Lung trajectories into adulthood of preterm born survivors and the influence of sex

Preterm birth is increasingly recognised as a major determinant of lifelong respiratory health. Longitudinal studies consistently demonstrate that individuals born preterm have persistently worse lung function from childhood to adulthood compared with their term born peers. These adverse effects vary across gestational categories including extremely preterm, very preterm and moderate-late preterm birth, and are further exacerbated by bronchopulmonary dysplasia (BPD). Pooled analyses show that children or adults born preterm without BPD had 7.2% [95 confidence interval (CI): 5.6-8.7%] lower percent predicted FEV₁ than term-born individuals. The %FEV₁ deficit was greater in those with BPD: 18.9% [16.7-21.1%] lower for the BPD₃₆ group when compared with the term born group. Lung function deficits in pre-term born survivors persist into adult life. Preterm birth is also associated with increased risk of COPD in later life. There is evidence that male sex confers additional vulnerability in pre-term survivors, with recent literature showing poorer lung function in males compared with females. Understanding these relationships is central to developing future phenotyping frameworks, enabling early identification of those at greatest risk, and informing surveillance strategies aimed at preserving lung function and preventing early onset of chronic obstructive pulmonary disease.