Outcomes of Prematurity… Pregnancy!

One very long term outcome study of premature infants has just been published by my colleagues from Sainte Justine: Boivin A, Luo Z-C, Audibert F, Mâsse B, Lefebvre F, Tessier R, Nuyt AM: Pregnancy complications among women born preterm. Canadian Medical Association Journal 2012. Using a linked data base approach, the authors examined what pregnancy complications were recorded among women who themselves had been born prematurely. They found that the more preterm the woman was born the higher the risk of pregnancy complications when she was pregnant herself. The complications examined were pre-eclampsia, gestational hypertension and gestational diabetes. and the risk of having at least one of these increased from 9.6% among women born at term to 17% among the very prematurely (before 32 weeks) born women during their first pregnancy. There are multiple possible explanations for this finding: it could be that there is a genetic component to these complications, and that the mothers of the included women had the same complications, which increased their chances of delivering prematurely. It could be that being born prematurely changes you cardiovascular development, or your insulin resistance profile (see Barker hypothesis).

Anne-Monique Nuyt and her co-workers also found that being Small for Gestational Age increased the same risks, and did so in an additive fashion across the groups of women, term, premature, and very premature.

This very interesting study has much stronger data than other previous attempts to investigate this issue, and includes over 7400 women who were born preterm and then delivered a baby (and 2 controls for each former preterm woman). I don’t think we should include this in our prenatal counselling guidelines! (Even though total disclosure of everything is the expected norm) but I do think it warrants some more thought and more investigation.

About keithbarrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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