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Cited by 122Birth, Development, and HealthInfant Development and Preterm CareMaternal and Neonatal Healthcare

Mortality Among Young Adults Born Preterm and Early Term in 4 Nordic Nations

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Risnes, Kari, Bilsteen, Josephine Funck, Brown, Paul, Pulakka, Anna, Andersen, Anne-Marie Nybo, Opdahl, Signe, Kajantie, Eero, Sandin, Sven·2021·JAMA Network Open
DOI 10.1001/jamanetworkopen.2020.32779PMC PMC7794670
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Abstract

Importance: Adverse long-term outcomes in individuals born before full gestation are not confined to individuals born at extreme gestational ages. Little is known regarding mortality patterns among individuals born in the weeks close to ideal gestation, and the exact causes are not well understood; both of these are crucial for public health, with the potential for modification of risk. Objective: To examine the risk of all-cause and noncommunicable diseases (NCD) deaths among young adults born preterm and early term. Design, Setting, and Participants: This multinational population-based cohort study used nationwide birth cohorts from Norway, Sweden, Denmark, and Finland for individuals born between 1967 and 2002. Individuals identified at birth who had not died or emigrated were followed up for mortality from age 15 years to 2017. Analyses were performed from June 2019 to May 2020. Exposures: Categories of gestational age (ie, moderate preterm birth and earlier [23-33 weeks], late preterm [34-36 weeks], early term [37-38 weeks], full term [39-41 weeks] and post term [42-44 weeks]). Main Outcomes and Measures: All-cause mortality and cause-specific mortality from NCD, defined as cancer, diabetes, chronic lung disease, and cardiovascular disease (CVD). Results: A total of 6 263 286 individuals were followed up for mortality from age 15 years. Overall, 339 403 (5.4%) were born preterm, and 3 049 100 (48.7%) were women. Compared with full-term birth, the adjusted hazard ratios (aHRs) for all-cause mortality were 1.44 (95% CI, 1.34-1.55) for moderate preterm birth and earlier; 1.23 (95% CI, 1.18-1.29) for late preterm birth; and 1.12 (95% CI, 1.09-1.15) for early-term birth. The association between gestational age and all-cause mortality were stronger in women than in men (P for interaction = .03). Preterm birth was associated with 2-fold increased risks of death from CVD (aHR, 1.89; 95% CI, 1.45-2.47), diabetes (aHR, 1.98; 95% CI, 1.44-2.73), and chronic lung disease (aHR, 2.28; 95% CI, 1.36-3.82). The main associations were replicated across countries and could not be explained by familial or individual confounding factors. Conclusions and Relevance: The findings of this study strengthen the evidence of increased risk of death from NCDs in young adults born preterm. Importantly, the increased death risk was found across gestational ages up to the ideal term date and includes the much larger group with early-term birth. Excess mortality associated with shorter gestational age was most pronounced for CVDs, chronic lung disease, and diabetes.

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  • These factors include hormones, vitamins, diet-derived metabolites and environmental chemicals.

    “These include hormones, vitamins, diet-derived metabolites and environmental chemicals [48,98,103,104].”

    From Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment (2022) · cites this paper as [103]

    The Introduction discusses early-life development and gestational age, while the Methods describe birth and mortality data; neither identifies hormones, vitamins, diet-derived metabolites, or environmental chemicals as the factors in the citing sentence. Searches for those terms and related exposure terms found no passage addressing the claim. Page numbers were not provided in our copy. (LLM, conf=0.76)

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Authors
Risnes, K., Bilsteen, J. F., Brown, P., Pulakka, A., Andersen, A.-M. N., Opdahl, S., Kajantie, E., & Sandin, S.
Affiliations
  • Norwegian University of Science and Technology (NO)
  • University of Copenhagen (DK)
  • Finnish Institute for Health and Welfare (FI)
  • University of Helsinki (FI)
  • Chinese University of Hong Kong (HK)
Corresponding author
Risnes, Kari
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2021-01-08
Volume
4
Issue
1
Pages
e2032779
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2020.32779
PMC
PMC7794670
OpenAlex
W3118296718
Cited by
122
References
2
Citations by year
2026: 8 · 2025: 16 · 2024: 20 · 2023: 26 · 2022: 28 · 2021: 24
FWCI
24.24
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
  • STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
  • WOS
Funders
  • European Commission
  • Novo Nordisk Fonden (NNF20OC0063930, NNF19OC0057393)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
preterm birth, early term birth, gestational age, all-cause mortality, non-communicable disease mortality, cardiovascular mortality, diabetes mortality, chronic lung disease, cancer mortality, sex differences, young adults, birth cohort, Norway, Sweden, Denmark, Finland, Nordic countries, risk factors, maternal diabetes, maternal hypertension
MeSH terms
Adolescent, Adult, Cause of Death, Denmark, Female, Finland, Gestational Age, Humans, Male, Norway, Risk Factors, Sweden, Premature Birth, Mortality, Premature

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