Medical history taking in adults should include questions about preterm birthBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4860 (Published 01 August 2014) Cite this as: BMJ 2014;349:g4860
- Casey Crump, clinical assistant professor of medicine, Department of Medicine, Stanford University, Palo Alto, California 94304-1426, USA
Clinicians increasingly encounter adult patients who were born preterm (after fewer than 37 completed weeks of gestation). Advances in neonatal care that were introduced in the 1970s and 1980s, including high frequency ventilation, surfactant therapy, and antenatal corticosteroids, have enabled unprecedented numbers of such infants to survive. The first generation to benefit from those advances are now young adults. And a growing body of evidence for long term health consequences has contributed to a developmental model for early life origins of chronic disease.
Variations in fetal and postnatal nutrition are hypothesised to permanently alter gene expression, resulting in so called programming for the onset of chronic disease in later life.1 This involves a complex interplay of hormonal and immunological mechanisms and is commonly associated with preterm birth. Epidemiological studies have shown that the long term health consequences are wide ranging, including increased risks of diabetes, cardiovascular disease, respiratory disease, and neurological and psychiatric disorders into adulthood.2 3 4 5 These health effects also carry increased long term risks of mortality.
In a large national cohort study in Sweden, my colleagues and I found that among all people who survived …