Abstract
Evidence suggests that increased survival over the last decades of very preterm (VPT; gestational age < 32 weeks)– and very low birth weight (VLBW; birth weight < 1500 g)–born infants is not matched by improved outcomes. The objective of our study was to evaluate the reproductive rate, fertility, and pregnancy complications in 35-year-old VPT/VLBW subjects. All Dutch VPT/VLBW infants born alive in 1983 and surviving until age 35 (n = 955) were eligible for a POPS-35 study. A total of 370 (39%) subjects completed a survey on reproductive rate, fertility problems, pregnancy complications, and perinatal outcomes of their offspring. We tested differences in these parameters between the VPT/VLBW subjects and their peers from Dutch national registries. POPS-35 participants had less children than their peers in the CBS registry. They reported more problems in conception and pregnancy complications, including a three times increased risk of hypertension during pregnancy.Conclusion: Reproduction is more problematic in 35-year olds born VPT/VLBW than in the general population, possibly mediated by an increased risk for hypertension, but their offspring have no elevated risk for preterm birth.What is known:At age 28, the Dutch national POPS cohort, born very preterm or with a very low birth in 1983, had lower reproductive rates than the general Dutch population (female 23% versus 32% and male 7% versus 22%).What is new:At age 35, the Dutch POPS cohort still had fewer children than the general Dutch population (female 56% versus 74% and male 40% versus 56%). Females in the POPS cohort had a higher risk of fertility problems and pregnancy complications than their peers in the Dutch national registries, but their offspring had no elevated risk for preterm birth.
Highlights
Preterm birth is the major cause of neonatal deaths in the Western world
Reproduction is more problematic in 35-year olds born very preterm (VPT)/very low birth weight (VLBW) than in the general population, possibly mediated by an increased risk for hypertension, but their offspring have no elevated risk for preterm birth
Females in the POPS cohort had a higher risk of fertility problems and pregnancy complications than their peers in the Dutch national registries, but their offspring had no elevated risk for preterm birth
Summary
Preterm birth is the major cause of neonatal deaths in the Western world. Over a third of the estimated neonatal mortality is associated with preterm birth complications, such as respiratory distress syndrome, intraventricular hemorrhages, necrotizing enterocolitis, and sepsis [1]. The estimated rate of preterm births in Europe is 8.7% (690.931 cases) and over 11% in North America in 2014. Advanced perinatal technology and improved neonatal care greatly increased the survival rate of VPT and VLBW infants over the last decades. Long-term follow-up studies after preterm birth are relevant sources of information on physical health, well-being, and health-related quality of life of VPT/ VLBW infants who are adults [8]. A few studies [9, 10] assessed reproductive outcomes of VPT/VLBW adults [11] and these studies are often based on large registry cohorts [12,13,14] without detailed information on possible complications that influence reproductive rates. Long-term cohort studies on fertility and pregnancy of adults born VPT and/or VLBW are scarce
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