Objectives: The objectives of the current study were to examine the relationship among primary caregivers’ quality of life, parenting stress, and children’s quality of life using structured equation model (SEM) for preschoolers born with VLBW and a group of controls. We also examined whether there was a moderating effect of VLBW on the relationships.

Methods: The study participants were 118 children born with VLBW and 170 non- VLBW controls in Taiwan. Primary caregivers of the study children completed structured questionnaires when the children were 3 to 4 years of age. Health-related quality of life among children and their caregivers were measured by the TZO-AZL Preschool Children Quality of Life (TAPQOL) and the World Health Organization Questionnaire on Quality of Life: BREF-Taiwan Version (WHOQOL-BREF-TAIWAN), respectively. Parenting stress was measured by the parenting stress index/short form (PSI/SF).

Results: Children with VLBW had lower quality of life scores compared with controls. The SEM model demonstrated that quality of life among caregivers affected parenting stress directly, and parenting stress affected children’s quality of life directly. As much as 66% of the variance in TAPQOL could be explained by the VLBW, current health problems among the children, WHOQOL, and PSI. The status of VLBW did not moderate the relationship of PSI on TAPQOL and WHOQOL on PSI. Conclusions: Quality of life among preschoolers born with VLBW was poorer. In addition to manage current health problems among children, programs that aimed at improving caregivers’ quality of life and ameliorating parenting stress may help improving children’s quality of life.