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Preterm Birth and Risk of Heart Failure Up to Early Adulthood
Hanna Carr1, Sven Cnattingius1, Fredrik Granath1
1Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Insights
Preterm birth before 32 weeks gestation is linked to a higher risk of heart failure (HF) in children and young adults. This study suggests preterm birth may be an unrecognized risk factor for HF development.
Area of Science:
- Cardiology
- Pediatrics
- Public Health
Background:
- Previous studies indicate preterm birth is associated with cardiac abnormalities and increased cardiovascular mortality in youth.
- Understanding long-term cardiovascular risks following preterm birth is crucial for early intervention.
Purpose of the Study:
- To investigate the association between preterm birth and the risk of developing heart failure (HF) in pediatric and young adult populations.
- To identify specific gestational age thresholds for increased HF risk.
Main Methods:
- A large-scale, register-based cohort study in Sweden (1987-2012) included over 2.6 million individuals.
- Follow-up extended from age 1 year to December 31, 2013, with HF diagnoses identified from national registers.
- Poisson regression analysis, adjusted for multiple covariates, was used to assess the association between preterm birth and incident HF.
Main Results:
- An inverse association was observed between gestational age and HF risk.
- Extremely preterm birth (<28 weeks) showed a 17-fold increased risk of HF, while very preterm birth (28-31 weeks) showed a 3.58-fold increased risk.
- No significant increase in HF risk was found for moderately preterm birth (32-36 weeks).
Conclusions:
- Preterm birth before 32 weeks of gestation is strongly associated with an increased risk of heart failure in childhood and young adulthood.
- While the absolute risk of HF remains low in younger populations, preterm birth emerges as a potential, previously unrecognized risk factor.
- These findings highlight the importance of long-term cardiovascular monitoring for individuals born preterm.
Background:
In small clinical studies, preterm birth was associated with altered cardiac structure and increased cardiovascular mortality in the young.
Objectives:
The goal of this study was to determine the association between preterm birth and risk of incident heart failure (HF) in children and young adults.
Methods:
This register-based cohort study included 2,665,542 individuals born in Sweden from 1987 to 2012 who were followed up from 1 year of age to December 31, 2013. The main study outcome was diagnosis of HF in the National Patient Register or the Cause of Death Register. The association between preterm birth and risk of incident HF was analyzed by using a Poisson regression model. Estimates were adjusted for maternal and pregnancy characteristics, socioeconomic status, and maternal and paternal cardiovascular disease.
Results:
During 34.8 million person-years of follow-up (median 13.1 years), there were 501 cases of HF. After exclusion of 52,512 individuals with malformations (n = 196 cases), 305 cases of HF remained (0.88 per 100,000 person-years). Gestational age was inversely associated with the risk of HF. Compared with individuals born at term (≥37 weeks' gestation), adjusted incidence relative risks for HF were 17.0 (95% confidence interval [CI]: 7.96 to 36.3) after extremely preterm birth (<28 weeks) and 3.58 (95% CI: 1.57 to 8.14) after very preterm birth (28 to 31 weeks). There was no risk increase after moderately preterm birth (32 to 36 weeks) (relative risk: 1.36; 95% CI: 0.87 to 2.13).
Conclusions:
There was a strong association between preterm birth before 32 weeks of gestation and HF in childhood and young adulthood. Although the absolute risk of HF is low in young age, our findings indicate that preterm birth may be a previously unknown risk factor for HF.
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