Preterm birth shown to impact health decades later

The stress preterm infants experience at birth can carry on throughout a lifetime and cause negative health impacts later in life, necessitating the routine inclusion of birth history in medical records and the development of clinical guidelines for adults born preterm, the longest continuously running study of individuals born preterm in the United States has shown.

University of Rhode Island College of Nursing Professor Amy D'Agata is continuing the work that began in the 1980s with a group of babies born preterm at Women & Infants Hospital. Involving 215 people born 35 years ago-including a control group of full-term babies, and preterm babies born at 22 to 36 weeks-the study tracks the successes and difficulties preterm babies continue to face into adulthood, and compares them to the group of participants born full term. The project has so far garnered more than $10 million in research grant funding.

D'Agata, who took over as principal researcher after the retirement of Professor Emeritus Mary Sullivan, has published the most recent results in the Journal of the American Medical Association. The published paper focuses physiological and psychological health outcomes that D'Agata and her team of researchers have identified as the study participants approach 40 years old. Those born preterm have shown a higher risk of high blood pressure, high cholesterol, increased abdominal fat, and low bone density. Psychologically, the group tends to internalize problems, often resulting in increased levels of depression and anxiety.

"Preterm birth is not just a neonatal issue. It, in fact, is a lifelong condition," D'Agata said the study shows. "For individuals who have medical complications early in life, we are now seeing an increased risk of different chronic health issues later in life. We are now realizing that there is a very strong link between what happens to you early in life and later health outcomes."

The study offers important takeaways for health-care clinicians, who are not always aware a patient was born preterm because birth history is not commonly included in adult medical records. D'Agata's study is showing the need to include the information, and to develop adult screening guidelines for individuals who have a history of preterm birth. The work is also helping people who have been impacted by preterm birth understand that their birth history should be included in their medical records and should be considered in the context of their overall health.

"In this country, millions of people born preterm have grown into adulthood and are now seeing clinicians across primary care and various specialties, yet providers rarely ask about birth history," D'Agata said. "We are urging that birth history be included as a standard question on every adult intake form. Health cannot be fully optimized if we overlook such a critical assessment piece. Understanding an individual's birth history, alongside growing research identifying increased health risks for those born preterm and the development of targeted clinical guidelines, will advance health equity for survivors of early birth. We believe a paradigm shift is needed in health care that recognizes preterm birth as a chronic condition requiring lifelong monitoring and support."

While the study's most recent results were just published in JAMA Network Open in July, D'Agata is already looking toward the next set of findings. Continuing to work with fellow URI professor Justin Parent, D'Agata is examining epigenetic age acceleration among individuals born preterm. Understanding any differences in epigenetic aging that may exist between preterm and full-term born adults may be another approach to understanding long-term health.