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Prematurity is a well-known leading cause of perinatal death. Whether preterm birth increases risk for death during adulthood is unknown. Investigators examined the association between gestational age at birth and mortality through young adulthood in a national cohort of 674,820 singleton infants born in Sweden from 1973 to 1979 who survived past age 1 year. Four percent of infants were born before 37 weeks' gestation, and most of those (80%) were born at 34–36 weeks.
During 20.8 million person-years of follow-up, 7095 deaths occurred. A significant inverse association was found between gestational age at birth and mortality rates in young adulthood (age range, 18–36). Adjusted hazard ratios for death in young adulthood ranged from 1.31 for those born at 34–36 weeks' gestation to 1.91 for those born at 22–27 weeks' gestation. In young adulthood, gestational age at birth had the strongest inverse association with death from congenital anomalies followed by respiratory (AHR, 0.85) and endocrine disorders (AHR, 0.88), and cardiovascular disease (AHR, 0.93). Gestational age was not associated with death from cancer or injuries in young adults.
Crump C et al. Gestational age at birth and mortality in young adulthood. JAMA 2011 Sep 21; 306:1233.
Comment
The association between prematurity and death during early adulthood is important because of the improved survival of premature infants. The association indicates that prematurity has lifelong health effects. A history of extreme prematurity might be elicited during a patient's health history, but preterm birth after 34 weeks' gestation might not. On the basis of these findings, clinicians should consider taking birth histories more carefully and enhancing health surveillance of patients who were born preterm.