Association of Preterm Birth With Risk of Ischemic Heart Disease in Adulthood
JAMA Pediatr. 2019;173(8):736-743. doi:10.1001/jamapediatrics.2019.1327
Casey Crump, MD, PhD1,2; Elizabeth A. Howell, MD, MPP2,3,4; Annemarie Stroustrup, MD, MPH3,5; et al Mary Ann McLaughlin, MD2,6; Jan Sundquist, MD, PhD1,2,7; Kristina Sundquist, MD, PhD1,2,7
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Reduces Evidence 0. Chance of not conceiving 3.4 times Observe 1. Miscarriage 2.5 times Observe 2. Pre-eclampsia 3.6 times RCT 3. Gestational Diabetes 3 times RCT 4. Good 2nd trimester sleep quality 3.5 times Observe 5. Premature birth 2 times RCT 6. C-section - unplanned 1.6 times Observe Stillbirth - OMEGA-3 4 times RCT - Omega-3 7. Depression AFTER pregnancy 1.4 times RCT 8. Small for Gestational Age 1.6 times meta-analysis 9. Infant height, weight, head size
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- Preterm Births decreased by Omega-3 (analysis of 184 countries) – April 2019
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- Preterm Births - promising preventions – anti-oxidants, Vitamin D, Omega-3, Zinc, etc. – Jan 2019
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Might the increase risk due to preterm reach 2X by age 60?
Objective To determine whether preterm birth is associated with an increased risk of IHD in adulthood in a large population-based cohort.
Design, Setting, and Participants This national, population-based cohort study included all 2 141 709 persons who were born as singleton live births in Sweden during 1973 to 1994. The data were analyzed in September 2018.
Exposures Gestational age at birth, identified from nationwide birth records in the Swedish Birth Registry.
Main Outcomes and Measures Ischemic heart disease that was identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age, 43 years). A Cox regression was used to examine gestational age at birth in association with IHD in adulthood while adjusting for other perinatal and maternal factors. Cosibling analyses assessed for potential confounding by unmeasured shared familial factors.
Results Of 2 141 709 participants, 1 041 906 (48.6%) were female and there were 1921 persons (0.09%) who received a diagnosis of IHD in 30.9 million person-years of follow-up. Gestational age at birth was inversely associated with IHD risk in adulthood. At ages 30 to 43 years, adjusted hazard ratios for IHD associated with preterm (gestational age <37 weeks) and early-term birth (37-38 weeks) were 1.53 (95% CI, 1.20-1.94) and 1.19 (1.01-1.40), respectively, compared with full-term birth (39-41 weeks).
Preterm-born women had lower IHD incidence than preterm-born men (15.16 vs 22.00 per 100 000 person-years) but had a higher adjusted hazard ratio (1.93; 95% CI, 1.28-2.90 vs 1.37; 95% CI, 1.01-1.84). These associations did not appear to be explained by shared genetic or environmental factors in families.
Conclusions and Relevance In this large national cohort, preterm and early-term birth were associated with an increased IHD risk in adulthood. Persons born prematurely need early evaluation and preventive actions to reduce the risk of IHD.Preterm birth increases risk of heart disease by 1.5 X by age 40 – June 2019
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