Preterm birth is the leading cause of neonatal death globally. Nevertheless, there are now increasing survival rates for infants born very preterm. For this reason, interest in the long-term consequences of being born preterm is increasing. In this presentation, Modi presented data from Sweden, Finland and Canada that associates preterm birth with increasing rates of adverse health outcomes (eg, cerebrovascular disease, stroke, hypertension). Increasingly, evidence points to multiple altered biological pathways in individuals whose development in the third trimester was disrupted due to being born preterm. Modi also discussed various biomarkers associated with long-term outcomes in infants born preterm. Nevertheless, it was acknowledged that the search for biomarkers of long-term risk is in its early stages. The natural experiment of preterm birth is an opportunity to understand epidemiological associations with early life exposures in order to improve adult health.