Lung function in adults born preterm

PLoS One. 2018 Oct 19;13(10):e0205979. doi: 10.1371/journal.pone.0205979. eCollection 2018.

Abstract

Very preterm birth, before the gestational age (GA) of 32 weeks, increases the risk of obstructed airflow in adulthood. We examined whether all preterm births (GA<37 weeks) are associated with poorer adult lung function and whether any associations are explained by maternal, early life/neonatal, or current life factors. Participants of the ESTER Preterm Birth Study, born between 1985 and 1989 (during the pre-surfactant era), at the age of 23 years participated in a clinical study in which they performed spirometry and provided detailed medical history. Of the participants, 139 were born early preterm (GA<34 weeks), 239 late preterm (GA: 34-<37 weeks), and 341 full-term (GA≥37 weeks). Preterm birth was associated with poorer lung function. Mean differences between individuals born early preterm versus full-term were -0.23 standard deviation (SD) (95% confidence interval (CI): -0.40, -0.05)) for forced vital capacity z-score (zFVC), -0.44 SD (95% CI -0.64, -0.25) for forced expiratory volume z-score (zFEV1), and -0.29 SD (95% CI -0.47, -0.10) for zFEV1/FVC. For late preterm, mean differences with full-term controls were -0.02 SD (95% CI -0.17, 0.13), -0.12 SD (95% CI -0.29, 0.04) and -0.13 SD (95% CI -0.29, 0.02) for zFVC, zFEV1, and zFEV1/FVC, respectively. Examination of finer GA subgroups suggested an inverse non-linear association between lung function and GA, with the greatest impact on zFEV1 for those born extremely preterm. The subgroup means were GA<28 weeks: -0.98 SD; 28-<32 weeks: -0.29 SD; 32-<34 weeks: -0.44 SD; 34-<36 weeks: -0.10 SD; 36-<37weeks: -0.11 SD; term-born controls (≥37weeks): 0.02 SD. Corresponding means for zFEV1/FVC were -1.79, -0.44, -0.47, -0.48, -0.29, and -0.02. Adjustment for maternal pregnancy conditions and socioeconomic and lifestyle factors had no major impact on the relationship. Preterm birth is associated with airflow limitation in adult life. The association appears to be attributable predominantly to those born most immature, with only a modest decrease among those born preterm at later gestational ages.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Case-Control Studies
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Linear Models
  • Lung / physiopathology*
  • Lung Diseases, Obstructive / physiopathology
  • Male
  • Pregnancy
  • Premature Birth / physiopathology*
  • Respiratory Function Tests
  • Young Adult

Grants and funding

This study was funded by the Academy of Finland (SALVE programme for 2009–2012 and grants 127437, 129306, 130326, 134791, and 263924 to EK; The Doctoral Program for Public Health, University of Tampere (to MSL); Emil Aaltonen Foundation to EK; The European Commission (Framework 5 award QLG1-CT-2000-001643 and Horizon2020 award 733280 RECAP to EK) to Dr M-RJ; Finnish Foundation for Paediatric Research to EK; Finnish Government Special Subsidiary for Health Sciences (evo) (to JGE); Finnish Medical Society Duodecim to EK; Finska Läkaresällskapet to EK; Jalmari and Rauha Ahokas Foundation to EK and PGN; Juho Vainio Foundation to EK and MSL; National Graduate School of Clinical Investigation to MT; Novo Nordisk Foundation to EK and MV; Päivikki and Sakari Sohlberg Foundation to PNG; Research Foundation of the Pulmonary Diseases to PNG; Signe and Ane Gyllenberg Foundation to EK, JGE and PNG; Sigrid Jusélius Foundation to EK; Yrjö Jahnsson Foundation to EK, MSL, and MV. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.