This longitudinal cohort study followed VP/VLBW adults (born <32 weeks or <1500 g) and term-born controls from Bavaria, Germany (born 1985–1986) to age 34, examining whether childhood person, process, and context factors predicted distinct positive functioning profiles across wealth, risk avoidance, and social relationships.
Three functioning profiles emerged at age 34: optimal (63% overall; 56% of VP/VLBW), moderate (26%; low partner scores), and low economic/social functioning (12%; 18% of VP/VLBW). Life satisfaction was markedly higher in the optimal vs. low-functioning group (mean difference = 7.71; 95% CI, 5.17–10.24; d = 1.46). Each 1-SD increase in childhood IQ (at age 8) was associated with 79% lower odds of low vs. optimal functioning (OR = 0.21; 95% CI, 0.13–0.34).
- ~42% of the original 715 eligible adults were not assessed at age 34, raising potential attrition bias. - Sample restricted to one geographic region (Bavaria, Germany), limiting generalizability. - IQ and other childhood factors were measured at a single time point (age 6–8), which may not capture developmental trajectories.
A meaningful subgroup (~18%) of VP/VLBW adults shows poor economic and social functioning by their mid-30s. Interventions that support cognitive development in early childhood may be a key lever for improving long-term life outcomes in this population.
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