Grand Rounds

Could Preterm Birth Be a Risk Factor for Early Adult Heart Failure?

BACKGROUND AND PURPOSE:

In small clinical studies, preterm birth was associated with altered cardiac structure and increased cardiovascular mortality in the young
In this study, Carr et al. (Journal of the American College of Cardiology, 2017) examines the association between preterm birth and risk of heart failure in children and young adults

Prospective register-based cohort study
2,665,542 individuals born from 1987 to 2012 were followed up from 1 year of age
305 cases were used for this study
Estimates were adjusted for maternal and pregnancy characteristics, socioeconomic status, and maternal and paternal cardiovascular disease
Median individual time of follow-up for all subjects was 13.1 years

Overall incidence as incidence 0.89 per 100,000 person-years
Gestational age was inversely associated with the risk of heart failure
Compared to term (≥37 weeks):
- <28 weeks GA: Increased risk of heart failure (adjusted relative risk 17; 95% CI 7.96 to 36.3)
- 28 – 31 weeks GA: Increased risk of heart failure (adjusted relative risk 3.58; 95% CI 1.57 to 8.14)
- 32 – 36 weeks GA: No risk increase (relative risk: 1.36; 95% CI: 0.87 to 2.13).

Absolute risk for heart failure is still very low
There is a strong association between preterm birth before 32 weeks of gestation and heart failure in childhood and young adulthood
Not clear as to the underlying mechanism for this finding, but alterations of cardiac function in preterm individuals is a known phenomenon
The authors suggest that this study demonstrates preterm birth is a previously unrecognized risk factor for heart failure and survivors of extremely and very preterm birth should be followed more closely for cardiac function

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