The Preterm Birth-COVID Connection: What the Data Shows

A study funded by the National Institutes of Health (NIH) and published in the Proceedings of the National Academy of Sciences provides critical insights into this population. Researchers analyzed California hospital birth records from 2014 to 2023, focusing on siblings to control for socioeconomic and genetic factors. Their findings highlight two key trends:

• Increased Preterm Birth Risk: Maternal COVID-19 infection during the third trimester raised the likelihood of preterm birth from 7.1% to 8.3% between July 2020 and February 2023. The risk was highest in 2020, with a 5.4% spike in preterm births during the July-November wave of infections.
• Vaccination’s Protective Role: By late 2022, the risk of COVID-related preterm birth largely dissipated, partly due to widespread vaccination. This aligns with broader evidence that COVID-19 vaccines are safe and effective during pregnancy.

These findings underscore the dual burden faced by preterm-born adolescents: their early arrival into the world already predisposed them to health challenges, and the pandemic amplified these vulnerabilities.

Healthcare Utilization: Why Preterm Adolescents Sought More Care

A separate study from the Environmental Influences on Child Health Outcomes (ECHO) Program sheds light on how preterm-born children and adolescents interacted with healthcare systems during the pandemic. The research, which focused on individuals born at or before 37 weeks’ gestation, revealed striking patterns:

• Adolescents born preterm were more likely to seek care for COVID-19 symptoms compared to their full-term peers.
• Those born extremely preterm (28 weeks or earlier) were twice as likely to request in-person or telehealth evaluations.
• Interestingly, these differences weren’t explained by pre-existing conditions like asthma or chronic lung disease, suggesting other factors—such as heightened health awareness or parental concern—played a role.

Dr. Elisabeth McGowan, one of the study’s authors, noted that these findings highlight the need for targeted healthcare strategies during public health crises. “Understanding how preterm-born individuals engage with healthcare can aid providers tailor support during future pandemics,” she explained.

Health Perceptions: A Lifetime of Vigilance

For adolescents born preterm, the pandemic wasn’t just a temporary disruption—it reinforced a lifetime of health vigilance. Many in this group already navigate conditions like:

• Respiratory challenges (e.g., asthma, bronchopulmonary dysplasia)
• Neurodevelopmental differences (e.g., ADHD, learning disabilities)
• Increased susceptibility to infections

The pandemic amplified these concerns. A study published in JAMA Network Open found that preterm-born individuals were more likely to report COVID-19 symptoms and seek medical attention, even when their overall appointment attendance rates matched those of full-term peers. This suggests a proactive approach to health management, likely shaped by early-life experiences.

“Preterm birth isn’t just a neonatal event—it’s a lifelong journey. The pandemic reminded us that these individuals and their families often develop a heightened awareness of health risks, which can be both a strength and a source of anxiety.”

Key Takeaways for Parents and Providers

• Preterm-born adolescents may need extra support during public health crises. Their increased healthcare utilization during COVID-19 reflects both biological vulnerabilities and learned health behaviors.
• Vaccination matters. Maternal COVID-19 vaccination not only protects pregnant individuals but also reduces the risk of preterm birth, offering long-term benefits for the child.
• Health perceptions are shaped early. Adolescents born preterm often develop a proactive approach to health, which can be leveraged to promote positive behaviors but may also require emotional support.
• Telehealth is a valuable tool. The pandemic demonstrated that preterm-born individuals and their families are open to virtual care, which can improve access to specialized services.

Looking Ahead: Lessons for Future Health Crises

The COVID-19 pandemic offered a unique lens through which to view the long-term impacts of preterm birth. As healthcare systems prepare for future public health challenges, several strategies can help support this vulnerable population:

1. Targeted Communication: Provide clear, accessible information about health risks and preventive measures tailored to preterm-born individuals and their families.
2. Mental Health Support: Address the anxiety and stress that may accompany heightened health vigilance, particularly during crises.
3. Care Coordination: Ensure seamless transitions between pediatric and adult care, as well as access to specialists familiar with preterm-related health challenges.
4. Research Priorities: Continue studying the long-term effects of preterm birth, including how early-life experiences shape health behaviors and outcomes in adolescence and adulthood.