Walters Anthony G B, Gamble Greg D, Crowther Caroline A, Dalziel Stuart R, Eagleton Carl L, McKinlay Christopher J D, Milne Barry J, Harding Jane E
Liggins Institute, Auckland, New Zealand.
Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.
Pediatrics. 2025 Jan 1;155(1). doi: 10.1542/peds.2024-066929.
Preterm birth results in neonatal and childhood morbidity and mortality. Additionally, population-based studies show poorer cardiovascular health in adult survivors, but a full range of health outcomes has not been investigated into midlife. We aimed to assess the health outcomes after preterm vs term birth at 50 years in survivors of a randomized trial of antenatal betamethasone.
Participants were asked to complete a health questionnaire and for consent to access administrative data. Participants deceased prior to follow-up were assessed with administrative data alone. The primary outcome was a composite: any of diabetes mellitus, prediabetes, treated hypertension, treated dyslipidemia, or a previous major adverse cardiovascular event. Secondary outcomes included respiratory, mental health, educational, and other health outcomes.
We included 470 participants: 424 assessed at mean age 49.3 years and 46 who died after infancy. The primary outcome occurred in 34.5% (112/325) of those born preterm and 29.9% (43/144) of those born at term; adjusted relative risk (aRR) 1.14 (95% CI, 0.85-1.54; P = .37). Cardiovascular events were less common in those born preterm (9/326 [2.8%] vs 10/144 [6.9%]; aRR 0.33, 95% CI, 0.14-0.79), while self-reported hypertension was more common (101/291 [34.7%] vs 23/116 [19.8%]; aRR 1.74, 95% CI, 1.16-2.61), although treated hypertension was not statistically significantly different (66/323 [20.4%] vs 22/143 [15.4%]; aRR 1.32, 95% CI, 0.84-2.06). Other components of the composite endpoint were similar between those born preterm and at term.
Those aged 50 years born preterm were more likely to have hypertension but had similar risk of diabetes, prediabetes, and dyslipidemia than those born at term, and their risk of cardiovascular events was lower.
早产会导致新生儿及儿童期发病和死亡。此外，基于人群的研究表明，成年幸存者的心血管健康状况较差，但尚未对中年时期的一系列健康结局进行调查。我们旨在评估产前倍他米松随机试验的幸存者在50岁时早产与足月出生后的健康结局。
要求参与者完成一份健康问卷并同意获取行政数据。在随访前死亡的参与者仅通过行政数据进行评估。主要结局是一个复合指标：糖尿病、糖尿病前期、治疗的高血压、治疗的血脂异常或既往重大心血管事件中的任何一项。次要结局包括呼吸、心理健康、教育及其他健康结局。
我们纳入了470名参与者：424名在平均年龄49.3岁时接受评估，46名在婴儿期后死亡。主要结局在早产出生者中发生率为34.5%（112/325），足月出生者中为29.9%（43/144）；调整后相对风险（aRR）为1.14（95%CI，0.85 - 1.54；P = 0.37）。心血管事件在早产出生者中较少见（9/326 [2.8%] 对比10/144 [6.9%]；aRR 0.33，95%CI，0.14 - 0.79），而自我报告的高血压更常见（101/291 [34.7%] 对比23/116 [19.8%]；aRR 1.74，95%CI，1.16 - 2.61），尽管治疗的高血压在统计学上无显著差异（66/323 [20.4%] 对比22/143 [15.4%]；aRR 1.32，95%CI，0.84 - 2.06）。复合终点的其他组成部分在早产和足月出生者之间相似。
50岁的早产出生者患高血压的可能性更大，但与足月出生者相比，患糖尿病、糖尿病前期和血脂异常的风险相似，且其心血管事件风险较低。
