Psychosocial outcomes of preschool children with a history of preterm birth: a cross-sectional observational study

Abstract

Background Preterm birth is associated with long-term neurodevelopmental challenges, yet evidence on psychosocial outcomes in Chinese preschool children, particularly in less developed regions, remains scarce. Methods A cross-sectional study was conducted in a western Chinese city from February 28 to March 5, 2025. Using stratified cluster sampling, 20,913 parent–child dyads were recruited from 189 kindergartens. Preterm birth (< 37 weeks gestation) was parent-reported. For the assessment of psychosocial functioning, the Chinese adaptation of the Strengths and Difficulties Questionnaire (SDQ) was utilized, with its focus on total difficulties, internalizing problems, externalizing problems and prosocial behavior. Multivariable regression models were used, adjusting for child age and gender, child birth weight, number of children, parental age, parental gender, education level, employment status, marital status, annual family income, smoking status, alcohol intake status, and parental depressive symptoms (CES-D score). Subgroup analyses explored effect modification. Results Of 20,913 children (mean age 4.82 ± 0.89 years), 860 (4.1%) were preterm. After full adjustment, preterm birth was significantly associated with increased odds of total difficulties (OR = 1.32, p = 0.0015), but not with internalizing problems (OR = 1.07, p = 0.4153), externalizing problems (OR = 1.02, p = 0.8083), or prosocial behavior (OR = 0.89, p = 0.1009). Conclusions Preterm birth in preschool children from Western China was associated with higher odds of total difficulties, but not with internalizing problems, externalizing problems, or prosocial behavior after full adjustment. Stratified interaction analyses revealed that these associations differed by alcohol intake status (for total difficulties) and parental education level (for prosocial behavior) after FDR correction.