Exploring preterm birth and low birth weight as environmental sensitivity factors: A scoping review of socio-emotional and cognitive developmental outcomes

Abstract

Perinatal adversities, such as preterm birth and low birth weight, have traditionally been viewed as vulnerability factors. However, emerging evidence suggests that these conditions may also increase sensitivity to environmental exposures in a for-better-and-for-worse manner, consistent with the concept of Environmental Sensitivity (ES) and Differential Susceptibility theory. This scoping review examines whether preterm birth and low birth weight function as ES factors for socio-emotional and cognitive outcomes. We reviewed 134 studies published up to June 2024, identifying 20 that explored the interplay between birth condition and postnatal environmental variables. Evidence was mixed across Differential Susceptibility, Vantage Sensitivity, and Dual-risk models. Differential Susceptibility was more frequently observed in studies using observational methods and assessing the environment and outcomes early in life, while Dual-risk effects were often reported in studies relying on parent-report. Only a few studies identified Vantage Sensitivity, and these were primarily in samples of moderately preterm children. Future research leveraging secondary datasets and incorporating broader parental and infant variables-such as prenatal stress and infant temperament-could clarify the conditions under which perinatal adversities predict heightened environmental sensitivity. Such insights may inform tailored interventions aimed at supporting families facing preterm birth and low birth weight, promoting both recovery and flourishing developmental outcomes.

Keywords: Differential susceptibility; Environmental sensitivity; Low birth weight; Pre-term birth; Prenatal programming.