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Hospitalizations in adolescence and early adulthood among Swedish men and women born preterm or small for gestational age
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
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2008 (English)In: Epidemiology, ISSN 1044-3983, Vol. 19, no 1, 63-70 p.Article in journal (Refereed) Published
Abstract [en]

Background: Preterm birth and reduced intrauterine growth appear to be related to morbidity in childhood and later adulthood. We studied whether the risk of all-cause hospitalization in adolescence and early adulthood differed between individuals who were born preterm or small for gestational age (SGA) compared with those bom at term and appropriate for gestational age.

Methods: Using Swedish registries, we followed 304,275 men and women born in 1973-1975 for any hospitalizations occurring in 1987-1996. Preterm birth was defined as <37 weeks of gestation and SGA as babies smaller than 2 standard deviations below the mean weight for gestational length, according to Swedish standards. We created 3 mutually exclusive categories: "preterm" (<37 weeks and not SGA), "SGA" (SGA and not preterm), and "both preterm and SGA." The comparison group was all term births not SGA. Childhood socioeconomic characteristics were accounted for in the analyses.

Results: The overall risk of hospitalization was higher for men and women bom SGA (adjusted odds ratio = 1.16; 95% confidence interval = 1.12-1.21), for those born preterm (1.06; 1.02-1.10), and for those born both preterm and SGA (1.42; 1.26-1.59). In addition to higher risks for previously reported adverse health outcomes, such as neurodevelopment sequelae and congenital anomalies, men and women born SGA or preterm were more likely to be hospitalized due to unspecified symptoms. SGA also appeared to be associated with genitourinary diseases and drug use.

Conclusions: Men and women born SGA or preterm were at higher risk for hospitalization during adolescence and early adulthood, with men and women born SGA more at risk than those bom preterm.

Place, publisher, year, edition, pages
2008. Vol. 19, no 1, 63-70 p.
Identifiers
URN: urn:nbn:se:liu:diva-14627OAI: oai:DiVA.org:liu-14627DiVA: diva2:24057
Available from: 2007-08-24 Created: 2007-08-24 Last updated: 2009-08-17
In thesis
1. Birth-characteristics, hospitalisations, and childbearing: Epidemiological studies based on Swedish register data
Open this publication in new window or tab >>Birth-characteristics, hospitalisations, and childbearing: Epidemiological studies based on Swedish register data
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In the past decades there has been an improvement in the medical treatment of children born preterm or with reduced foetal growth. This has resulted in a much higher survival rate of these children, but also in a higher number of surviving children with chronic conditions. These changes have, in turn, increased interest in investigating the connection between birth-characteristics and outcomes in later life. The overall aim of the present thesis was to study the relations between birth-characteristics, subsequent hospitalisations, and childbearing by means of data available in Swedish population-based registries.

The study population in this thesis consisted of women (and men in Paper III) born in 1973-75 according to the Medical Birth Register and the Total Population Register. Information available in other registries, such as the Hospital Discharge Register, was obtained by individual record linkage.

In Paper I, 148,281 women, alive and living in Sweden at 13 years of age, were included. Of the women, 4.1% were born preterm and 5.4% were born small for gestational age, and approximately 30% of all women had given birth between 13 and 27 years of age. We found that reduced foetal growth and possibly preterm birth were related to the likelihood of giving birth during the study period. The intergenerational effects of preterm birth and reduced foetal growth were investigated in Paper II and the study population consisted of 38,720 mother-offspring pairs. An intergenerational effect of reduced foetal growth was found, and reduced foetal growth in the mother also increased the risk for preterm birth in the child.

Paper III was concerned with 304,275 men and women living in Sweden at 13 years of age. Of these men and women, 30% were hospitalised during adolescence and early adulthood (i.e. between 12 and 23 years of age). We found that men and women born small for gestational age or preterm were more likely to be hospitalised, and that those born small for gestational age seemed to be more at risk compared to those born preterm. Finally, in Paper IV, the relation between hospitalisations during adolescence and the likelihood of giving birth was studied in 142,998 women living in Sweden at 20 years of age. We found that a majority of the causes of hospitalisation during adolescence were positively connected to the likelihood of giving birth between 20 and 27 years of age. The relations presented in Papers I-IV were evident although socio-economic characteristics were adjusted for.

Place, publisher, year, edition, pages
Institutionen för molekylär och klinisk medicin, 2007
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1012
Keyword
Birth rate, Cohort studies, Epidemiology, Hospitalisation, Morbidity, Preterm infant, Reproduction, Small-for-gestational-age infant
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-9660 (URN)978-91-85831-50-0 (ISBN)
Public defence
2007-10-05, Berzeliussalen, Campus US, Ingång 65, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2007-08-24 Created: 2007-08-24 Last updated: 2009-08-22

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Ekholm Selling, KatarinaCarstensen, JohnFinnström, OrvarJosefsson, AnnSydsjö, Gunilla

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Ekholm Selling, KatarinaCarstensen, JohnFinnström, OrvarJosefsson, AnnSydsjö, Gunilla
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Obstetrics and gynecology Faculty of Health SciencesHealth and SocietyFaculty of Arts and SciencesPediatrics Department of Paediatrics in LinköpingDepartment of Gynecology and Obstetrics in Linköping
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