Dear study participant,

34 years ago, the Bavarian Longitudinal Study began in South Bavaria, and in 2013 we completed the last extensive data collection phase of the study, which included participant interviews, MRI examinations, and telephone interviews with parents. After a long preparation period, we have succeeded in continuing the study with funding from the Europewide project called RECAPpreterm (www.recap-preterm.eu). We would like to express our sincere thanks to you for your loyalty and repeated participation in our study!

We look back on a series of assessment phases that have made the Bavarian Longitudinal Study one of the largest and most important studies worldwide in the field of preterm medicine and the development of children born neonatally healthy. We would like to show you the course so far using a diagram. All of this was only possible thanks to your participation and commitment. Thank you very much!!

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Planning the study design and searching for funding always take a very long time in studies. Therefore, we are very pleased to now be able to continue the study as part of a large European project. This is an excellent opportunity to learn what effects preterm birth, but also experiences such as relationships with other people (e.g., parents and peers), have on the personal and professional life from childhood into early adulthood.

In the European project, we are working together with colleagues from a 20 studies from the United Kingdom, Norway, Finland, the Netherlands, and other European countries, who also follow preterm and full-term children into adulthood. The collaboration takes place exclusively with completely anonymised data, so that no individuals can be identified. This is the general procedure in longitudinal studies, which also includes the Bavarian Longitudinal Study.

The collaboration will allow us to compare life trajectories into adulthood with studies from other countries with different school, employment, and social structures. You can see that the Bavarian Longitudinal Study is of great international interest, and through your support and participation we can maintain the value of the study.

The BEST team:

‍The leadership of the study lies partly in the hands of Prof. Dr. Dr. h.c. Dieter Wolke from the Department of Psychology at the University of Warwick (England). Prof. Wolke has been involved in the study from the beginning. Since 1990 he has been the lead investigator of the study, at that time still at the Dr. von Hauner’schen Children’s Hospital at the University of Munich. He and his staff are responsible for the development and supervision of participant interviews and for data analysis. Since 2009, Prof. Dr. Dr. Peter Bartmann from the Centre for Pediatrics, Department of Neonatology, University of Bonn has been colead investigator of the study.

The study office continues to be located in Bonn. Dr. Busch, who has also been working for the study since 2009, is now a qualified pediatrician and works parttime in the office. You know her from letters, phone calls, and telephone interviews from Phase 4. New staff members are Ms. Stahl as study assistant and Ms. Herbort as medical doctoral candidate in Bonn. Together, they will coordinate and conduct the renewed data collection.

In Warwick/ England, Ms. Baumann has also been working on the study since 2009. As a medical documentalist, she is of immense value for the quality of the data. She has also written several publications about the study.

Study results:

We would like to inform you again about the latest study results. For this purpose, we would like to present two publications to you in more detail. If you would like to read the original papers, you can find them on our website.

Romantic relationships in adulthood

The first publication is from the working group in Warwick, England. The title is “Association of Preterm Birth and LowBirth Weight With Romantic Partnership, Sexual Intercourse, and Parenthood inAdulthood: A Systematic Review and Meta-analysis.” (Mendonça M, Bilgin A, WolkeD. JAMA Netw Open. 2019 Jul 3;2(7):e196961. doi: 10.1001/jamanetworkopen.2019.6961.)

Our colleague Dr. Marina Mendonça from the study group in Warwick examined in a metaanalysis (analysis of all published data on a topic) how the social relationships of preterm individuals develop in adulthood. For this, 21 studies with a total of over 4 million participants were analysed.

Close partnerships increase satisfaction and physical and mental wellbeing. The results show that for preterm individuals (born before 37 weeks of gestation) it is more often difficult than for fullterm individuals to enter such partnerships, because they are often shy, socially withdrawn, and less risktaking and funoriented. For preterm individuals, the likelihood of entering a romantic relationship in adulthood decreases by 28%, becoming a parent by 22%, and they have overall 2.3 times fewer sexual relationships than fullterm individuals.

This trend is even more pronounced for very preterm individuals born before 32 weeks of gestation or weighing less than 1500 g at birth, and for extremely preterm individuals (born before 28 weeks or less than 1000 g birth weight).

Nevertheless, most preterm individuals do enter romantic relationships, and when they do, these relationships are even slightly happier than those of fullterm individuals.

Preterm birth is associated with increased shyness, social withdrawal, and lower risktaking in adulthood. This may make it more difficult for preterm individuals to find partners for romantic relationships.

Prof. Wolke emphasises that people who care for preterm children, such as teachers and parents, should be aware of how important the role of social development and social integration is for these children. Because they are more timid and reserved, they should be supported in finding friends and being integrated into their peer group. This will help them find partners for romantic relationships and become parents, which will increase their overall wellbeing.

Better chances despite birth risk

Secondly, we would like to present a publication by Tobey Nichols and our longtime colleague Dr. Julia Jäkel: „Differential susceptibility effects of maternal sensitivity in childhood onsmall for gestational age adults’ wealth.“ (Nichols T, Jäkel J, Bartmann P,Wolke D. Dev Psychopathol. 2020 Feb;32(1):197-203. doi: 10.1017/S0954579418001669.)

Underweight newborns are more susceptible to environmental influences than children born with normal weight. Small for Gestational Age (SGA) describes underweight newborns who weigh less at birth than 90% of newborns of the same sex born in the same gestational week. An SGA birth is considered a potential developmental risk that can have longterm negative effects into adulthood.

Is it possible that those who are more sensitive to their environment are not only negatively affected by negative factors, such as less sensitive parenting behaviour, but can especially benefit from positive parenting behaviour? Data from 438 participants of the Bavarian Longitudinal Study (109 SGA children and 329 children with normal birth weight for their gestational age) were included in the analysis to answer this question.

Our results clearly show that SGA children are not only more sensitive to environmental influences than children born with normal weight, but that sensitive parenting enables them to be more economically successful than their peers later on. Through sensitive parenting, SGA children receive the support and foundation they need to compensate for the disadvantages of low birth weight, so that they can become more successful later in life.

This is an important positive signal for potential investments in programmes to promote improved parentchild relationships in SGA children.

You are welcome to visit our website (www.bayerische-entwicklungsstudie.de) to find additional publications from the team of the Bavarian Longitudinal Study. There you will also find more detailed information about the current Phase 5 and the progress of the study.

Your participation changes care: From research results to practice

Your participation in the Bavarian Longitudinal Study and the resulting findings have significant impact on the care of newborns and their support throughout life. For example, through your repeated participation in motor and cognitive assessments, we were able to show that by the end of the second year of life—though not earlier—it is possible to identify children at risk of longterm motor and learning problems. These findings have contributed to the fact that followup examinations are now uniformly conducted at two years of age in Germany and in many European countries. This means the results help develop new standards of care (see https://newborn-health-standards.org/).

Similarly, the findings on the transition to school and the disadvantage of summerborn children (youngest in the class) have contributed to changes in legislation in other countries, allowing delayed school entry.

As a final example, results from the BLS have contributed to the development of informational material for teachers on how a highrisk birth affects concentration, mathematics learning, or social relationships, helping them better support affected children. Your participation in the study is improving childcare worldwide!

With this newsletter we would like to thank you for your continued interest and participation in the study, and of course we hope for your willingness to participate just as actively in this phase of the study.

For 2020, we send our best wishes — stay healthy and enjoy life, even if everyday life may sometimes not be so easy.

With warm regards
Yours
D. Wolke    P. Bartmann    B. Busch

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