Departments of Family Medicine and Community Health, and of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Center for Primary Health Care Research, Lund University, Malmö, Sweden.
Int J Epidemiol. 2021 Nov 10;50(5):1604-1614. doi: 10.1093/ije/dyab038.
Adverse perinatal exposures have been associated with psychiatric disorders and suicidal behaviours later in life. However, the independent associations of gestational age at birth or fetal growth with suicide death, potential sex-specific differences, and causality of these associations are unclear.
A national cohort study was conducted of all 2 440 518 singletons born in Sweden during 1973-98 who survived to age 18 years, who were followed up through 2016. Cox regression was used to compute hazard ratios (HRs) for suicide death associated with gestational age at birth or fetal growth while mutually adjusting for these factors, sociodemographic characteristics and family history of suicide. Co-sibling analyses assessed the influence of unmeasured shared familial (genetic and/or environmental) factors.
In 31.2 million person-years of follow-up, 4470 (0.2%) deaths by suicide were identified. Early preterm birth (22-33 weeks) was associated with an increased risk of suicide among females [adjusted hazard ratio (HR), 1.97; 95% confidence interval CI), 1.29, 3.01; P = 0.002) but not males (0.90; 0.64, 1.28; P = 0.56), compared with full-term birth (39-41 weeks). Small for gestational age was associated with a modestly increased risk of suicide among females (adjusted HR, 1.27; 95% CI, 1.08, 1.51; P = 0.005) and males (1.14; 1.03, 1.27; P = 0.02). However, these associations were attenuated and non-significant after controlling for shared familial factors.
In this large national cohort, preterm birth in females and low fetal growth in males and females were associated with increased risks of suicide death in adulthood. However, these associations appeared to be non-causal and related to shared genetic or prenatal environmental factors within families.
围产期不良暴露与以后生活中的精神障碍和自杀行为有关。然而，出生时的胎龄或胎儿生长与自杀死亡的独立关联、潜在的性别特异性差异以及这些关联的因果关系尚不清楚。
对瑞典 1973 年至 1998 年间出生的所有 2440518 名单胎活产儿进行了一项全国性队列研究，这些儿童在 18 岁时随访至 2016 年。采用 Cox 回归计算与出生时胎龄或胎儿生长相关的自杀死亡风险比（HR），同时相互调整这些因素、社会人口特征和自杀家族史。同胞分析评估了未测量的共同家族（遗传和/或环境）因素的影响。
在 3120 万人年的随访中，共确定了 4470 例（0.2%）自杀死亡。与足月出生（39-41 周）相比，早产（22-33 周）与女性自杀风险增加相关[调整后的 HR，1.97；95%置信区间（CI），1.29，3.01；P=0.002]，但与男性无关（0.90；0.64，1.28；P=0.56）。小于胎龄与女性（调整后的 HR，1.27；95% CI，1.08，1.51；P=0.005）和男性（1.14；1.03，1.27；P=0.02）自杀风险略有增加相关。然而，在控制了共同的家族因素后，这些关联减弱且不再具有统计学意义。
在这项大型全国性队列研究中，女性早产和男性及女性胎儿生长不良与成年后自杀死亡风险增加相关。然而，这些关联似乎是非因果的，与家庭内共同的遗传或产前环境因素有关。
