Stroke Risks in Adult Survivors of Preterm Birth: National Cohort and Cosibling Study.
Stroke Risks in Adult Survivors of Preterm Birth: National Cohort and Cosibling Study.
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DOI：
10.1161/strokeaha.120.033797
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发表时间：
2021-08
期刊：
影响因子：
8.3
通讯作者：
Sundquist K
中科院分区：
文献类型：
--
作者：
Crump C;Sundquist J;Sundquist K
Clinicians will increasingly encounter adult patients who were born preterm and will need to understand their long-term sequelae. Adult survivors of preterm birth have been reported to have increased risks of hypertension and other stroke risk factors. However, their stroke risks have seldom been examined and the findings are discrepant, possibly due to small sample sizes, insufficient follow-up, or survivor bias. We examined whether preterm birth is associated with stroke in a large population-based cohort. A national cohort study was conducted of all 2,140,866 singletons born in Sweden during 1973–1994 who survived to age 18 years, who were followed up for first-time stroke through 2015 (maximum age 43). Cox regression was used to examine stroke risks associated with gestational age at birth, adjusting for other perinatal and parental factors. Co-sibling analyses assessed for potential confounding by shared familial (genetic and/or environmental) factors. In 28.0 million person-years of follow-up, 4,861 (0.2%) persons were diagnosed with stroke. At ages 18–43 years, the adjusted hazard ratio (aHR) for stroke associated with preterm birth (<37 weeks) was 1.26 (95% CI, 1.12–1.43; P<0.001), and further stratified was 1.42 (1.11–1.81; P=0.005) for early preterm (22–33 weeks) and 1.22 (1.06–1.40; P=0.004) for late preterm (34–36 weeks), compared with full-term (39–41 weeks). Positive associations were found with both hemorrhagic stroke (early preterm: aHR, 1.42; 95% CI, 1.04–1.94; any preterm: 1.15; 0.97–1.35) and ischemic stroke (early preterm: 1.33; 0.87–2.03; any preterm: 1.31; 1.07–1.60). These findings were similar in men and women and only partially explained by shared determinants of preterm birth and stroke within families. In this large national cohort, preterm birth was associated with increased risks of both hemorrhagic and ischemic stroke in adulthood. Preterm birth survivors need early preventive evaluation and long-term clinical follow-up to reduce their lifetime risk of stroke. Adjusted hazard ratios (aHRs) for first-time stroke at ages 18-43 years by gestational age at birth, Sweden, 1973–2015 (dotted lines represent 95% CI). Early preterm (22–33 weeks) and late preterm (34–36 weeks) birth were associated with 1.4-fold (aHR, 1.42; 95% CI, 1.11-1.81; P=0.005) and 1.2-fold (aHR, 1.22; 1.06–1.40; P=0.004) risks of stroke, respectively, compared with full-term birth (39–41 weeks). Preterm birth should be recognized as a risk factor for stroke later in life. Preterm birth survivors may need early preventive evaluation and long-term clinical follow-up to reduce their lifetime risk of stroke.
