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To the Editor: In their cohort study of more than 1 million Norwegians identified from the Medical Birth Registry, Dr Swamy and colleagues¹ reported that preterm birth was associated with diminished long-term survival and reproduction. These findings are consistent with a growing body of evidence supporting the hypothesis of a fetal or developmental origin of adult disease.² However, we are concerned that the results could be confounded by a more dominant influence of low birth weight, which often accompanies preterm birth.

Elucidating the relative influences of low birth weight vs prematurity is important because these 2 parameters reflect different underlying mechanisms (ie, poor in utero growth vs maternal infections, respectively) and require different maternal interventional strategies. Maternal and neonatal health programs, particularly in developing countries, need to determine which modifiable perinatal factor might have the greatest effect on adult health, as this will influence public health strategies.

The authors also . . . [Full Text of this Article]

Gerald Liew, MBBS, MMed; Jie Jin Wang, MMed, PhD; Paul Mitchell, MD, PhD
paul_mitchell@wmi.usyd.edu.au
Department of Ophthalmology
Westmead Millennium Institute
University of Sydney
Sydney, Australia

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