Preterm Birth Does Not Affect Self-Esteem in Adolescence

A full-term pregnancy lasts approximately 40 weeks, but some babies arrive sooner. Premature or preterm birth is when a baby is born before 37 weeks of pregnancy. Every year worldwide, more than 1 in 10 babies are born preterm, influencing families all around the world.

Most preterm babies are born just a few weeks early. However, some are born and survive as early as 23 weeks, which is just over halfway through a full-term pregnancy.

After birth, babies born full-term would go to a normal maternity ward with their mother and would be discharged home within a few days. In contrast, preterm babies, particularly those born very preterm (i.e., born before 32 weeks of pregnancy), are likely to stay in a neonatal intensive care unit (NICU) for several weeks or months.

Thus, some preterm babies make a very different start to life than full-term babies.

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Long-term effects of preterm birth

Preterm babies, particularly very preterm babies, are born before their brain and other organs develop fully, which puts them at risk of physical health problems and cognitive impairments (Twilhaar et al., 2018).

In addition to these problems, it was described that preterm-born children show a "behavioral phenotype," which includes an increased risk of attention and emotional problems but a decreased risk of aggressive or delinquent behaviors (Johnson & Wolke, 2013).

In addition, very preterm-born children are more likely to be socially withdrawn and less likely to engage in risk-taking behavior. Relatedly, they are more likely to have difficulties in social relationships, such as peer relationships (Ritchie, Bora, & Woodward, 2015). The earlier a baby is born, the higher the risk of having these difficulties.

Is it all bad news?

Looking at these findings could be quite alarming for parents; however, they do not mean that all preterm-born babies will develop problems. These findings only show an overall increased risk, but the actual risk differs from one individual to the other. Many preterm-born children live their lives without showing any of these problems.

For example, it was shown that when preterm-born adolescents have peer relationships, the quality of those relationships is as good as the quality of the relationships of full-term-born adolescents (Sullivan, Barcelos Winchester, Parker, & Marks, 2012).

Moreover, it is important to realize that an increased risk for cognitive or emotional difficulties does not necessarily impact someone’s happiness and well-being. That is why it is important to consider how preterm individuals feel about themselves and their lives.

Does preterm birth also influence self-esteem and well-being?

Young people tend to be particularly vulnerable to having low self-esteem and well-being during adolescence when there are biological, social, and emotional changes. Given the risks associated with preterm birth, one might expect to see that the self-esteem and well-being of preterm-born adolescents are particularly lower compared to full-term-born adolescents. However, there has been a limited focus on this so far.

In a recent study (Bilgin et al., 2021), we used information from around 14,000 people born in the UK, Germany, and Switzerland, who were tracked into adolescence. We showed that adolescents born preterm report similar levels of self-esteem and overall well-being to those born full-term.

This finding is quite encouraging and means that preterm-born adolescents are happy about themselves and their lives in general.

In addition to the overall well-being, we were interested in looking into well-being in different aspects of the lives of preterm-born adolescents, such as well-being in their relationship with their parents and peers, well-being in the school environment, and well-being about their physical appearance.

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We found that adolescents born preterm report similar levels of well-being to those born full-term regarding their relationships with the family, school environment, and physical appearance.

The only exception was the very preterm group (i.e., born before 32 weeks of pregnancy), who reported low well-being in their peer relationships. This could be due to their withdrawn personality. Thus, it is important for caregivers and teachers of very preterm-born children to be aware of this and support them in making friends and being integrated into their peer groups.

While it is important to be aware of the risks of health, behavioral, and social relationship problems linked with preterm birth, it is equally important to acknowledge the resilience of preterm-born individuals, most of whom live happy and productive lives and feel good about their self-worth.