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. 2012 Mar 1:344:e896.
doi: 10.1136/bmj.e896.

Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study

Elaine M Boyle  1 , Gry Poulsen, David J Field, Jennifer J Kurinczuk, Dieter Wolke, Zarko Alfirevic, Maria A Quigley
Affiliations

Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study

Elaine M Boyle et al. BMJ. .

Abstract

Objective: To investigate the burden of later disease associated with moderate/late preterm (32-36 weeks) and early term (37-38 weeks) birth.

Design: Secondary analysis of data from the Millennium Cohort Study (MCS).

Setting: Longitudinal study of infants born in the United Kingdom between 2000 and 2002.

Participants: 18,818 infants participated in the MCS. Effects of gestational age at birth on health outcomes at 3 (n = 14,273) and 5 years (n = 14,056) of age were analysed.

Main outcome measures: Growth, hospital admissions, longstanding illness/disability, wheezing/asthma, use of prescribed drugs, and parental rating of their children's health.

Results: Measures of general health, hospital admissions, and longstanding illness showed a gradient of increasing risk of poorer outcome with decreasing gestation, suggesting a "dose-response" effect of prematurity. The greatest contribution to disease burden at 3 and 5 years was in children born late/moderate preterm or early term. Population attributable fractions for having at least three hospital admissions between 9 months and 5 years were 5.7% (95% confidence interval 2.0% to 10.0%) for birth at 32-36 weeks and 7.2% (1.4% to 13.6%) for birth at 37-38 weeks, compared with 3.8% (1.3% to 6.5%) for children born very preterm (<32 weeks). Similarly, 2.7% (1.1% to 4.3%), 5.4% (2.4% to 8.6%), and 5.4% (0.7% to 10.5%) of limiting longstanding illness at 5 years were attributed to very preterm birth, moderate/late preterm birth, and early term birth.

Conclusions: These results suggest that health outcomes of moderate/late preterm and early term babies are worse than those of full term babies. Additional research should quantify how much of the effect is due to maternal/fetal complications rather than prematurity itself. Irrespective of the reason for preterm birth, large numbers of these babies present a greater burden on public health services than very preterm babies.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow chart of eligibility and participation
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Fig 2 Classification of weight status according to body mass index at 3 and 5 years for gestational age groups
See this image and copyright information in PMC

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