J JAMA Netw Open. 2018;1(8):e186085. doi:10.1001/jamanetworkopen.2018.6085
osephine Funck Bilsteen, MSc1,2; David Taylor-Robinson, PhD3; Klaus Børch, PhD1; et al Katrine Strandberg-Larsen, PhD2; Anne-Marie Nybo Andersen, PhD2
Signicant problems for pregnancies <36 weeks
Note: More Vitamin D/Omega-3 ==> fewer premature births, healthier moms, healthier children
- Preterm births are VERY costly – Feb 2017 $50,000 more in the first12 months
Vitamin D Helps
- Preterm birth rate reduced by vitamin D – 78 percent if non-white, 39 percent if white – July 2017
- Preterm birth interventions – 4 studies found possible vitamin D benefit – Cochrane – Nov 2018
- Preterm birth 4X more likely if very low Vitamin D (Chinese) - Feb 2018
- Preterm births 12 X more likely if poor Vitamin D Receptor (white infants in Italy) – meta-analysis Aug 2018
- Preterm birth extended by 2 weeks with Omega-3 – Meta-analysis Nov 2015
- Preterm births strongly related to Vitamin D, Vitamin D Receptor, Iodine, Omega-3, etc
- Omega-3 added during pregnancy helps in many ways – Cochrane Review of RCTs Nov 2018
- Omega-3 helps pregnancy in many ways: preterm 26 percent less likely etc – review July 2012
- Pre-term birth rate of pregnant smokers cut in half if take Omega-3 – RCT May 2017
- Typical pregnancy is now 39 weeks – Omega-3 and Vitamin D might restore it to full 40 weeks
Healthy pregnancies need lots of vitamin D has the following summary
|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 |
within normal limits
|10. Childhood Wheezing||1.3 times||RCT|
|11. Additional child is Autistic||4 times||Intervention|
|12.Young adult Multiple Sclerosis||1.9 times||Observe|
|13. Preeclampsia in young adult||3.5 times||RCT|
|14. Good motor skills @ age 3||1.4 times||Observe|
|15. Childhood Mite allergy||5 times||RCT|
|16. Childhood Respiratory Tract visits||2.5 times||RCT|
RCT = Randomized Controlled Trial
Societal Costs of Preterm Birth (age 0-7 years)- Chapter in 2007 book
- Preterm birth in the United States was at least $26.2 billion in 2005 (first year)
- Special education services associated with a higher prevalence of four disabling conditions among premature infants added $1.1 billion.
- Lost household and labor market productivity associated with those disabilities contributed $5.7 billion.
- Appears to ignore all costs to society after age 7
For < 34 weeks: >1.5 X more likely to be on welfare, >2.3 X more likely to be on disability
- Question How was the whole range of gestational age at birth associated with socioeconomic outcomes in adulthood (education, personal income, and primary source of income)?
- Findings In this cohort study including 228 030 singletons, lower gestational age (<39 weeks of gestation) was associated with lower odds of high educational level and high personal income and increased odds of receiving disability pension and cash welfare benefits compared with individuals born at 40 weeks of gestation.
- Meaning These findings suggest that lower gestational age even within the term range may have implications for long-term opportunities and well-being as measured by socioeconomic outcomes in adulthood.
Importance The poor health outcomes associated with preterm birth are well established. However, it is less clear how small variations in gestational age, even within the term range, are associated with long-term opportunities and well-being, as measured by socioeconomic outcomes in adulthood.
Objective To examine the association of gestational age at birth with educational achievement, income, and primary source of income in adulthood.
Design, Setting, and Participants This Danish population-based, register-based cohort study examined all live-born singletons born in Denmark from 1982 to 1986 without congenital anomalies and who lived in Denmark at age 28 years. Data analysis was conducted from November 2, 2017, to June 15, 2018.
Exposures Gestational age at birth in completed weeks (22-45 weeks).
Main Outcomes and Measures Educational attainment, personal income, and primary source of income at age 28 years.
Results In a population of 228 030 singletons (4.0% preterm, 12.1% early term; 49.4% female), 36.3% had a tertiary education at age 28 years. Among adults born at 22 to 27 weeks of gestation, 21.6% had a tertiary education, and 23.2% had an income in the highest tertile. Using 40 weeks of gestation as the reference, the adjusted odds ratio for tertiary education for individuals born at 22 to 27 weeks of gestation was 0.21 (95% CI, 0.13-0.35) and the corresponding figures for 28 to 31, 33, 36, 38, and 43 to 45 weeks of gestation were 0.45 (95% CI, 0.37-0.55), 0.67 (95% CI, 0.54-0.83), 0.84 (95% CI, 0.77-0.93), 0.85 (95% CI, 0.81-0.89), and 0.93 (95% CI, 0.83-1.04), respectively. The adjusted odds ratio for highest income tertile for individuals born at 22 to 27 weeks of gestation was 0.66 (95% CI, 0.41-1.06) and the corresponding figures for 28 to 31, 33, 36, 38, and 43 to 45 weeks of gestation were 0.80 (95% CI, 0.68-0.94), 0.77 (95% CI, 0.63-0.93), 0.89 (95% CI, 0.82-0.96), 0.95 (95% CI, 0.91-0.99), and 1.00 (95% CI, 0.91-1.12), respectively. All estimates were adjusted for sex, birth year, parity, maternal age, maternal education, and maternal country of origin.
Conclusions and Relevance Shorter gestational duration even within the term range was associated with poorer socioeconomic outcomes in adulthood. While adults born at 35 to 38 weeks of gestation experienced only slightly increased risk of adverse socioeconomic outcomes, this may have a significant impact on public health, since a large proportion of all children are born in these weeks.