Preterm birth associated with higher risk of death in early childhood, young adulthood

In a study that included more than 600,000 individuals born in Sweden between 1973-1979, those born preterm (less than 37 weeks gestation) had a higher risk of death during early childhood and young adulthood than persons born at term, according to a study in the September 21 issue of JAMA.

Preterm birth is the leading cause of perinatal (pertaining to the period immediately before and after birth) illness and death in . "Although the early effects of preterm birth are well documented, less is known about the longer-term outcomes in adulthood. These outcomes have a growing clinical and public health importance because of the high prevalence of preterm birth and improved early survival," the authors write. In the past 3 decades, the prevalence of preterm birth in the United States has increased to more than 12 percent. "As a result, of individuals who were born preterm are now surviving to adulthood. A comprehensive understanding of their outcomes in adulthood is needed to enable earlier prevention, detection, and treatment of the long-term health sequelae."

Casey Crump, M.D., Ph.D., of Stanford University, Stanford, Calif., and colleagues conducted a study to examine the association between at birth and mortality in young adulthood. The study included a national cohort of 674,820 individuals born in Sweden in 1973 through 1979 who survived to age 1 year, including 27,979 (4.1 percent) born preterm, followed up to 2008. A total of 7,095 deaths occurred in follow-up from age 1 year to the maximum attained ages of 29 to 36 years.

The researchers found a strong inverse association between gestational age at birth and mortality in (ages 1-5 years), no association was observed in late childhood (ages 6-12 years) or adolescence (ages 13-17 years), and an inverse association reappeared in young adulthood (ages 18-36 years). In early childhood as well as young adulthood, preterm birth was associated with increased mortality even among individuals born late preterm (34-36 weeks), relative to those born full-term.

"In young adulthood, gestational age at birth had the strongest inverse association with mortality from congenital anomalies and respiratory, endocrine, and cardiovascular disorders and was not associated with mortality from neurological disorders, cancer, or injury," the authors write.

The researchers write that, to their knowledge, this is the first study to report the specific contribution of gestational age at birth on mortality in adulthood. "The underlying mechanisms are still largely unknown but may involve a complex interplay of fetal and postnatal nutritional abnormalities; other intrauterine exposures, including glucocorticoid [a steroid hormone] and sex hormone alterations; and common genetic factors."

"Although most survivors have a high level of function and self-reported quality of life in , our previous and current findings demonstrate the increased long-term morbidities and that may also be expected. Clinicians will increasingly encounter the health sequelae of throughout the life course and will need to be aware of the long-term effects on the survivors, their families, and society."

More information: JAMA. 2011;306[11]:1233-1240.

add to favorites email to friend print save as pdf

Related Stories

Preterm birth linked to lifelong health issues

Mar 25, 2008

The healthcare implications of being born premature are much broader and reach further into adulthood than previously thought, according to a long-term study of more than a million men and women by Duke University and Norwegian ...

Preterm birth rate drops

Mar 18, 2009

The nation's preterm birth rate declined slightly in 2007 - a finding that the March of Dimes hopes will prove to be the start of a new trend in improved maternal and infant health.

Recommended for you

The hunt for botanicals

Dec 19, 2014

Herbal medicine can be a double-edged sword and should be more rigorously investigated for both its beneficial and harmful effects, say researchers writing in a special supplement of Science.

Mozambique decriminalises abortion to stem maternal deaths

Dec 19, 2014

Mozambique has passed a law permitting women to terminate unwanted pregnancies under specified conditions, a move hailed by activists in a country where clandestine abortions account for a large number of maternal deaths.

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.