US Faces Rise in 1:34 Preterm Births
(CNN) -
One in 10 babies worldwide is born prematurely.
And the vastly improved survival rates of premature babies are one of the most surprising advances in modern healthcare.
The overwhelming majority of those born prematurely reach adulthood.
But what are the long-term health risks of being born too early as these babies approach middle age and old age?
It's a question that has been difficult to answer with follow-up studies of many people who are still too young to draw meaningful conclusions.
However, new research that looked at more than 6 million people born in Sweden, Norway, Denmark and Finland, mainly in the 1960s, 1970s and 1980s, found that people who were born prematurely have a moderately higher risk of dying. prematurely in adulthood compared to those born after 38 weeks.
In particular, preterm birth was associated with a twofold increase in the risks of death from cardiovascular diseases such as heart attacks or strokes, chronic lung disease and diabetes, compared with those born closer to full gestation, the study found.
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These findings support other research, and "the evidence is now clear that preterm and full-term labor are important risk factors for premature mortality in adulthood," said Dr. Casey Crump, professor and vice president for research in the department of medicine. Family and Community Health at Mount Sinai Hospital in New York City.
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"Preterm labor and early birth should now be recognized as chronic conditions that require long-term clinical follow-up for preventive actions, monitoring and treatment of health sequelae (consequences) throughout life," said Crump, who did not He was involved in the research, but wrote a commentary on the study, which was published in the JAMA Network Open on January 8.
A developing baby goes through significant growth throughout pregnancy, even in the last months and weeks.
Preterm labor is when a baby is born too early, before 37 weeks of pregnancy have been completed, according to the US Centers for Disease Control and Prevention. The earlier a baby is born, the greater the risk death or serious disability.
In the United States, the preterm birth rate increased for the fifth year in a row in 2019, and 1 in 10 babies (10%) was born too early.
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Why are babies born premature?
Experts don't know all the reasons why some babies are born prematurely.
According to the CDC, some risk factors for preterm labor include delivering a premature baby in the past;
multiple pregnancies;
tobacco use and substance abuse, as well as a short time (less than 18 months) between pregnancies.
However, a woman can have a premature delivery even if she has no known risk factors.
'The take-home message is, first and foremost, that gestational age should be widely recognized clinically as a risk factor and that information about the time of birth, and complications related to the fetal and neonatal period should be included in the medical history of evaluations, ”said study lead author Dr Kari Risnes, professor of pediatrics in the faculty of medicine and health sciences at the Norwegian University of Science and Technology.
“The risk of general death and death from chronic diseases in the young adults we studied (up to a maximum of 50 years) is very low.
I would advise anyone born before full term to tell their doctor if they are premature so that proper risk assessments can be done and lifestyle changes and treatments can be applied appropriately to prevent chronic disease. , said.
There is a "moderate" risk of being born prematurely
The Scandinavian researchers used information from nationwide birth records established in the 1960s and 1970s in the four countries that tracked people's health from birth to a maximum of 50 years.
Of the 6.3 million people included in the study, about 5.4% were born preterm and the researchers divided them into three categories: preterm birth (born between 22 and 33 weeks), late preterm (34 to 36 weeks) and preterm (37 to 38 weeks).
The earlier a baby was born than the ideal time of birth was associated with an increased risk of premature death, the study found.
However, although modest, the finding that babies born between 37 and 38 weeks had a 10% higher risk of dying prematurely, compared with those born after that gestation, was important given that the preterm delivery was two or three three times more common than term delivery, Crump said.
“The health impacts on the population are likely to be even greater in countries like the United States, which have a much higher prevalence of premature and on-time births.
Future studies should examine preterm births as a separate group whenever possible to better understand their long-term health trajectory into adulthood, ”Crump said.
These links held true after the researchers said they had taken into account other factors that could explain the association, such as socioeconomic, genetic or environmental.
The results were also similar in the four different countries.
“We compared siblings and found that the risk was higher in those born preterm compared to siblings born in full pregnancy.
This led us to conclude that the increased risk in preterm infants could not be fully explained by factors shared by siblings, such as genetic or socioeconomic factors, living conditions, or lifestyle factors in childhood, "said Risnes.
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The way gestational age was measured was a limitation of the study.
Estimates based on a mother's last menstrual period were used more frequently during the first few years of the time period covered by the study and are less reliable than those based on ultrasound scans.
'Neonatal survival and treatment have changed substantially since the beginning of the study period;
therefore, it is unclear to what extent our findings can be generalized between children born today and those born in other less resourceful settings, ”the study said.
"It remains to be seen if these patterns of higher mortality in individuals born before term persist later into adulthood and if they apply to more recent birth series with higher neonatal survival."
It is unclear what explains the link between premature birth and premature death in adulthood, Crump said.
It could be explained by epigenetics (how behavior and environment can cause changes that affect the way your genes work) and impaired organ development that could affect your chances of having diabetes, heart disease, or stroke.
However, he emphasized that the absolute risk of dying early is "modest."
"Most people who were born pre-term or early term survive to adulthood without major comorbidities and often report a high level of function and quality of life," he said.
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