What Happens When Babies Born Very Early Grow Up? A 34-Year Look at Work, Money, Friendships and Happiness

Adults from the Bavarian Longitudinal Study at age 34 (Gönen et al., JAMA Pediatrics 2026)

A large German study that followed people from birth to age 34 found that most adults who were born very early or very small are doing well in life, with good relationships and financial independence. About one in five of the very-early-born group, however, faced lasting money and social difficulties and felt less satisfied with life. Children's thinking and learning abilities at age 8 were the clearest early clue to who was in that group.

Every parent of a baby born very early wonders what the future holds. In the NICU, the questions are about breathing, feeding and going home. Later, they become questions about school and friends, and eventually about whether their child will grow up to live independently, hold a job, build relationships and be happy. This article explains new research that begins to answer that last question.

Why this question has been so hard to answer

Doctors have known for a long time that babies born very early, before 32 weeks of pregnancy, or very small, under about 3 pounds 5 ounces (1,500 grams), can face extra challenges as children. Research has shown that, on average, children born this early score lower on thinking tests [1], and a recent review examined how these outcomes have changed over time [2]. Over time, researchers began following these children into adulthood. They looked at things like friendships and social life [3], romantic relationships [4], income and education [5] and adult intelligence [6].

Twenty or thirty years ago, families had almost no information about adulthood. Even now, most studies report average differences between groups, which can hide a more important truth: not everyone ends up the same. Some very preterm adults do wonderfully, and others struggle. Families and doctors want to know how common each outcome is, and what can be done in childhood to help. The study described here [7] set out to answer exactly this.

A note on words: "very preterm" means born before 32 weeks of pregnancy, and "very low birth weight" means weighing under 1,500 grams at birth. Researchers often group these babies together because so many babies are both. The study compared them with babies born at full term, which helps show what is due to early birth and what is simply part of growing up in a particular place and time.

How the study worked

The study is called the Bavarian Longitudinal Study, and it has followed a group of babies born in southern Germany between January 1985 and March 1986 [7]. The research team had also described the children's thinking skills at age 6 [8]. Some were born very early or very small, and others were born at full term as a comparison group. When the participants were 6 and 8 years old, researchers measured things such as intelligence, self-control, how parents interacted with them, friendships and family life. At age 34, 416 of them, including 214 who had been born very early or very small, were interviewed at length [7]. That is roughly 58 out of every 100 people the researchers hoped to reach.

The interview asked about five areas of adult life: avoiding risky behaviour, money and financial independence, and relationships with parents, romantic partners and friends. Participants also answered questions about how satisfied they were with their lives overall. A computer method then sorted people into groups with similar life patterns, without the researchers deciding the groups in advance. The study followed accepted rules for reporting this kind of research [9].

What the researchers found

The computer method found three groups, or profiles [7].

The first group, called "optimal functioning", made up 63 out of every 100 adults in the study. These adults had average to above-average scores in all five areas. Among those born very early or very small, a little over half (56 out of every 100) were in this group. So the largest single group of very preterm adults was in the best-functioning profile.

The second group, "moderate functioning", made up 26 out of every 100 adults, and also 26 out of every 100 of the very-early-born adults. People in this group had lower scores in risk avoidance and money, and especially in romantic relationships.

The third group, "low economic and social functioning", was the smallest: 12 out of every 100 adults overall. But it included 18 out of every 100 of the very-early-born adults, compared with only 1.5 out of every 100 of those born at full term. These adults had the lowest scores for money, partner relationships and friendships. Interestingly, they scored above average in their relationships with their parents and in avoiding risky behaviour. Nine out of every ten people in this group (39 of 42) had been born very early or very small.

Importantly, how people scored on the life measures matched how they said they felt. On a happiness-with-life scale that runs from 5 to 35, adults in the moderate group scored about 3 points lower than those in the best group, and adults in the third group scored about 8 points lower [7]. The differences in outcomes were real and were felt by the people living them.

What in childhood predicted these paths?

The researchers looked back at childhood information for clues. They examined being born very early, sex, self-control, intelligence at age 8, parenting, friendships, family income and education, the family atmosphere, and how well the parents got along. When they considered everything together, one factor stood out: intelligence test scores at age 8 [7]. Each 15-point higher score (a standard step on such tests) was linked to about 79% lower odds of ending up in the third group rather than the best group.

It helps to know what this does not mean. An intelligence test score at 8 is not a fixed destiny, and this was an observational study, so it cannot prove that raising a child's scores will change how their adult life turns out. Being born very early was also linked to the third group, but after accounting for the many comparisons tested, the link was no longer strong enough to be sure of. Family income and education at birth did not predict the adult pattern, which was a surprise. And nothing the researchers measured in childhood explained who ended up in the middle group, so some difficulties, such as those in romantic relationships, cannot yet be predicted.

Other kinds of research offer encouraging leads. For example, this platform has reported on a programme in which parents gave extra touch and sensory experiences in the NICU, followed by a cognitive advantage at early school age, described here. Another In[Neo]Sight article describes how anxiety and mood difficulties rise from childhood to age twenty in both very preterm and full-term people, discussed here.

What this means for your family

If your baby was born very early, this study offers real hope. Most adults born very early or very small in the study were in the best-functioning group, and that group reported the highest satisfaction with life. Being born early is a risk factor, not a verdict.

The study also gives families a practical message: support for learning and thinking skills matters. Ask your child's follow-up team about developmental checks, and if a school or therapy service is recommended, try to make sure your child receives it. Noticing and supporting learning needs early, and continuing that support through the school years, is something families and professionals can act on together. Because the authors also found that money and relationships were the areas most affected, teenagers and young adults may benefit from help with planning for independence, managing money and building friendships.

Try to keep the numbers in perspective. These adults were born in the mid-1980s, before many of the advances that today's NICUs offer, and it is not known whether outcomes for babies born now will look the same. Only about 6 in 10 of the people the researchers invited took part, and those who could not be reached had, on average, been smaller at birth and had more health problems, so the picture may be somewhat rosier than the true one [7]. The version of the paper used for this article was an accepted manuscript, so a few details may differ in the final print version. The authors themselves note that thinking-skill outcomes in children born very early have not improved over the last four decades, so families should not assume that newer care has closed the gap; the wider link between newborn care and later development has been reviewed elsewhere [10].

What researchers are working on next

The authors call for repeating the study in more recent groups of babies and other regions, and note that other early influences, such as nutrition around birth, specific social-thinking skills and how children adjust to school, may be worth studying. They also want to understand why some adults have difficulties in romantic relationships that nothing in childhood explained. In our view, perhaps most important is testing whether programmes that support thinking and learning in childhood truly lead to better adult lives. Studies of self-control in childhood, which is known to predict later outcomes in the general population [11], may also help.

Conclusion

Growing up after a very early birth can lead to many different adult lives. In this careful 34-year study, most adults were doing well, a smaller group had lasting struggles with money and relationships and felt less satisfied, and how well a child could think and learn at age 8 was the clearest early sign of who was in that group [7]. Knowing this gives families and clinicians something concrete to act on: to celebrate the many good outcomes, and to support learning early and consistently.

References

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