The trouble with preemies

The Public Health Agency of Canada says three out of every five adults in this country has one or more chronic diseases, such as high blood pressure or diabetes. Together, these conditions account for almost two-thirds of all deaths worldwide.Now researchers have uncovered an important risk factor with huge implications - as published in the current issue of the Canadian Medical Association Journal (CMAJ). Apologies for the paywall.

The new factor is being born prematurely.

When it comes to chronic diseases, we tend to focus on factors like poor diets and lack of exercise. Researchers from the University of Montreal and from the Sainte Justine Research Centre looked at evidence from studies around the world and found that babies born at least three weeks premature (less than 37 weeks) are at increased risk of high blood pressure, diabetes, heart attacks and strokes, chronic lung problems, osteoporosis and pregnancy problems later in life.

Why are adults who are born prematurely at a greater risk of chronic disease?One reason is that preemies are exposed to various sources of injury in the womb and following birth. Another is that the fetus or newborn adapts to being born prematurely in ways that permit them to live in the short term but cause organ damage later in life. There are factors thathappen to the baby close to the time of premature birth that cause inflammation and damage to the baby's vital organs. These include being born to a mother with gestational diabetes, reduced growth while in the womb, low birth weight of less than 1500 grams, and prolonged stay on a ventilator in the neonatal intensive care unit. In addition, adults born prematurely are at increased risk of osteoporosis because the last weeks of pregnancy are the ones in which the greatest amount of calcium is added to the bone.

In general, chronic diseases begin in middle age. But when prematurity is a factor, the effects begin in young adulthood. People born prematurely start to have noticeably high blood pressure in young adulthood. Women born prematurely have a 50 per cent increased risk of developing high blood pressure while pregnant. Being premature has a direct effect on heart muscle. Young adults born prematurely are at increased risk of lung problems that include shortness of breath and wheezing. Ten per cent of them use puffers compared to 4 per cent of the general population.

Much can be done to help curb these adverse health effects.The authors of the paper in CMAJ say doctors and nurse practitioners should ask about prematurity. Once they identify patients born prematurely, they need to monitor them for chronic diseases more frequently. That means more frequent blood pressure measurements and especially checking blood pressure more frequently in pregnant women. For adults with lung problems, they need to send those patients for pulmonary function testing. To prevent osteoporosis and broken bones, adults born prematurely should have a diet high in calcium and should also be encouraged to do weight-bearing exercises.

Premature birth as a risk factor for chronic disease needs to be recognized as a public healthemergency.In Canada, eight per cent of babies are born premature. Advances in obstetrical, perinatal and neonatal care mean that more than 90 per cent of them survive. Currently, there are no guidelines for identifying adults at risk, let alone doing something to manage the risk. Compared to those born at full term, young adults born at least three weeks premature have a 40 per cent higher risk of dying prematurely.

So, it's costly to them, and it's also costly to us. We spend three out of every four health care dollars managing the very chronic diseases premature babies maydevelop when they reach adulthood. The growing cohort of adults born prematurely means the burden of takingcare of them will get more and more expensive.

The time to act is now.