+Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.
+1. In a multinational retrospective cohort study, preterm birth was associated with an increased risk of atrial fibrillation (AF).
+2. Neonatal factors such as being small for gestational age were associated with increased AF risk before age 18 years and being large for gestational age was associated with AF at all age groups studied.
+Evidence Rating Level: 2 (Good)
+Neonatal factors such as restricted (small for gestational age; SGA) or excess (large for gestational age; LGA) fetal growth have been linked to increased risk of cardiovascular diseases. One cardiovascular disease, atrial fibrillation (AF), is of importance as a common cardiac arrhythmia that is associated with significant morbidity. Although SGA and LGA are associated with several AF-specific risk factors (cardiometabolic disorders, hypertension), a direct association between abnormal fetal growth and AF has not been formally studied. To address this question, this study used a multinational cohort study design in Danish, Swedish, and Finnish health registries (n=8,012,433) to investigate the relationship between preterm birth, SGA, or LGA and risk of AF later in life. Those who were born SGA had an increased risk of developing AF by 18 years of life (but not later) and those born LGA had an increased risk of developing AF at any age. Prematurity was associated with an increased risk of AF which was more prominent in childhood than adulthood. Limitations of this study include missed cases of asymptomatic or mild AF, as well as AF that occurred after the follow-up period (maximum age of 49 years). This is a large cohort study that provides evidence that fetal growth and prematurity may influence the risk of developing AF later in life. Further studies are required to understand the pathophysiology of these risk factors whether the development of AF can be prevented.
In-Depth [retrospective cohort]:
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+Using a multinational cohort study design, this study linked several nationwide registers to health outcomes in patients in Denmark (singletons from 1978 to 2016, n= 2,332,882), Sweden (singletons from 1973 to 2014, n = 4,171,006), and Finland (random sample of 90% of singletons from 1987 to 2014, n = 1,636,116). The outcome of interest was AF and atrial flutter, diagnosed based on International Classification of Diseases (ICD) codes. Follow-up started at birth and ended on the date of the first AF diagnosis, death, emigration, or the latest date with available data. The maximum age at the end of follow-up was 49 years (median 21 years; IQR 11.7 to 30.7 years). Of the patients included, 0.14% (11,464) had AF. Preterm birth was associated with increased AF risk within the first 18 years of life (aHR 2.36, 95% CI 1.90-2.94) and afterward (aHR 1.16, 95% CI 1.05-1.29). SGA was associated with an increased risk of AF up to age 18 years old (aHR 1.27, 95% CI 1.07-1.50), but was not associated with increased risk afterward (aHR 0.90, 95% CI 0.84-0.96). LGA was associated with an increased risk of AF before 18 years old (aHR 1.44, 95% CI 1.23-1.68) as well as afterward (aHR 1.56, 95% CI 1.47-1.66). The relationship between preterm birth, SGA, LGA, and AF risk did not differ by sex or country of birth. In general, being LGA and preterm were associated with an increased risk of AF when compared to LGA and term, and this relationship was more pronounced when <18 years of age.
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