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pregnancy, prematurity

Preterm birth linked with increased death later in life: the study that breaks my heart:

It’s not enough that premature birth (a delivery before 37 weeks), which affects 12% of all American newborns, is the leading cause if infant death.

It’s also not enough that premature delivery is the leading cause of disability among children.

No, a new study has to come out telling us that adults who were born prematurely are simply more likely to die when compared with adults who were born after a full 37 weeks of pregnancy.

Sigh.

The study, published in JAMA in September (2011), is from the impressive Swedish Birth and Death Registries. They study followed more than 600,000 people born between 1973 and 1979 until 2008 (so to the age of 29-36). The study controlled for confounders such as sex, birth year, fetal growth, birth order, maternal age at birth, maternal marital status, and maternal and paternal education.

During the study period 5% of births in Sweden were premature (for which we should feel very, very ashamed. That’s the outcome of high quality, universal prenatal care, BTW).

The outcome:

Each additional week of pregnancy confers an 8% survival advantage for children between the ages of 1 and 5 years (so, born at 26 weeks, my boys were apparently shortchanged 88% in the whole survival odds thing…dodged that bullet, but given the number of ICU admissions for poor Oliver, we dodged it narrowly). By the age of 18- to 36-years, each additional week of pregnancy gives a 4% survival advantage. So it seems that my boys are 44% more likely to die than their peers. Better than 88%, but it still fucking sucks.

The cause of death? Birth defects (a common cause of premature delivery), usually heart defects (super great, because Oliver has a bitchin’ heart defect), breathing problems (oh yeah, he has lung disease too), and hormone issues (my God, Victor has that). It really sucks reading a study, looking at all the bad outcome variables and after each one you read, you think, “check.”

So I guess this means when you are a parent of a premature baby you will always be worried, more worried than many, many other parents. And for those of us with extremely premature babies, well the greatest risks were for those babies born at 27 weeks or earlier (yet another unlucky demographic that hits too close to home).

What positives can we take from this?

Well, seeking out excellent care. Being complaint with medications. Not smoking in the house. Getting vaccinations and spreading the word so other get vaccinated too (premature babies, who often have weakened immune systems for years, and much more dependent on herd immunity). Try and eat healthy. Exercise. Be positive.

But apart from that, there is nothing really concrete. No medication to reduce the risk. No preventative surgery.

I hate this study. I hate it because it has confirmed for me what I have always known in my heart. That there is no “out of the woods” with prematurity. And now I know there is no salve to heal my wounds.

Not even time.

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Discussion

2 thoughts on “Preterm birth linked with increased death later in life: the study that breaks my heart:

  1. Sometimes it’s hard to know too much. I hope your boys beat the odds, as some DO.

    Posted by PGYx | September 30, 2011, 3:16 am
  2. Two thoughts – it was a study of singletons not twins I think? Twins are frequently born a little smaller and often early.

    Also In glancing at the study the risk is still very very low. It looks like there were only 7095 deaths out of 674 820 so just about 1 in 1000? for all children whether they were born premature or not.

    So I wouldn’t worry too much about the stats and instead just focus on your own child who is 1 of 1 well in this case 1 of 2 perhaps. He is blessed since so few preemies have mom’s who are health care providers like yourself.

    Posted by georgia e | September 30, 2011, 6:50 am

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