Department of Pediatrics, Hvidovre University Hospital, Hvidovre, Denmark.
Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
JAMA Netw Open. 2018 Dec 7;1(8):e186085. doi: 10.1001/jamanetworkopen.2018.6085.
The poor health outcomes associated with preterm birth are well established. However, it is less clear how small variations in gestational age, even within the term range, are associated with long-term opportunities and well-being, as measured by socioeconomic outcomes in adulthood.
To examine the association of gestational age at birth with educational achievement, income, and primary source of income in adulthood.
DESIGN, SETTING, AND PARTICIPANTS: This Danish population-based, register-based cohort study examined all live-born singletons born in Denmark from 1982 to 1986 without congenital anomalies and who lived in Denmark at age 28 years. Data analysis was conducted from November 2, 2017, to June 15, 2018.
Gestational age at birth in completed weeks (22-45 weeks).
Educational attainment, personal income, and primary source of income at age 28 years.
In a population of 228 030 singletons (4.0% preterm, 12.1% early term; 49.4% female), 36.3% had a tertiary education at age 28 years. Among adults born at 22 to 27 weeks of gestation, 21.6% had a tertiary education, and 23.2% had an income in the highest tertile. Using 40 weeks of gestation as the reference, the adjusted odds ratio for tertiary education for individuals born at 22 to 27 weeks of gestation was 0.21 (95% CI, 0.13-0.35) and the corresponding figures for 28 to 31, 33, 36, 38, and 43 to 45 weeks of gestation were 0.45 (95% CI, 0.37-0.55), 0.67 (95% CI, 0.54-0.83), 0.84 (95% CI, 0.77-0.93), 0.85 (95% CI, 0.81-0.89), and 0.93 (95% CI, 0.83-1.04), respectively. The adjusted odds ratio for highest income tertile for individuals born at 22 to 27 weeks of gestation was 0.66 (95% CI, 0.41-1.06) and the corresponding figures for 28 to 31, 33, 36, 38, and 43 to 45 weeks of gestation were 0.80 (95% CI, 0.68-0.94), 0.77 (95% CI, 0.63-0.93), 0.89 (95% CI, 0.82-0.96), 0.95 (95% CI, 0.91-0.99), and 1.00 (95% CI, 0.91-1.12), respectively. All estimates were adjusted for sex, birth year, parity, maternal age, maternal education, and maternal country of origin.
Shorter gestational duration even within the term range was associated with poorer socioeconomic outcomes in adulthood. While adults born at 35 to 38 weeks of gestation experienced only slightly increased risk of adverse socioeconomic outcomes, this may have a significant impact on public health, since a large proportion of all children are born in these weeks.
早产与较差的健康结果有关，这一点已得到充分证实。然而，较小的妊娠年龄变化，即使在足月范围内，与成年后社会经济结果相关的长期机会和福祉的关系还不太清楚，这些结果通过社会经济结果来衡量，如成年后的教育程度、收入和主要收入来源。
研究出生时的胎龄与成年后的教育成就、收入和主要收入来源之间的关系。
设计、地点和参与者：这项丹麦基于人群的、基于登记册的队列研究调查了 1982 年至 1986 年期间丹麦所有无先天异常且在 28 岁时居住在丹麦的单胎活产儿。数据分析于 2017 年 11 月 2 日至 2018 年 6 月 15 日进行。
出生时的胎龄（22-45 周）。
28 岁时的教育程度、个人收入和主要收入来源。
在 228030 名单胎儿（4.0%早产儿，12.1%早期早产儿；49.4%女性）中，36.3%在 28 岁时有高等教育学历。在 22 至 27 周出生的成年人中，21.6%接受了高等教育，23.2%的人收入处于最高三分之一。以 40 周的胎龄为参考，22 至 27 周出生的个体接受高等教育的调整后比值比为 0.21（95%置信区间，0.13-0.35），28 至 31 周、33 周、36 周、38 周和 43 至 45 周的相应数字为 0.45（95%置信区间，0.37-0.55）、0.67（95%置信区间，0.54-0.83）、0.84（95%置信区间，0.77-0.93）、0.85（95%置信区间，0.81-0.89）和 0.93（95%置信区间，0.83-1.04）。22 至 27 周出生的个体中收入最高三分之一的调整后比值比为 0.66（95%置信区间，0.41-1.06），28 至 31 周、33 周、36 周、38 周和 43 至 45 周的相应数字为 0.80（95%置信区间，0.68-0.94）、0.77（95%置信区间，0.63-0.93）、0.89（95%置信区间，0.82-0.96）、0.95（95%置信区间，0.91-0.99）和 1.00（95%置信区间，0.91-1.12）。所有估计均根据性别、出生年份、胎次、母亲年龄、母亲教育程度和母亲原籍国进行了调整。
即使在足月范围内，妊娠时间较短与成年后的社会经济结果较差有关。虽然在 35 至 38 周出生的成年人仅略微增加了不良社会经济结果的风险，但这可能对公共卫生产生重大影响，因为大部分儿童都在这些周出生。
