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    2 Comments for this article
    Improving neonatal discharge practice
    Edward Schor |
    The study by Mendonça and colleagues found generally consistent evidence of creating social relationships among adults who had been born prematurely or of low birth weight. The authors noted that their findings were consistent with the growing understanding of the impact of early life experiences on adult outcomes. Early life experiences are determined by children’s families which either create those experiences or filter those emanating from outside the family. Interesting, two of those same authors failed to identify differences in parenting of preterm and full term children. However, that study found no differences in mothers’ behavior toward their children regardless of pregnancy duration.
    What then accounts for lower levels of social skills among preterm children? Assuming that their parents’ childrearing did not differ from that experienced by other children, an assumption challenged by a variety of other studies, perhaps preterm children, more often raised in smaller family units, had fewer opportunities to develop social skills. Some parents of higher risk children become overprotective which might take the form of fewer social encounters and opportunities to develop self-confidence. Even though social skills development is a lifelong process with learning opportunities at every age , basic patterns of social-emotional relationships develop early and a weak foundation can modify the ability to learn from subsequent experiences.
    One take-away from this study is that the discharge process for high risk neonates as well as their follow-up care should include a discussion of the special need for these children to have adequate social learning opportunities.
    Perinatal Baseline Homeostasis and Innate Temperament
    Paul Nelson, M.D., M.S. | Family Health Care, P.C.
    The origins for a person's baseline homeostasis at birth is largely based on the maternal cytoplasm contributed by the person's originating ovum, aka epigenetic inheritance. Its complexity is demonstrated by the occurrence of multigenerational epigenetic lineage. Is it possible that the character of synergy between a person's baseline homeostasis and innate temperament forms near the end of a term pregnancy? And if so, does this late gestational modulation contribute to a person's developmental resilience during the first 2 years of life, thereafter expressed during a person's lifetime? The 7:1 return on investment from early childhood learning would corroborate this line of analysis, especially children born into a family with minimal caring relationships.

    Here is my expansion of Carl Rogers defining attributes of a caring relationship: "a variably asymmetric social interaction occurring between two persons that begins with a beneficent goal to enhance each other's autonomy AND flourishes from a timely obligation to communicate, in harmony, with warmth, acceptance, honesty, and empathy." A high standard to be sure, but anything less for an infant or the infant's mother is unacceptable.

    The origins of innate temperament is another matter. We are unlikely to unlock the occurrence of entrenched poverty without a better understanding of its origins.
    Original Investigation
    July 12, 2019

    Association of Preterm Birth and Low Birth Weight With Romantic Partnership, Sexual Intercourse, and Parenthood in Adulthood: A Systematic Review and Meta-analysis

    Author Affiliations
    • 1Department of Psychology, University of Warwick, Coventry, United Kingdom
    • 2Psychologische Hochschule Berlin, Berlin, Germany
    • 3Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
    JAMA Netw Open. 2019;2(7):e196961. doi:10.1001/jamanetworkopen.2019.6961
    Key Points español 中文 (chinese)

    Question  Are adults who were born preterm or with low birth weight less likely to experience social transitions normative of adulthood, such as romantic partnerships, sexual intercourse, or parenthood?

    Findings  In this systematic review and meta-analysis of 21 studies describing up to 4.4 million participants, adults who were born preterm or with low birth weight were less likely to experience a romantic partnership, sexual intercourse, or parenthood than their peers who were born full-term. The likelihood of experiencing these social transitions decreased with lower gestational age and birth weight, and was similar in both young and middle adulthood.

    Meaning  The findings suggest that adults who were born preterm or with low birth weight are less likely to have sexual or partner relationships than adults born full-term, which might put them at increased risk of decreased well-being and poorer physical and mental health.


    Importance  Social relationships are important determinants of well-being, health, and quality of life. There are conflicting findings regarding the association between preterm birth or low birth weight and experiences of social relationships in adulthood.

    Objective  To systematically investigate the association between preterm birth or low birth weight and social outcomes in adulthood.

    Data Sources  PubMed, PsycINFO, Web of Science, and Embase were searched for peer-reviewed articles published through August 5, 2018.

    Study Selection  Prospective longitudinal and registry studies reporting on selected social outcomes in adults who were born preterm or with low birth weight (mean sample age ≥18 years) compared with control individuals born at term.

    Data Extraction and Synthesis  The meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The data were collected and extracted by 2 independent reviewers. Pooled analyses were based on odds ratios (ORs) with 95% confidence intervals and Hedges g, which were meta-analyzed using random-effects models.

    Main Outcomes and Measures  Ever being in a romantic partnership, ever having experienced sexual intercourse, parenthood, quality of romantic relationship, and peer social support.

    Results  Twenty-one studies were included of the 1829 articles screened. Summary data describing a maximum of 4 423 798 adult participants (179 724 preterm or low birth weight) were analyzed. Adults born preterm or with low birth weight were less likely to have ever experienced a romantic partnership (OR, 0.72; 95% CI, 0.64-0.81), to have had sexual intercourse (OR, 0.43; 95% CI, 0.31-0.61), or to have become parents (OR, 0.77; 95% CI, 0.65-0.91) than adults born full-term. A dose-response association according to degree of prematurity was found for romantic partnership and parenthood. Overall, effect sizes did not differ with age and sex. When adults born preterm or with low birth weight were in a romantic partnership or had friends, the quality of these relationships was not poorer compared with adults born full-term.

    Conclusions and Relevance  These findings suggest that adults born preterm or with low birth weight are less likely to experience a romantic partnership, sexual intercourse, or to become parents. However, preterm birth or low birth weight does not seem to impair the quality of relationships with partners and friends. Lack of sexual or partner relationships might increase the risk of decreased well-being and poorer physical and mental health.