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Consequences of Preterm Birth in Childhood and Adulthood

Preterm birth is associated with decreased long-term survival and lower rates of reproduction.

The long-term outcome of children born preterm (<37 weeks’ gestation) was assessed by Norwegian investigators in a population-based birth cohort of more than 1 million singleton births from 1967 through 1988 that were followed through 2004. Overall, 5.6% of boys and 4.7% of girls were born prematurely.

Compared with term boys, extremely preterm (22–27 weeks’ gestation) boys had increased risk for death early (age range, 1–6) and late (age range, 6–13) in childhood (relative risks, 5.3 and 7.0, respectively). Extremely preterm girls had increased risk for early, but not late, childhood mortality (RR, 9.7) compared with term girls. Very preterm (28–32 weeks’ gestation) boys, but not girls, also had increased early and late childhood mortality. Post-term (43 weeks) boys and girls had increased infant mortality, but only boys also had increased late childhood mortality (RR, 1.4). In subgroup analysis, men and women (aged 28–37) born preterm had lower rates of reproduction compared with their term counterparts (65%–75% lower for extremely preterm adults and 20%–30% lower for very preterm adults). Women, but not men, born prematurely were at increased risk for having a preterm child. Overall, lower gestational age at birth was associated with lower educational achievement.

Comment: In this large study with excellent long-term follow-up, researchers used gestational age, rather than birth weight, to assess outcomes. As reported previously, mortality rates were higher for boys than for girls born at all preterm gestational ages. Compared with term birth, preterm birth was associated with lower childhood survival rates, less education, and lower rates of reproduction. However, differences between Norway and the U.S. (e.g., infant mortality and racial disparities) need to be taken into account when interpreting these findings. As neonatal care continues to improve, outcomes associated with prematurity will require ongoing review.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine April 9, 2008

Citation(s):

Swamy GK et al. Association of preterm birth with long-term survival, reproduction, and next-generation preterm birth. JAMA 2008 Mar 26; 299:1429.

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Adams MM and Barfield WD. The future of very preterm infants: Learning from the past. JAMA 2008 Mar 26; 299:1477.

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• Medline abstract (Free)