Preterm Birth and Adult Illness

By Rita Beamish

Premature birth is a global killer.

Leaving the womb too early accounts for more than 1 million infant deaths each year, the latest data reveals, almost half of all newborn mortality worldwide. But it’s not just the toll on newborns that increasingly concerns health experts. Paralleling the rise in early births are advances in medicine that allow more preterm babies to survive. Scientists are finding  the complexities of perinatal health and prematurity have implications for physical and neurological problems that shadow the survivors into adulthood.

Researchers at Stanford and elsewhere are working to stem early labor while trying to understand and reduce the longer term health effects of being born too early.

“Much larger numbers of people who were born preterm are now surviving to adulthood. Their health outcomes in adulthood will have an increasing public health impact over the next few decades,” said Dr. Casey Crump, clinical assistant professor of medicine at Stanford University, leading researcher on prematurity, and a Stanford Center on Longevity Faculty Affiliate.

For starters, he cited “extensive and growing evidence for an increased risk of morbidities throughout the life course.” And at least one study showed elevated risk of dying in young adulthood – although Crump noted the absolute risk for death was low, meaning that most preterm babies have life spans similar to their full-term peers.

The United States holds the dubious distinction of having the highest rate of preterm births – those born before 37 weeks of gestation – of any developed nation, up 36 percent in three decades.

More than 12 percent of U.S. babies are born preterm, or more than half a million a year. The startling reality finds the United States in the ranks of Thailand, Turkey and Somalia, according to recent data compiled by the World Health Organization and the March of Dimes. Richer countries on average log 9 percent prematurity.

Poor countries suffer significantly from influences like infections, malaria, HIV and teen pregnancy, while U.S contributing factors include both older women and teenagers giving birth,  fertility-treatment-driven multiple births, and risk factors like maternal obesity, hypertension, diabetes, smoking . The U.S. pricetag in health care spending and lost productivity is as much as $26 billion a year, the Institute of Medicine reports.

Researchers at Stanford’s March of Dimes Prematurity Research Center are trying to puzzle out the pathways and causes of early labor. Using multidisciplinary research, they hope to shed light on the little understood interplay among environmental and social influences, internal microorganisms and risk factors, and find ways to prevent preterm births, said Center on Longevity Affiliate Dr. Paul Wise, Stanford professor of pediatrics and co-principle investigator at the prematurity center.

 Premature birth, said Wise, is “a potentially important illustration of how early life events and preventing these adverse events could have long term implications for adults and public health.”

Researchers have found that children born more than three weeks early are at risk for cerebral palsy, developmental delays, hearing and vision impairment.

California’s Aging Population: Not Forever Young

Currently the sixth youngest state, California will soon begin aging faster than the nation. According to the State’s recently released Interim Population Projections, the number of old people in California, those age 65 and older, will double over the next twenty years from 4.3 million in 2010 to 8.4 million in 2030.

Stanford Researcher Marcia Stefanick Delves into Healthy Aging

By Rita Beamish

Marcia Stefanick, PhD

There was a time when menopausal hormone therapy was seen as a near-panacea for the ills of the aging woman. That was before Marcia Stefanick and her Women’s Health Initiative (WHI) colleagues put the theory to the test and upended the medical world.

Now Stefanick is on a different quest, but this time she’s not expecting to disprove a widely-held myth as she did with the assumed benefits of hormone therapy in the WHI. Instead, she hopes to provide  scientific underpinning to something widely believed – that exercise prolongs life and in particular sustains cardiovascular health.

“Why do some women do so well, while others age less successfully?” the professor of medicine and leader of women’s health and sex differences research at Stanford asks. “The aging of the cardiovascular system is the main question.”

Stefanick  has always been interested in questions of “successful aging,” along with her work on heart health and sex hormones.  The daughter of a Pennsylvania veterinarian, Stefanick grew up with four brothers and two sisters “in a sexist era where girls do this and boys do that.”  She developed  an intrinsic interest in the differences between the sexes. After more than two decades conducting a series of hormone studies, including the blockbuster National Institutes of Health (NIH)-funded WHI, she is looking more broadly at aging.  She continues work on non-hormone – and less publicized — aspects of the WHI, which started with nearly 162,000 women subjects aged 50-79 in 1993. In these studies, Stefanick  is looking at the aging characteristics of women, including physical and mental function, plus cardiovascular health, cancer and osteoporosis.

Stefanick seeks to know what, regardless of hormone use, predicts successful aging. Her search to date has involved diet, quality of life, stress measures,  and sleep patterns in WHI women, now aged 65 to 95, and also 6,000 men, aged 75 and older, who are enrolled in the so-called MrOS study  of osteoporotic fractures.  Delving deeper into the body’s response to aging, Stefanick’s team now is looking also at loss of skeletal muscle and changes in body fat.

Global Population Ageing: Peril or Promise?

Global ageing, in developed and developing countries alike, will dramatically alter the way that societies and economies work. The issues include how individuals find fulfilment, at what age they retire, and their quality of life once they do retire; how governments devise social contracts to provide financial security; how the older and younger generations interact as they divide up the economic pie; how businesses staff their jobs to compensate in many countries for shrinking workforces; and how health systems respond to the altered needs of those living longer.

Global Population Ageing: Peril or Promise is part of the long-term work on the issue by the World Economic Forum’s Global Agenda Council on Ageing and will provide the background for its activities over the next few years. This book is the product of a true collaboration among the business, political, academic, and other leaders of society that make up the Network of Global Agenda Councils.

Chapters co-authored by Laura Carstensen, Director of Stanford Center on Longevity

Chapter 1 : The Meaning of Old Age
Laura L. Carstensen and Linda P. Fried    Download chapter

Chapter 7 : Social Capital, Lifelong Learning and Social Innovation
Simon Biggs, Laura Carstensen and Paul Hogan    Download chapter

Chapter co-authored by Jack Rowe, Chairman of the Center on Longevity’s External Advisory Council and Visiting Scholar for the Winter 2012 term

Chapter 12: Design and Operation of Health Systems in Wealthy Industrial Countries
Linda P. Fried, Paul Hogan and Jack Rowe  Download chapter

Stanford Arthritis Shoe Hits Shelves

In his BioMotion Lab, Andriacchi and his team use cameras and sophisticated software to analyze the walking gaits of patients with diseases of the knee. The most prevalent of these is osteoarthritis, a disease affecting over 20 million Americans, caused by deterioration of cartilage. Andriacchi’s research has led not only to a greater understanding of osteoarthritis but also to something he never expected – a line of shoes that helps people suffering from the painful condition.

A Long Bright Future

The twentieth century bequeathed us a fabulous gift: thirty more years of life on average. Supersized life spans are going to radically alter society, and present an unprecedented opportunity to change our approach not only to old age but to all of life’s stages. The ramifications are just beginning to dawn on us…yet in the meantime, we keep thinking about, and planning for, life as it used to be lived.

In A Long Bright Future, longevity and aging expert Laura Carstensen guides us into the new possibilities offered by a longer life. She debunks the myths and misconceptions about aging that stop us from adequately preparing for the future both as individuals and as a society: that growing older is associated with loneliness and unhappiness, and that only the genetically blessed live well and long. She then focuses on other important components of a long life—including finances, health, social relationships, Medicare, and Social Security—challenging our preconceived notions of “old age” every step of the way.

“among the most praised psychological research in recent years is….Laura Carstensen’s work on happiness and aging.” —Los Angeles Times

“everyone should read and relish this empowering book. Carstensen’s conviction that it’s up to us to build a world in which we can live long, productive, and happy lives is revelatory…. In a world full of anxiety about aging, hers is a new and positive viewpoint.” —Library Journal