The Hidden Impact of Preterm Birth: Why Every Week Matters

In 2022 alone, nearly 46,000 babies were born before 37 weeks of pregnancy in England – accounting for 7.9% of all births. Behind these statistics lie profound implications for children's health, development, and life outcomes that can persist well into adulthood.

Understanding Preterm Birth

Preterm birth is defined as any birth occurring before 37 weeks of pregnancy. Medical professionals categorise these births into three groups: extremely preterm (less than 28 weeks), very preterm (28 to less than 32 weeks), and moderate to late preterm (32 to 36 weeks). While most people think of pregnancy as lasting nine months, those final weeks are critical for a baby's development.

The causes of preterm birth are complex and multifaceted. Some births occur spontaneously, with labour beginning unexpectedly. Others are medically initiated when continuing the pregnancy would pose risks to the mother or baby – for instance, in cases of pre-eclampsia or when the baby isn't growing properly. What makes prevention challenging is that many women who give birth preterm have no apparent risk factors. The biological mechanisms that trigger early labour remain poorly understood, despite decades of research.

The Immediate and Long-term Consequences

The impacts of being born too soon cannot be overstated. Preterm birth is the biggest cause of neonatal mortality in the UK, accounting for 79% of neonatal deaths in 2023. But survival is just the first hurdle. Children born prematurely face increased risks of disabilities, chronic health conditions, and developmental challenges that can persist throughout their lives.

The relationship between gestational age at birth and outcomes is striking. Research shows that 4.2% of surviving preterm babies will have a severe disability by age 18, while 18.5% will have a milder disability. Brain injuries are particularly common, occurring in 26 per 1,000 live preterm births compared to just 3.5 per 1,000 term births. These injuries significantly increase the risk of cerebral palsy.

The UK's preterm birth rate has remained stubbornly high in recent years, hovering around 7.9% despite a national ambition to reduce it to 6% by 2025.

Figure 1: Preterm birth rates in England between 2017 and 2022 and the trajectory required to meet the 2025 target

Source: House of Lords Preterm Birth Committee Report, 2024 (Based on ONS data)

As Figure 1 illustrates, after declining between 2017 and 2021, the rate increased again in 2022, making it clear that this target will not be met.

The health challenges extend far beyond infancy. A 2020 study found that children born before 28 weeks had hospital admission rates five times higher than those born at 40 weeks. Recent research from Finland and Norway revealed that preterm birth is associated with diverse patterns of multiple long-term health conditions in children aged 10-18, including increased risks of high blood pressure and chronic respiratory disease.

Hidden Developmental Challenges

Perhaps less visible but equally significant are the neurodevelopmental impacts. Research from the University of Leicester explains that while only a small proportion of preterm babies develop physical disabilities, the most common adverse outcomes are cognitive impairments, motor difficulties, and social and emotional problems.

Children born prematurely are more likely to have attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, and special educational needs than their term-born peers. Studies show that during primary school, 82.6% of children born at 24 weeks are defined as having special educational needs, compared to 29% of those born at full term. These educational difficulties persist: children born preterm show lower educational attainment up to age 16.

The effects don't simply disappear with time. Research from the University of Warwick notes that many impacts, including lower cognitive performance, continue into adulthood with little narrowing of the gap between those born preterm and full-term. Adults who were born prematurely often report subtle but multiple challenges in areas like physical and mental health, employment, and relationships.

The Inequality Factor

One of the most troubling aspects of preterm birth is the stark inequalities in who is affected. In 2021, 8.7% of births to Black mothers in England and Wales were preterm, compared to the overall rate of 7.9%. Asian mothers had the second-highest rate at 8.1%. Even more concerning, Black women were more than twice as likely to give birth to extremely preterm babies compared to White women.

These disparities persist even after accounting for socioeconomic deprivation, suggesting that ethnicity functions as an independent risk factor. A 2021 study estimated that 18.5% of preterm births in England could be attributed to socioeconomic inequality. In Birmingham, for example, if all women had the same risk as white women in the least deprived areas, there would be 76 fewer preterm births annually.

The National Child Mortality Database reports that mothers from Asian backgrounds face around a 60% increase in the chance of their baby dying from preterm birth by age 1, compared to White mothers. For Black mothers, this risk more than doubles. Tragically, deaths from prematurity have increased over the last 4 years, with these increases seen exclusively in children from non-White minority ethnic groups and the most deprived areas.

The Family Experience

The trauma of preterm birth extends far beyond the baby. Parents often spend weeks or months in neonatal intensive care units, watching their tiny infants connected to monitors and medical equipment. In a 2022 survey, 75% of parents reported not having access to overnight accommodation when their baby was critically ill, forcing them to leave their newborn each night.

The psychological toll is immense. Nearly one-quarter of parents surveyed had been diagnosed with post-traumatic stress disorder following their neonatal care experience. At discharge, 20% of mothers showed clinically significant depression levels, with 43% experiencing moderate to severe anxiety. These mental health impacts often don't fully emerge until months after discharge and can recur at milestones like first birthdays or subsequent pregnancies.

Financial pressures compound the emotional burden. Having a baby in neonatal care leads to average additional costs of £405 per week, with one in four families needing to borrow money or increase their debt to manage. One parent reported accruing more than £9,000 in accommodation, parking, and subsistence costs during their baby's treatment.

Improving Outcomes Through Better Care

While we cannot prevent all preterm births, significant opportunities exist to improve outcomes when they do occur. The Saving Babies' Lives Care Bundle outlines evidence-based interventions that, when consistently implemented, can dramatically improve survival and reduce complications.

Figure 2: Screening and preventive treatments.

Source: House of Lords Preterm Birth Committee Report, 2024

As Figure 2 illustrates, the pathway includes universal screening at the initial pregnancy booking appointment, followed by more detailed assessment for at-risk women, and targeted preventive treatments.

Interventions such as delayed cord clamping can reduce mortality by up to half for preterm babies. Ensuring extremely preterm babies are born in hospitals with the highest level of neonatal care significantly improves survival rates. Providing mothers with appropriate medications before delivery can support the baby's brain and lung development.

However, implementation remains inconsistent. Currently, only 15% of preterm babies in England and Wales receive all recommended core perinatal interventions, with rates varying between 10% and 25% across regions. Some units achieve delayed cord clamping in 8 out of 10 babies; others achieve it in fewer than 3 out of 10.

Family-integrated care, which enables parents to be active participants in their baby's care during the neonatal stay, has been shown to improve weight gain, reduce infection rates, decrease length of hospital stays, and reduce parental stress and anxiety. Yet practical barriers remain, particularly the lack of accommodation that would allow parents to stay with their babies around the clock.

The Need for Continued Support

The support needs of preterm babies and their families don't end at hospital discharge. The National Institute for Care and Excellence (NICE) guidelines recommend enhanced developmental surveillance and support for children born very preterm until age 2, and until age 4 for those born extremely preterm. These assessments are essential for identifying problems early and ensuring timely referral for support.

Yet provision is worryingly inconsistent. In 2023, only 77% of very preterm children had a documented medical follow-up at 2 years old, with figures for individual units varying from 62% to 90%. Even more concerning, only 6.7% of neonatal units were conducting assessments at age 4, despite their proven importance for school readiness.

Health visitors play a crucial role in supporting families after discharge, but they often lack specific training on the needs of preterm babies. Parents report that their health visitors frequently don't understand the neonatal experience or the developmental milestones of preterm children, leading to conflicting advice and additional stress.

Looking Ahead

The economic case for reducing preterm birth and improving outcomes is compelling. For an annual cohort of children in England and Wales, the total cost of preterm birth is estimated at £4.18 billion. Even a modest reduction in the preterm birth rate from 8.7% to 8.2% in Australia resulted in annual government savings of AU$90 million.

But this isn't just about economics – it's about giving every child the best possible start in life. Meeting this challenge requires a coordinated effort across multiple fronts: increased research funding to understand the mechanisms of preterm labour, improved implementation of evidence-based care, better support for families during and after neonatal care, and targeted efforts to reduce the stark inequalities in who is affected.

As one mother testified: "This experience has stayed with us for life." For the thousands of families affected by preterm birth each year, ensuring better outcomes isn't just a policy ambition – it's a matter of profound personal importance that will echo through generations.