Association between very to moderate preterm births, lung function deficits, and COPD at age 53 years: analysis of a prospective cohort study

Dinh S Bui; Jennifer L Perret; E Haydn Walters; Caroline J Lodge; Gayan Bowatte; Garun S Hamilton; Bruce R Thompson; Peter Frith; Bircan Erbas; Paul S Thomas; David P Johns; Richard Wood-Baker; John L Hopper; Peter G Davis; Michael J Abramson; Adrian J Lowe; Shyamali C Dharmage

doi:10.1016/S2213-2600(21)00508-7

Association between very to moderate preterm births, lung function deficits, and COPD at age 53 years: analysis of a prospective cohort study

Lancet Respir Med. 2022 May;10(5):478-484. doi: 10.1016/S2213-2600(21)00508-7. Epub 2022 Feb 18.

Authors

Dinh S Bui¹, Jennifer L Perret¹, E Haydn Walters², Caroline J Lodge¹, Gayan Bowatte¹, Garun S Hamilton³, Bruce R Thompson⁴, Peter Frith⁵, Bircan Erbas⁶, Paul S Thomas⁷, David P Johns⁸, Richard Wood-Baker⁸, John L Hopper¹, Peter G Davis⁹, Michael J Abramson¹⁰, Adrian J Lowe¹, Shyamali C Dharmage¹¹

Affiliations

¹ Centre for Epidemiology and Biostatistics, School of Population and Global health, The University of Melbourne, Melbourne, VIC, Australia.
² Centre for Epidemiology and Biostatistics, School of Population and Global health, The University of Melbourne, Melbourne, VIC, Australia; School of Medicine and Menzies Institute, University of Tasmania, Hobart, TAS, Australia.
³ School of Clinical Sciences, Monash University, Melbourne, VIC, Australia; Department of Lung, Sleep, Allergy and Immunology, Monash Health, Melbourne, VIC, Australia.
⁴ School of Health Sciences, Swinburne University of Technology, VIC, Australia.
⁵ College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
⁶ School of Psychology and Public Heath, la Trobe University, Bundoora, VIC, Australia.
⁷ Prince of Wales' Clinical School, Faculty of Medicine, UNSW, NSW, Australia.
⁸ School of Medicine, University of Tasmania, Hobart, TAS, Australia.
⁹ Department of Obstetrics and Gynaecology, University of Melbourne and Department of Newborn Research, The Royal Women's Hospital, Melbourne, VIC, Australia.
¹⁰ School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia.
¹¹ Centre for Epidemiology and Biostatistics, School of Population and Global health, The University of Melbourne, Melbourne, VIC, Australia. Electronic address: s.dharmage@unimelb.edu.au.

PMID: 35189074
DOI: 10.1016/S2213-2600(21)00508-7

Abstract

Background: Prematurity has been linked to reduced lung function up to age 33 years, but its long-term effects on lung function and chronic obstructive pulmonary disease (COPD) are unknown. To address this question, we investigated associations between prematurity, lung function, and COPD in the sixth decade of life using data from the Tasmanian Longitudinal Health Study (TAHS).

Methods: Data were analysed from 1445 participants in the TAHS. Lung function was measured at 53 years of age. Gestational ages were very preterm (28 weeks to <32 weeks), moderate preterm (32 weeks to <34 weeks), late preterm (34 weeks to <37 weeks) and term (≥37 weeks). Linear and logistic regression models were fitted to investigate associations of prematurity with lung function measures (FEV₁, forced vital capacity [FVC], FEV₁/FVC ratio, forced expiratory flow at 25-75% of FVC [FEF_25-75%], diffusing capacity for carbon monoxide [DLCO]) and COPD (post-bronchodilator FEV₁/FVC less than the lower limit of normal), adjusting for sex, age, height, parental smoking during pregnancy, number of older siblings, maternal age at birth, and childhood socioeconomic status. Interactions with smoking and asthma were also investigated.

Results: Of 3565 individuals with available data on gestational age from the TAHS cohort, 1445 (41%) participants were included in this study, 740 (51%) of whom were female. Compared with term birth, very to moderate preterm birth was significantly associated with an increased risk of COPD at age 53 years (odds ratio 2·9 [95% CI 1·1-7·7]). Very-to-moderate preterm birth was also associated with lower post-bronchodilator FEV₁/FVC ratio (beta-coefficient -2·9% [95% CI -4·9 to -0·81]), FEV₁ (-190 mL [-339 to -40]), DLCO (-0·55 mmol/min/kPa [-0·97 to -0·13]), and FEF_25-75% (-339 mL/s [-664 to -14]). The association between very-to-moderate preterm birth and FEV₁/FVC ratio was only significant among smokers (p_interaction=0·0082). Similar findings were observed for moderate preterm birth when analysed as a separate group. Compared with term birth, late preterm birth was not associated with lower FEV₁/FVC ratio or COPD.

Interpretation: This is the first study to investigate the effect of prematurity on lung function into middle-age. Data show that very-to-moderate prematurity is associated with obstructive lung function deficits including COPD well into the sixth decade of life and that this effect is compounded by personal smoking.

Funding: National Health and Medical Research Council (NHMRC) of Australia, European Union's Horizon 2020, The University of Melbourne, Clifford Craig Medical Research Trust of Tasmania, The Victorian, Queensland & Tasmanian Asthma Foundations, The Royal Hobart Hospital, Helen MacPherson Smith Trust, and GlaxoSmithKline.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Asthma*
Bronchodilator Agents
Child
Cohort Studies
Female
Forced Expiratory Volume
Humans
Infant
Infant, Newborn
Lung
Male
Middle Aged
Pregnancy
Premature Birth* / epidemiology
Premature Birth* / etiology
Prospective Studies
Pulmonary Disease, Chronic Obstructive* / epidemiology
Vital Capacity

Substances

Bronchodilator Agents