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Abstract Children with very low birth weight (VLBW, < 1500 g) or very pre-term birth (VPTB, < 32 weeks gestational age or GA) have more mathematics disabilities or deficiencies (MD) and higher rates of mathematics learning disabilities (MLD) than normal birth weight term-born children (NBW, > 2500 g and > 36 weeks GA). MD are found even in children without global disorders in cognition or neurosensory status and when IQ is controlled, and they are associated with other learning problems and weaknesses in perceptual motor abilities and executive function. Factors related to poorer mathematics outcomes include lower birth weight and GA, neonatal complications, and possible abnormalities in brain structure. While little is known about the nature of MD in these children, studies of MLD in other neurodevelopmental disorders and in children with learning disabilities provide useful models for further investigation. Further investigation of the neuropsychological and neuropathological correlates of distinct types of mathematics difficulties is also needed. Studies along these lines will yield information about the unique features of MD in children with VLBW/VPTB and about the nature and origins of poor mathematics achievement more generally.