Executive function development between ages 2 and 6 in children exposed to threatened preterm labor
8 affiliations
- 1Neuropsychology and Functional Neuroimaging Group, Department of Basic Psychology, Clinical Psychology and Psychobiology, Universitat Jaume I, Castelló de la Plana, Spain
- 2Mental Health Research Group, Health Research Institute La Fe, Avda. de Fernando Abril Martorell, 106, Valencia, 46026 Spain
- 3Department of Personality, Evaluation and Psychological Treatment, Universitat de València, Valencia, Spain
- 4North London NHS Foundation Trust and ReCognition Health, London, UK
- 5Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, Valencia, 46026 Spain
- 6Centre for Brain and Cognitive Development, Birkbeck College, University of London, London, UK
- 7Division of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, Valencia, 46026 Spain
- 8Applied Statistics and Operations Research, and Quality, Universitat Politècnica de València, Valencia, Spain
Abstract
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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00787-026-03115-2.
Related
- The configurational pathways associated with executive function in preschool children: An fsQCA analysis based on gross motor skill development
- Effects of physical activity on executive function components and academic performance in children aged 6–12 years: a systematic review and meta-analysis of randomized controlled trials
- Interoception-Based Interventions for Executive Functioning and Behavioral Outcomes in Children and Young Adults: A Scoping Review
- Profiles of everyday executive functioning in relation to adaptive behaviour in children and adolescents with Down syndrome
- The associations between muscle strength and executive function among Chinese adolescents
BibTeX
@article{miropadilla2026executive,
title = {{Executive function development between ages 2 and 6 in children exposed to threatened preterm labor}},
author = {Anna Miró-Padilla and Belén Almansa and Maite Ferrin and Marta Lizarán and Julia Andreu-Martínez and Adrián Torres-Villasante and Cristina Zapata-de Miguel and Julia Buesa and Alba Moreno-Giménez and Farah Ghosn and Vicente Diago and David Hervás and Ana García-Blanco},
journal = {European Child \& Adolescent Psychiatry},
year = {2026},
month = jun,
doi = {10.1007/s00787-026-03115-2},
url = {https://doi.org/10.1007/s00787-026-03115-2},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Executive function development between ages 2 and 6 in children exposed to threatened preterm labor
AU - Anna Miró-Padilla
AU - Belén Almansa
AU - Maite Ferrin
AU - Marta Lizarán
AU - Julia Andreu-Martínez
AU - Adrián Torres-Villasante
AU - Cristina Zapata-de Miguel
AU - Julia Buesa
AU - Alba Moreno-Giménez
AU - Farah Ghosn
AU - Vicente Diago
AU - David Hervás
AU - Ana García-Blanco
PY - 2026
DA - 2026/06/29
JO - European Child & Adolescent Psychiatry
DO - 10.1007/s00787-026-03115-2
UR - https://doi.org/10.1007/s00787-026-03115-2
AB - 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00787-026-03115-2.
SN - 1018-8827
SN - 1435-165X
ER -