Dear study participant,

Almost two years have passed since the last newsletter in 2020. Two years during which each of you had to manage your life under the often challenging conditions of the coronavirus pandemic — and surely reached your personal limits of what was possible or bearable more than once. All of us were able to follow medical developments and the constantly growing understanding of course, treatment, and prevention “live.” Especially because of these unusual circumstances, we are very grateful that you remained interested in the Bavarian Longitudinal Study during this time.

Assessments in phase V

This assessment phase was divided into two parts this time. As one part, we were able to ask you about your professional and private life situation since the end of the previous study phase in a 20-minute telephone interview. Additionally, you were able to independently answer further questions by completing an online questionnaire. From March 2019 to November 2021, we conducted telephone interviews with a total of 416 study participants. For 20 participants who could not respond due to health reasons, the questions were answered on their behalf by mostly parents. Participation in the online questionnaire was around 75% of those who completed the telephone interview. We will take this experience into account for future phases.

Thank You!

The quality of a study depends heavily on how many participants can be reassessed.
Equally important is interviewing participants with health impairments or, when necessary, their caregivers. This ensures that we obtain a complete picture of the entire group.

The participation of both preterm and fullterm individuals is particularly important for the scientific quality of this study. The two groups differ only in gestational age at birth 1985/86. They grew up under similar social and political conditions. This enables us find out, in which areas being born earlier or smaller affects the development, and in which areas other factors, e.g. the social environment someone is born into, affect preterm and term born individuals similarly.

A special thank you goes to the parents and caregivers who tirelessly remain loyal to the study and continue participating despite the significant challenges that come with the diverse health needs of their children. Without all of you, this internationally recognized and respected study would not exist.

How were we able to help?

In our conversations with participants, we heard about the particular challenges and personal experiences of our participants. At times, when asked, we were able to offer individual assistance, e.g.  connecting participants with others facing similar situations or answering specific medical questions. Many participants from the Bavarian Longitudinal Study now have families of their own, and some have contacted us with individual questions. These very personal interactions continually reinforce our commitment to continuing the study.

In Germany, we work with the association “Das frühgeborene Kind e.V.” (“The Preterm Child Foundation”), advocating for the needs of those born preterm. Increasingly, adults born preterm express a desire for opportunities to connect with others who share similar experiences. On the association’s website (https://www.fruehgeborene.de), you can find the section “Erwachsene Frühgeborene” (preterm born adults) under “Familie” (family), will all information about contact details and events (https://www.fruehgeborene.de/familie/erwachsene-fruehgeborene).

In September 2021, we were able to invite you to a threeday online symposium hosted by the association, titled: “Adults Born Preterm & Quality of Life”. The event gave you the opportunity to listen to presentations by the lead investigators of the Bavarian Longitudinal Study Prof. Dieter Wolke and Prof. Peter Bartmann on the topics “social relationships and interpersonal functioning” and “career choices and career start of adults born preterm” and also ask questions afterward. Your feedback on this event was very positive and clearly demonstrated the strong need for our work.

We collaborate with various organizations across Europe to support parents of preterm infants and adults born preterm and regularly give presentations and contribute to new clinical care guidelines.

What New Research Findings Are Available?

On our website (https://www.bayerische-entwicklungsstudie.de)
we try to keep the list of published research findings uptodate. Access to full journal articles is unfortunately sometimes restricted due to publisher rights, so in this newsletter we would like to present two recent publications.

Development of Peer Relationships in Very Preterm and Full-Term Individuals from Childhood to Early Adulthood

Social relationships are of crucial importance for human development throughout life.
Acceptance by peers and close friendships in childhood promote emotional development and well-being. They can also protect against bullying in the group. The successful development of interpersonal connections leads to better social adjustment during adolescence and later in life.

In the Bavarian Longitudinal Study, we asked parents and participants at ages 6, 8, 13, and 26 questions about three areas: peer acceptance, friendships and conflicts with peers. When analysing the data, we took into account many influencing factors, including: preterm vs. term birth, sex, socioeconomic status, medical risks as a newborn, parent–child relationship at 5 months, children’s selfregulation skills at 20 months and cognitive abilities at 20 months.

The statistical analysis showed that, after adjusting for all these factors,  children who had more advanced cognitive and motor development at 20 months were more likely to be accepted by peers, form friendships and experience less social exclusion by their peers. The effects were smaller than 10% but statistically significant. Moreover, a positive parent–child relationship at 5 months was associated with fewer peer problems from childhood into adulthood.

These findings provide indicators for promising early interventions to support social development.

(Source: Peer Relationship Trajectories in Very Preterm and Term Individuals from Childhood to Early Adulthood L.C.Reyes, J.Jaekel, P.Bartmann and D.Wolke, J Dev Behav Pediatr 42:621-630, 2021; PMID: 33789321; DOI: 10.1097/DBP.0000000000000949)

Math skills in childhood and development in early adulthood after preterm birth: A meta-analysis using individual participant-data

This study investigated how mathematics skills, assessed between the ages of eight and eleven, are associated with postschool education (e.g., university of applied sciences or university) and employment status in early adulthood. For this purpose, individual data from 954 (52% female) very preterm adults (<32 weeks of gestation or <1500g birth weight) were used. The participants came from six countries: Australia, Germany (BEST data), United Kingdom and Ireland, Canada, and the USA. All models were adjusted for birth year, gestational age, sex, maternal education, and childhood IQ.

These are the main findings:

Mathematics skills in childhood among very preterm individuals are significantly and positively associated with later higher education. Mathematics skills in childhood do not predict later employment status in adulthood. The childhood intelligence quotient of very preterm individuals is associated with educational attainment and employment status. The analysis revealed very large differences between the included studies, birth periods, and world regions. This study also again showed poorer outcomes for male participants and for children of mothers with lower educational levels. These findings should be taken into account when developing future support programs.

(Source: Mathematical Performance in Childhood and Early Adult outcomes After Preterm Birth: An Individual Participant Data Meta-Analysis J. Jaekel et al. Dev Med Child Neurol. 2022; 64:421-428;  PMID: 34913160;  DOI 10.1111/dmcn.15132)

What happens next?

We were successful in securing additional research funding. As part of two EU calls, our project proposals were reviewed positively.

This means that we can carry out another followup study in two parts. On the one hand, we would like to recontact all participants of the BEST and ask for consent to collect a mucus sample (saliva). We will explain why and how the collection via post works soon. This European project, which brings together more than 20 studies, investigates whether genetic factors together with environmental factors can improve the effects of neuropsychological diversity on social relationships and adaptation.

As part of the second project, we would like to ask participants to take part in another assessment in Munich. We are currently planning this and will inform you about it soon. It is planned to conduct a magnetic resonance imaging scan of the head for the first time or for the second time (for participants from the assessment round before the last round) in order to analyse aging processes.

As in the telephone interview during our last contact, we also plan to ask about your professional and family development.

In the next few months, we will contact you again by telephone to provide you with details and will then send you comprehensive written information.

We are aware that these examinations, which are important for science but also for everyday care, are only possible thanks to your willingness to participate. We thank you for this.

The study will continue to be led by Prof. Wolke, and the team in Bonn with Dr. Busch and Prof. Bartmann will also be part of this assessment round. To carry out the tasks, additional staff will be hired at all sites.

With warm regards, stay healthy

Prof. Dieter Wolke                 Prof. Peter Bartmann             Dr. Barbara Busch

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