Swamy Geeta K, Ostbye Truls, Skjaerven Rolv
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27710, USA.
JAMA. 2008 Mar 26;299(12):1429-36. doi: 10.1001/jama.299.12.1429.
Preterm birth is a major cause of infant morbidity and mortality. Less is known about long-term health among persons born preterm.
To determine the long-term effects of preterm birth on survival, reproduction, and next-generation preterm birth.
DESIGN, SETTING, AND PARTICIPANTS: Population-based, observational, longitudinal study using registry data from 1,167,506 singleton births in the Medical Birth Registry of Norway in 1967-1988. The cohort was followed up through 2002 for survival. The cohort was truncated to births from 1967-1976 for assessment of educational achievement and reproductive outcomes through 2004.
In relation to sex and gestational age at birth, absolute mortality, risk of fetal, infant, child, and adolescent mortality, and incidence and risk of reproduction and next-generation preterm birth. Singleton term (37-42 weeks) fetal deaths and live births, stratified by sex, served as the reference group for all analyses.
The percentage who were born preterm was higher among boys (5.6%) than among girls (4.7%). Preterm participants had an increased risk of mortality throughout childhood. For boys born at 22 to 27 weeks, mortality rates were 1.33% and 1.01% for early and late childhood death, with relative risks (RRs) of 5.3 (95% confidence interval [CI], 2.0-14.2) and 7.0 (95% CI, 2.3-22.0), respectively. The mortality rate for girls born at 22 to 27 weeks was 1.71% for early childhood death, with an RR of 9.7 (95% CI, 4.0-23.7); there were no late childhood deaths. For 28 to 32 weeks, the early and late childhood mortality rates among boys were 0.73% and 0.37%, with RRs of 2.5 (95% CI, 1.6-3.7) and 2.3 (95% CI, 1.3-4.1), respectively. Girls born at 28 to 32 weeks did not have a significantly increased risk of childhood mortality. Reproduction was diminished for index participants born preterm. For men and women born at 22 to 27 weeks, absolute reproduction was 29.3[corrected]% and 51.9[corrected]%, with RRs of 0.59 [corrected] (95% CI, 0.45[corrected]-0.79[corrected]) and 0.78 [corrected] (95% CI, 0.65[corrected]-0.93[corrected]), respectively. For 28 to 32 weeks, absolute reproduction was 43.1[corrected]% and 63.6[corrected]% for men and women, with RRs of 0.81[corrected] (95% CI, 0.77[corrected]-0.86[corrected]) and 0.89 [corrected] (95% CI, 0.86 [corrected]-0.93 [corrected]), respectively. Preterm women but not men were at increased risk of having preterm offspring.
In persons born in Norway in 1967-1988, preterm birth was associated with diminished long-term survival and reproduction.
早产是婴儿发病和死亡的主要原因。对于早产出生者的长期健康状况，人们了解较少。
确定早产对生存、生育以及下一代早产的长期影响。
设计、地点和参与者：基于人群的观察性纵向研究，使用了挪威医疗出生登记处1967 - 1988年1,167,506例单胎出生的登记数据。该队列随访至2002年以了解生存情况。队列截断为1967 - 1976年出生者，以评估截至2004年的教育成就和生殖结局。
与出生时的性别和胎龄相关的绝对死亡率、胎儿、婴儿、儿童和青少年死亡风险，以及生育和下一代早产的发生率及风险。单胎足月儿（37 - 42周）的胎儿死亡和活产，按性别分层，作为所有分析的参照组。
早产出生的男孩比例（5.6%）高于女孩（4.7%）。早产参与者在整个童年期的死亡风险增加。对于22至27周出生的男孩，儿童早期和晚期死亡的死亡率分别为1.33%和1.01%，相对风险（RRs）分别为5.3（95%置信区间[CI]，2.0 - 14.2）和7.0（95% CI，2.3 - 22.0）。22至27周出生的女孩儿童早期死亡的死亡率为1.71%，RR为9.7（95% CI，4.0 - 23.7）；无儿童晚期死亡。对于28至32周出生的男孩，儿童早期和晚期死亡率分别为0.73%和0.37%，RRs分别为2.5（95% CI，1.6 - 3.7）和2.3（95% CI，1.3 - 4.1）。28至32周出生的女孩儿童期死亡风险未显著增加。早产的索引参与者生育能力下降。对于22至27周出生的男性和女性，绝对生育力分别为29.3[校正]%和51.9[校正]%，RRs分别为0.59[校正]（95% CI，0.45[校正] - 0.79[校正]）和0.78[校正]（95% CI，0.65[校正] - 0.93[校正]）。对于28至32周出生的男性和女性，绝对生育力分别为43.1[校正]%和63.6[校正]%，RRs分别为0.81[校正]（95% CI，0.77[校正] - 0.86[校正]）和0.89[校正]（95% CI，0.86[校正] - 0.93[校正]）。早产女性而非男性生育早产后代的风险增加。
在1967 - 1988年出生于挪威的人群中，早产与长期生存和生育能力下降有关。
