Association of Preterm Birth With Long-term Risk of Heart Failure Into Adulthood

Abstract

IMPORTANCE Preterm birth has been associated with increased risk of heart failure (HF) early in life, but its association with new-onset HF in adulthood appears to be unknown. OBJECTIVE To determine whether preterm birth is associated with increased risk of HF from childhood into mid-adulthood in a large population-based cohort. DESIGN, SETTING, AND PARTICIPANTS This national cohort study was conducted in Sweden with data from 1973 through 2015. All singleton live births in Sweden during 1973 through 2014 were included. EXPOSURES Gestational age at birth, identified from nationwide birth records. MAIN OUTCOMES AND MEASURES Heart failure, as identified from inpatient and outpatient diagnoses through 2015. Cox regression was used to determine hazard ratios (HRs) for HF associated with gestational age at birth while adjusting for other perinatal and maternal factors. Cosibling analyses assessed for potential confounding by unmeasured shared familial (genetic and/or environmental) factors. RESULTS A total of 4 193 069 individuals were included (maximum age, 43 years; median age, 22.5 years). In 85.0 million person-years of follow-up, 4158 persons (0.1%) were identified as having HF (median [interquartile range] age, 15.4 [28.0] years at diagnosis). Preterm birth (gestational age <37 weeks) was associated with increased risk of HF at ages younger than 1 year (adjusted HR [aHR], 4.49 [95% CI, 3.86-5.22]), 1 to 17 years (aHR, 3.42 [95% CI, 2.75-4.27]), and 18 to 43 years (aHR, 1.42 [95% CI, 1.19-1.71]) compared with full-term birth (gestational age, 39-41 weeks). At ages 18 through 43 years, the HRs further stratified by gestational age were 4.72 (95% CI,) for extremely preterm births (22-27 weeks), 1.93 (95% CI, 1.37-2.71) for moderately preterm births (28-33 weeks), 1.24 (95% CI, 1.00-1.54) for late preterm births (34-36 weeks), and 1.09 (95% CI, 0.97-1.24) for early term births (37-38 weeks). The corresponding HF incidence rates (per 100 000 person-years) at ages 18 through 43 years were 31.7, 13.8, 8.7, and 7.3, respectively, compared with 6.6 for full-term births. These associations persisted when excluding persons with structural congenital cardiac anomalies. The associations at ages 18 through 43 years (but not <18 years) appeared to be largely explained by shared determinants of preterm birth and HF within families. Preterm birth accounted for a similar number of HF cases among male and female individuals. CONCLUSIONS AND RELEVANCEIn this large national cohort, preterm birth was associated with increased risk of new-onset HF into adulthood. Survivors of preterm birth may need long-term clinical follow-up into adulthood for risk reduction and monitoring for HF.

Physiological aspects of cardiopulmonary dysanapsis on exercise in adults born preterm

“…Recent studies have shown that respiratory (Lovering et al 2013(Lovering et al , 2014Duke et al 2014Duke et al , 2018Molgat-Seon et al 2019), cardiopulmonary (Laurie et al 2018;Goss et al 2018;Mulchrone et al 2020) and cardiovascular (Lewandowski et al 2013b;Huckstep et al 2018Huckstep et al , 2020, impairments persist into adulthood for preterms. These lead to high risk for early onset of chronic obstructive pulmonary disease (COPD), congestive heart failure, pulmonary hypertension and systemic vascular disease in adulthood (Carr et al 2017;Goss et al 2018;Crump et al 2019bCrump et al , 2019aCrump et al , 2020Crump et al , 2021Mulchrone et al 2020). In Table 1 we outline these known and unknown impairments that could or do contribute to a lesser aerobic exercise capacity in adults born preterm.…”

Association of Preterm Birth With Myocardial Fibrosis and Diastolic Dysfunction in Young Adulthood

“…Preterm birth (<37 gestational weeks) affects >10% of live births worldwide ( 1 ) and abruptly interrupts the trajectory of cardiac development, leading to neonatal ( 2 ) and long-term ( 3 ) morbidity. Large-scale birth registries investigating the impact of being born preterm have shown an increased risk for cardiovascular diseases by childhood and adulthood, including heart failure ( 4 , 5 ), ischemic heart disease ( 6 ), and early cardiovascular-related mortality ( 7 ).…”

Association of Preterm Singleton Birth With Fertility Treatment in the US

“…with term newborns. 4,5 It is imperative to identify the essential risk factors for preterm birth and to enhance perinatal and neonatal management.…”