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Original Investigation
June 3, 2019

Association of Preterm Birth With Risk of Ischemic Heart Disease in Adulthood

Author Affiliations
  • 1Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
  • 3Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
  • 4The Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
  • 5Departments of Pediatrics and of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
  • 6Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
  • 7Center for Primary Health Care Research, Lund University, Malmö, Sweden
JAMA Pediatr. Published online June 3, 2019. doi:10.1001/jamapediatrics.2019.1327
Key Points

Question  Is preterm birth associated with an increased risk of ischemic heart disease (IHD) in adulthood?

Findings  In this population-based cohort study of 2.1 million persons, preterm birth (gestational age <37 weeks) and early-term birth (37-38 weeks) were associated with 53% and 19% increased relative risks of IHD at ages 30 to 43 years, respectively, compared with full-term birth (39-41 weeks); these were significant increases.

Meaning  Persons born prematurely need long-term follow-up and early preventive actions to reduce the risk of IHD in adulthood.

Abstract

Importance  Preterm birth has previously been associated with increased risks of hypertension and diabetes, but not ischemic heart disease (IHD), in adulthood. The reasons for this lack of association with IHD despite associations with its risk factors have been elusive, but may be associated with methodologic issues, such as survivor bias, in prior studies.

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.

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