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Preterm or early term birth and long-term risk of asthma into midadulthood: a national cohort and cosibling study
Casey Crump1, Jan Sundquist2, Kristina Sundquist2
1Departments of Family Medicine and Community Health and of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA casey.crump@mssm.edu.
Insights
Preterm birth increases the risk of developing asthma from childhood through adulthood. This risk persists even for early term births, highlighting the need for long-term respiratory monitoring.
Area of Science:
- Pediatric Pulmonology
- Epidemiology
- Perinatal Medicine
Background:
- Preterm birth is linked to early-life pulmonary issues.
- Long-term asthma risks associated with preterm birth into adulthood remain unclear.
Purpose of the Study:
- To investigate the association between gestational age at birth and asthma risk from childhood into adulthood.
- Utilized a large, population-based Swedish cohort for comprehensive analysis.
Main Methods:
- Conducted a national cohort study of over 4 million singletons born in Sweden (1973-2013).
- Asthma diagnoses were tracked through nationwide registries up to 2018 (median follow-up 46 years).
- Employed Cox regression and cosibling analyses to adjust for confounders and familial factors.
Main Results:
- Preterm birth was associated with significantly increased asthma risk across all age groups (<10, 10-17, and 18-46 years).
- Risk increased with decreasing gestational age, with extremely preterm births showing the highest association (aHR 3.01).
- Early term births (37-38 weeks) also showed an elevated asthma risk (aHR 1.13) compared to full-term births.
Conclusions:
- Preterm and early term birth are associated with elevated asthma risks extending into mid-adulthood.
- Individuals born prematurely require ongoing, long-term follow-up for early asthma detection and management.
- Findings were robust and not attributable to shared familial factors.
Background:
Preterm birth is associated with pulmonary complications early in life; however, long-term risks of asthma into adulthood are unclear.
Objective:
To determine asthma risks from childhood into adulthood associated with gestational age at birth in a large population-based cohort.
Methods:
A national cohort study was conducted of all 4 079 878 singletons born in Sweden during 1973-2013, followed up for asthma identified from primary care, specialty outpatient and inpatient diagnoses in nationwide registries through 2018 (up to 46 years). Cox regression was used to adjust for potential confounders, and cosibling analyses assessed the influence of unmeasured shared familial (genetic and/or environmental) factors.
Results:
In 91.9 million person-years of follow-up, 607 760 (14.9%) persons were diagnosed with asthma. Preterm birth was associated with increased risk of asthma at ages <10 years (adjusted HR 1.73; 95% CI 1.70 to 1.75), 10-17 years (1.29; 1.27 to 1.32) and 18-46 years (1.19; 1.17 to 1.22). Across all ages, adjusted HRs further stratified were 3.01 (95% CI 2.88 to 3.15) for extremely preterm (22-27 weeks), 1.76 (1.72 to 1.79) for very or moderately preterm (28-33 weeks), 1.31 (1.29 to 1.32) for late preterm (34-36 weeks) and 1.13 (1.12 to 1.14) for early term (37-38 weeks), compared with full-term (39-41 weeks) birth. These findings were not explained by shared familial factors. Asthma risks were elevated after spontaneous or medically indicated preterm birth and with or without perinatal respiratory complications.
Conclusions:
In this large national cohort, preterm and early term birth were associated with increased risks of asthma from childhood into midadulthood. Persons born prematurely need long-term follow-up into adulthood for timely detection and treatment of asthma.
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