Long-term impact of preterm birth on exercise capacity in healthy young men: a national population-based cohort study
Jenny Svedenkrans1, Ewa Henckel, Jan Kowalski
1Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden ; Department of Neonatology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Insights
Preterm birth is linked to lower physical fitness in adulthood, independent of other factors. This reduced exercise capacity, seen even in healthy young men, highlights long-term health implications of prematurity.
Area of Science:
- Public Health
- Cardiovascular Health
- Developmental Pediatrics
Background:
- Preterm birth survivors face poorly understood long-term health risks, including diabetes, obesity, and cardiovascular diseases.
- Reduced physical fitness may be a key factor linking preterm birth to adult diseases.
- This study investigated the association between preterm birth and adult exercise capacity.
Purpose of the Study:
- To determine if preterm birth independently predicts lower physical fitness in adulthood.
- To quantify the association between preterm birth and maximal exercise capacity (Wmax).
- To compare the effect of preterm birth on fitness to other known risk factors.
Main Methods:
- A population-based national cohort study of 218,820 Swedish males conscripted for military service (1993-2001).
- Data linkage with national birth, conscript, and census registers.
- Maximal exercise testing (Wmax) results analyzed using general linear modeling, controlling for perinatal and socioeconomic factors.
Main Results:
- Preterm birth was dose-responsively associated with reduced Wmax, with a 25 Watt reduction for those born ≤27 weeks.
- Low birth weight for gestational age also independently predicted lower Wmax (32 Watt reduction).
- Low parental education and elevated BMI were also associated with reduced Wmax.
Conclusions:
- Preterm birth and being small for gestational age predict lower exercise capacity in young men.
- The impact of preterm birth on fitness is comparable to or greater than other risk factors like low parental education and overweight.
- These findings suggest preterm birth has significant long-term implications for physical fitness and potentially adult health.
Background:
Increasing numbers of survivors of preterm birth are growing into adulthood today. Long-term health-effects of prematurity are still poorly understood, but include increased risk for diabetes, obesity and cardiovascular diseases in adult life. To test if reduced physical fitness may be a link in the causal chain of preterm birth and diseases in later life, the association of preterm birth and adult exercise capacity was investigated. The hypothesis was that preterm birth contributes independently of other risk factors to lower physical fitness in adulthood.
Methods And Findings:
Population-based national cohort study of all males conscripting for military service in 1993-2001 and born in Sweden 1973-1983, n = 218,820. Data were retrieved from the Swedish Conscript Register, the Medical Birth Register and the Population and Housing Census 1990. Primary outcome was the results from maximal exercise test (Wmax in Watt) performed at conscription. Association to perinatal and socioeconomic risk factors, other co-variates and confounders were analysed. General linear modelling showed that preterm birth predicted low Wmax in a dose-response related pattern, with 25 Watt reduction in Wmax for the lowest gestational ages, those born ≤27 weeks. Low birth weight for gestational age also independently predicted low Wmax compared to normal and high birth weight (32 Watt reduction for those with a birth weight Standard Deviation Score <2). Low parental education was significantly associated with reduced Wmax (range 17 Watt), as well as both low and high current BMI, with severe obesity resulting in a 16 Watt deficit compared to Wmax top performance.
Conclusion:
Being born preterm as well as being born small for gestational age predicts low exercise capacity in otherwise healthy young men. The effect size of being born preterm equal or exceed that of other known risk factors for unfitness in adults, such as low parental education and overweight.
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