first sexual intercourse for young adults with VLBW and those who were born at term. Plots are curtailed at the age of latest event in the study population. HRs and adjustments for covariates are shown in Table 3.

 
Cohabiting
At examination, VLBW adults were less likely ever to have cohabited with an intimate partner or spouse (OR: 0.61 [95% CI: 0.37–1.00]; P = .05, adjusted for age and gender). Analyzed by gender, this difference was statistically significant only for women and only after adjustment for the covariates (Table 2). Table 3 and Fig 1 show that the HRs of the Cox regression, indicating the lower likelihood of VLBW adults to begin cohabiting, were similar for both genders, although the lower number of events make the CIs wider for men and thus the HRs statistically significant only for women.

VLBW women and men preferred, on average, a similar number of children as did those born at term. VLBW women preferred an earlier age at first childbirth than did women who were born at term (Table 2).

Sexual Experience
At examination, VLBW women were 2.21-fold (95% CI: 1.04–4.71; P = .04 adjusted for age) and VLBW men were 2.87-fold (95% CI: 1.26–6.51; P = .01) more likely not to have experienced sexual intercourse. These associations remained similar when adjusted for the other covariates but became stronger when additionally adjusted for school grades (women: OR: 3.98 [95% CI: 1.62–9.78; P = .003]; men: OR: 3.66 [95% CI: 1.41–9.46]; P = .008). For men, the associations were slightly weakened after additional adjustment for height (OR: 1.78 [95% CI: 0.69–4.55]; P = .2) or for timing of puberty (OR: 2.13 [95% CI: 0.85–5.32]; P = .1). Figure 1 and Table 3 show that VLBW women were more likely to be older at first sexual intercourse, association unaffected by adjustment for the covariates (Table 3). The HRs did not reach statistical significance for men, for whom they were also additionally attenuated after adjustment for current height and timing of puberty.

In comparison with their term-born counterparts, both VLBW women (P = .002 for trend, adjusted for age) and VLBW men (P = .02) reported a smaller lifetime-to-date number of sex partners (Fig 2). This association remained similar when adjusted for the other covariates, although in men it became nonsignificant after adjustment for height or for timing of puberty (both P = .1). The VLBW adults and those born at term gave, on average, a similar rating to their own sexual attractiveness (Table 2).


Figure 2
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  		FIGURE 2 Percentages of young adults with VLBW and those who were born at term in groups according to lifetime-to-date number of sex partners.

 
Associations With Perinatal Factors
We first assessed whether results for the 50 VLBW adults who were born SGA differed from those of the 121 VLBW adults who were born appropriate for gestational age (AGA). At examination, the VLBW SGA individuals were less likely to have left the parental home (OR: 3.08 [95% CI: 1.30–7.30]; P = .01), although this difference was no longer statistically significant when analyzed separately for women (OR: 2.58 [95% CI: 0.89–2.76]; P = .08) and men (OR: 4.42 [95% CI: 0.99–19.82]; P = .05). Moreover, VLBW SGA women were less likely to have begun cohabiting with an intimate partner than were their VLBW AGA counterparts (Cox regression HR: 0.38 [95% CI: 0.15–0.99]; P = .05). No differences emerged in age at leaving the parental home or at first sexual intercourse or in the number of sex partners, self-evaluated sexual attractiveness, or ideal number of children or age at having one's first child.

No difference existed in the outcomes between singleton VLBW individuals and the 27 VLBW individuals who were born from a multiple pregnancy. When we reanalyzed the data excluding these individuals from analysis, the results were little changed.


   DISCUSSION
TOP
 ABSTRACT
 METHODS
 RESULTS
 DISCUSSION
CONCLUSIONS
 REFERENCES
 
We found that during their late teens and early 20s, healthy people with VLBW were less likely to leave the parental home, start cohabiting, or experience sexual intercourse, as compared with their peers who were born at term. They also reported a smaller number of sex partners. These differences were independent of parental age and education, number of siblings, timing of puberty, or academic achievements as assessed by school grades.

The differences that we found were robust and have a significant potential impact on how VLBW adults attain their place as autonomous adult members of society. A slower tempo of leaving the parental home, starting cohabitation, and having sexual experience is likely to carry both benefits and disadvantages for health and quality of life. Remaining single is associated with more health problems and distress as one ages.28–30 Whether a larger proportion of VLBW adults actually remain single in later life remains to be elucidated. This possibility is supported by a study of late middle–aged men showing that those with lower birth weight and earlier gestational age at birth were more likely never to have married.40 The relationship between good health and cohabitation/marriage is, however, more controversial for people in their early 20s, with some studies even suggesting it to be associated with more distress.28,41 Cohabitation/marriage is preceded by romantic partnership(s) and in most cases sexual activity; however, at least in adolescence, romantic involvements raise the risk for subsequent depressive symptoms.42 A slower tempo in taking these steps could thus be protective.

Comparisons of the study outcomes with population studies should be interpreted with caution because of the different age intervals and definitions of outcomes among studies. Despite this limitation, our findings for individuals who were born at term are in line with Finnish population surveys and are also relatively similar to data from the United States. This indicates that the differences that we found between VLBW and term-born adults also stand up to comparison with population data.

Whether the individual has left home, started cohabiting, or experienced sexual intercourse at the time of the study is only one part of the outcome; the timing of these actions is another. To incorporate these 2 into the same analysis, we used Cox regression, a powerful method to study differences in time-to-event variables of events that have not yet occurred for all individuals, especially if the individuals represent a wide age range. That the proportional hazards assumption of this analysis was met suggests that no age threshold exists for the time-to-event outcomes; in other words, for the VLBW individuals, the lower likelihood of these events holds to a similar degree throughout their late teens and early 20s.

Our finding of a lower likelihood of leaving the parental home is consistent with findings from Liverpool, England, that VLBW adults at ages 19 to 22 were 2.52-fold (95% CI: 1.10–3.57) more likely to live with their parents than were those who were born at term.3 Neither cohabitation nor marriage was specifically assessed in those relatively young individuals. A different result, however, emerged for 22- to 25-year-old ELBW individuals of the Canadian McMaster cohort. Although ELBW men were more likely to be living with their parents when interviewed, no such difference appeared for women. Moreover, a similar proportion of ELBW and normal birth weight individuals were cohabiting or married, and among individuals who had left home or were cohabiting or married, there existed no difference in the age of attaining these events.19 It is difficult to find any convincing reason for this difference. Although the proportion of 2-parent families was lower in our study (66.7% vs 82%), our results remained similar when adjusted for parental divorce/death. The level of parental education was comparable in these cohorts, and both Finnish and Canadian residents have universal access to comprehensive health care. A technical comment may be worthwhile, however: We used Cox regression, which incorporates current living status and age at attaining that status into the same analysis and thus may be more sensitive in detecting differences than assessing these variables separately.

We are aware of 2 studies that assessed sexual behavior in VLBW adults. Hack et al1 reported that VLBW women in the Cleveland cohort were less likely to have had sexual intercourse than were women born at term. In contrast, Cooke et al3 reported no difference in sexual experience or intimate relationships for either gender, although that study was smaller, with individuals on the average younger (19–22 years). We found that VLBW women and men were less likely to have experienced sexual intercourse and reported a smaller number of sex partners than did their term-born peers. They were older at the first sexual intercourse, as indicated by the lower HRs in the Cox regression. To our knowledge, this has not been shown before. Although the HRs were not formally statistically significant for men, they were of a similar magnitude as those for women, and a true gender difference seems unlikely. An exception is that for men, the results were considerably attenuated when the VLBW men's shorter height was allowed for; this was not seen for women.

The differences that we found are likely to stem from behavioral characteristics that are more common in adults with VLBW. From an evolutionary perspective, links between prenatal and immediate postnatal events with adult behavior are prevalent across species and involve an array of pathways, including programming of function of the hypothalamic-pituitary-adrenal axis and key neurotransmitter systems. These pathways may be triggered by biochemical cues, such as maternal regulation of the steroid environment—or absence thereof—after preterm delivery or by psychological signals, for example differences in parenting practices or parental psychopathology. The driving force behind such mechanisms has been suggested to be evolutionary pressure to fine-tune reproductive behavior according to prevailing environmental conditions.43,44 Indeed, temperamental and personality characteristics that we and others have shown to be characteristic of VLBW adults include a lower degree of behavioral approach,11 of openness to experience,13 and of extraversion,13,22 as well as a higher degree of conscientiousness and agreeableness.13 These characteristics suggest cautiousness in interpersonal relationships and in gaining autonomy. Low extraversion and high conscientiousness and agreeableness have also been consistently associated with less sexual promiscuity.45 In addition, studies have reported lower degrees of risk-taking behaviors such as excessive use of alcohol and recreational drugs in VLBW adults.1–3,14,46 Casual sex may be considered a risk-taking behavior, and it more likely occurs after excessive use of alcohol.47

Most of the characteristics that we found in VLBW adults were present to a similar degree in those who were born SGA as in those who were born AGA, consistent with most of our previous findings on personality and temperament in VLBW adults.11,13 An exception was the SGA VLBW adults' lower likelihood of leaving the parental home and (for women) starting cohabiting, which parallels our recent findings of a higher degree of depressive48 and attention-deficit/hyperactivity disorder46 symptoms in VLBW adults who were born SGA, as compared with those who were born VLBW AGA or at term. Most SGA VLBW infants are born by cesarean section, indicated by a condition that threatens the fetus or the mother, such as preeclampsia and/or placental insufficiency. The SGA-specific findings in VLBW adults may reflect consequences of mechanisms related to these conditions, such as hypoxia or glucocorticoid excess,49 whereas findings common to VLBW SGA and VLBW AGA adults may reflect conditions experienced after birth by both groups, including inadequate nutrition during the immediate postnatal period and differences in parenting later in childhood.

Physical characteristics are important contributors to sexual attractiveness and activity.50,51 Adults who were born small preterm are shorter2,3,5,32 and less muscular4,5,32 than are their peers who were born at term. That for men the effect of VLBW birth on first sexual intercourse and the number of sex partners is attenuated by adjustment for height is consistent with women's preference for dating taller men50 and suggests that the shorter height of VLBW men may affect their sexual behavior or success; however, how adults who were born preterm evaluate their own attractiveness varies across studies. Consistent with a report on ELBW adolescents,52 we found no effect of VLBW on self-evaluated sexual attractiveness or romantic appeal for either gender. In contrast, 19- to 22-year-old VLBW adults of the Liverpool cohort3 rated themselves as less attractive than those who were born at term; VLBW women also wished to be taller than they were. Although variation in ages and subtle cultural preferences may explain these dissimilarities, it is likely that differences in physical appearance contribute to differences in sexual behavior and perhaps in success in the partner selection market.

Although our original cohort comprised the whole of the population of VLBW infants in the area who were discharged alive after neonatal intensive care, our participants may not be representative of the original cohort. Our participation rate, however, is similar to or higher than for most1–3,9,12,14,20,22,53–56 although not all4,19 clinical or questionnaire follow-up studies of preterm adults. Moreover, our results are based on internal comparisons within the study sample, and nonparticipation would introduce bias only if the effect of VLBW on adult outcomes differed for nonparticipants. This seems unlikely but cannot be excluded. Self-reporting may be prone to bias, but, again, this would affect the results only if it differed between the groups compared. VLBW adults have been suggested to tend to give answers that seem more socially acceptable,22 and it is also possible that men and women may answer differently in particular to questions related to sexual behavior. The study cohort had too few of their own children yet to allow meaningful comparisons of their numbers, and we were unable to test a previous finding of a lower number of children produced by women with VLBW.1


   CONCLUSIONS
TOP
 ABSTRACT
 METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
REFERENCES
 
We found that, compared with their peers who were born at term, healthy young adults with VLBW were slower to leave the parental home, start cohabiting, and have sexual intercourse, and they also reported a smaller number of sex partners. This finding was not explained by socioeconomic status, family structure, or school achievement, although shorter height may limit VLBW men's sexual activity. Although none of these findings is beneficial or disadvantageous per se, together they may have a profound impact on how VLBW individuals attain their place as adult members of society.


   ACKNOWLEDGMENTS
 
This study was supported by grants from the Academy of Finland, the Biomedicum Helsinki Foundation, the Children's Castle Foundation, the Finnish Foundation for Pediatric Research, the Finnish Diabetes Foundation, Finnish Medical Societies (Duodecim and Finska Läkaresällskapet), the Juho Vainio Foundation, the National Graduate School of Clinical Investigation, the Novo Nordisk Foundation, the Päivikki and Sakari Sohlberg Foundation, the Perklén Foundation, the Research Foundation of Orion Corporation, the Signe and Ane Gyllenberg Foundation, University of Helsinki, the Yrjö Jahnsson Foundation, and the Wilhelm and Else Stockmann Foundation


   FOOTNOTES
 
Accepted Feb 14, 2008.

Address correspondence to Eero Kajantie, MD, PhD, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. E-mail: eero.kajantie{at}helsinki.fi

The authors have indicated they have no financial relationships relevant to this article to disclose.

* Refs 1, 2, 5, 6, 15, 18, 20, 23, 25, and 26. Back

{dagger} Refs 1, 2, 7, 8, 12, 15, 16, 18, 21, and 23. Back


What's Known on This Subject

Most children and adults who are born very preterm live healthy lives. On average, however, they have lower cognitive scores, more internalizing behaviors, and more deficits in social skills than their peers who were born at term.

 

What This Study Adds

Healthy young adults with very low birth weight show a delay in leaving the parental home and starting sexual activity and partnerships. This may have a profound impact on how they attain their place as adult members of society.

 


   REFERENCES
TOP
 ABSTRACT
 METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 

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