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Original Investigation
April 5, 2021

Association of Preterm Birth With Long-term Risk of Heart Failure Into 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 Pediatrics, Dell Medical School, The University of Texas at Austin, Austin
  • 4Center for Primary Health Care Research, Lund University, Malmö, Sweden
JAMA Pediatr. Published online April 5, 2021. doi:10.1001/jamapediatrics.2021.0131
Key Points

Question  Is preterm birth associated with an increased risk of heart failure in adulthood?

Findings  In this population-based cohort study of 4.1 million persons, preterm birth (gestational age, <37 weeks) and extremely preterm birth (gestational age, 22-27 weeks) were associated with 1.4-fold and 4.7-fold risks of new-onset heart failure, respectively, at ages 18 to 43 years, compared with individuals born at full term (gestational age, 39-41 weeks), which were significant increases.

Meaning  Survivors of preterm birth may need long-term clinical follow-up into adulthood for risk reduction and monitoring for heart failure.

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, 2.11-10.52) 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 Relevance  In 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.

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