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Preterm birth and mortality and morbidity: a population-based quasi-experimental study
Brian M D'Onofrio1, Quetzal A Class, Martin E Rickert
1Department of Psychological and Brain Sciences, Indiana University-Bloomington.
JAMA Psychiatry
|September 27, 2013
Summary
Preterm birth is linked to mortality and psychiatric issues, largely independent of family factors. However, academic and social problems associated with preterm birth may stem from confounding influences.
Area of Science:
- Perinatal Epidemiology
- Developmental Psychology
- Public Health
Background:
- Preterm birth is a significant risk factor for infant and long-term offspring mortality and morbidity.
- Previous research has struggled to disentangle the direct effects of preterm birth from potential confounding familial factors.
Purpose of the Study:
- To investigate the extent to which associations between early gestational age and offspring mortality and morbidity are attributable to confounding factors.
- To utilize a sibling-comparison approach within a large population-based cohort to control for unmeasured familial confounds.
Main Methods:
- A population-based cohort study using Swedish registries, linking over 3.3 million individuals born between 1973 and 2008.
- Employed a quasi-experimental sibling-comparison design to mitigate confounding by shared family environment and genetics.
- Examined associations between gestational age and a wide range of outcomes, including mortality, psychiatric disorders, academic achievement, and social factors.
Main Results:
- A dose-response relationship was observed between earlier gestational age and increased risk for mortality, psychiatric disorders, lower educational attainment, and social welfare benefits.
- Associations between early gestation and mortality and psychiatric morbidity remained robust after controlling for familial factors, suggesting a causal link.
- Associations with academic outcomes and some social problems were significantly attenuated in sibling-comparison models, indicating a substantial role for confounding.
Conclusions:
- The mechanisms underlying preterm birth associations are outcome-specific.
- Mortality and psychiatric morbidity risks associated with preterm birth appear largely causal, independent of shared familial confounds.
- Educational and social outcome associations are significantly influenced by confounding factors, highlighting the need for both preterm birth prevention and family support interventions.
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