Executive function development between ages 2 and 6 in children exposed to threatened preterm labor

Children born after threatened preterm labor (TPL) are at increased risk for executive function (EF) difficulties, even when born at term. However, EF development in this population remains understudied, particularly regarding the role of gestational age and early psychosocial adversity. Prenatal stress (e.g., maternal anxiety at TPL diagnosis and trauma history) and postnatal environmental factors may contribute to variability in EF outcomes. In this prospective cohort study with a 6-year follow-up, EF was assessed at ages 2 and 6 using the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P). The sample included 180 mother-child dyads: 120 children born after TPL (full-term n = 27, late-preterm n = 56, very-preterm n = 37) and 60 full-term controls. Bayesian mixed-effects models were used to examine associations between EF outcomes and gestational age group, time, and relevant prenatal and postnatal factors, including child sex, parental education, maternal trauma history, and maternal anxiety. The models showed a group × time interaction for global EF scores. At age 2, all TPL groups showed higher EF difficulty scores compared with controls, with the largest differences observed in the very-preterm group. Between ages 2 and 6, EF scores decreased in TPL groups relative to controls, indicating a greater reduction in EF difficulties over time, although patterns varied across EF domains. Higher maternal anxiety (prenatal and postnatal), greater maternal trauma exposure, and lower parental education were associated with higher EF difficulty scores, whereas female sex was associated with lower scores. Children born after TPL show early EF vulnerabilities across gestational ages, including those born at term. EF outcomes change across early childhood and are associated with both biological and environmental factors. These findings support the importance of early monitoring of children exposed to prenatal complications and highlight the role of perinatal maternal mental health and family context in early executive function development.