Petteri Hovi

• Finnish Institute for Health and Welfare

People born preterm have reduced bone mineral density, subnormal peak bone mass, and an increased risk of osteoporosis. Whether this translates to increased risk of bone fractures is uncertain. We assessed fracture risk from childhood to early adulthood in relation to gestational age and sex by conducting a nationwide register-linkage cohort study...

Background Individuals born preterm at very low birthweight (VLBW, < 1500 g) tend to attain a smaller adult body size compared with term‐born peers but less is known regarding specific body composition characteristics. Objectives We aimed to assess whether adults born at VLBW have less beneficial body composition characteristics, potentially media...

There is mixed evidence on personality differences among those born very preterm or with very low birth weight (VP/VLBW). This meta-analysis of individual participant data aimed to examine differences in personality traits between VP/VLBW ( n = 568) and term-born ( n = 1,060) adults, and the role of neonatal characteristics and neurosensory impairm...

Aim To compare romantic and sexual relationships between adults born very preterm (VP; <32 weeks of gestation) or with very low birth weight (VLBW; <1500 g) and at term, and to evaluate potential biological and environmental explanatory factors among VP/VLBW participants. Methods This individual participant data (IPD) meta‐analysis included longit...

Background Globally, one in ten babies is born preterm (<37 weeks), and 1–2% preterm at very low birth weight (VLBW, <1500 g). As adults, they are at increased risk for a plethora of health conditions, e.g., cardiometabolic disease, which may partly be mediated by epigenetic regulation. We compared blood DNA methylation between young adults born at...

Background and aims: The SARS-CoV-2 mRNA vaccines are associated with an increased risk of myocarditis. This association appears to be strongest in male adolescents and younger males and after the second dose. The aim was to evaluate the risk of myocarditis following SARS-CoV-2 mRNA booster vaccination in 12-to-39-year-olds. Methods: A multinati...

COVID-19 vaccinations began globally at the end of 2020. By the end of 2021, 9.8 million doses were given in Finland. Regarding safety, most vaccine-related adverse reactions have been mild, but serious and lethal ones have also occurred. Autopsies in post vaccination deaths may give insight to the extent of fatal health conditions with potential C...

Objective Individuals born very preterm (<32 weeks of gestation) or with very low birthweight (<1500g) have lower cognitive function compared with term-born peers. Furthermore, some studies suggest that they are less physically active as young adults than controls, but the relationship between physical activity and cognitive function remains unclea...

Aim Adults born preterm have increased risk of mental health problems and other neurodevelopmental conditions. We aimed to investigate associations of mental health with pain and tiredness in adults born very preterm (VP; <32 weeks) or very low birthweight (VLBW; <1500 g) and at term, and whether these associations are influenced by physical activi...

Background Preterm survivors have increased risk for impaired cardiometabolic health. We assessed glucose regulation and cardiometabolic biomarkers in adult very low birth weight (VLBW, <1500 g) survivors, using siblings as controls. Methods VLBW-participants were matched with term-born, same-sex siblings. At mean age 29.2 years (SD 3.9), 74 VLBW-...

Safe vaccination is essential for mitigation of the COVID-19 pandemic. Two adenoviral vector vaccines, ChAdOx1 nCov-19 (AstraZeneca) and Ad26.COV2.S (Johnson&Johnson/Janssen) have shown to be effective and they are distributed globally, but reports on serious cerebral venous sinus thrombosis (CVST) associated with thrombocytopenia, have emerged. Ou...

Objective To investigate the clinical outcomes of myocarditis associated with mRNA vaccines against the SARS-CoV-2 virus compared with other types of myocarditis. Design Population based cohort study. Setting Nationwide register data from four Nordic countries (Denmark, Finland, Norway, and Sweden), from 1 January 2018 to the latest date of follo...

Attendance in special education (SE) is more common among individuals born preterm than among those born at term. Less is known about school grades of those born preterm in mainstream education (ME), and how these grades predict later educational attainment. This population-based register-linkage study assessed (1) attendance in SE, and then focuse...

Importance The SARS-CoV-2 mRNA vaccines are associated with an increased risk of myocarditis. This association appears to be strongest in male adolescents and younger males and after the second dose. Few studies have evaluated the association after booster doses. Objective To evaluate the risk of myocarditis following SARS-CoV-2 mRNA booster vaccin...

Importance Spontaneous adverse reaction reports of sudden hearing loss have been observed, and a population-based cohort study conducted in Israel showed an increase in the incidence of sudden sensorineural hearing loss (SSNHL) following vaccination with messenger RNA COVID-19 vaccine BNT162b2 (Pfizer-BioNTech). However, in this setting, the possib...

Objectives To studysexually transmitted Chlamydia trachomatis infections (STCTs), teenage pregnancies, and payment defaults in individuals born preterm as proxies for engaging in risk-taking behavior. Study design Our population-based register-linkage study included all 191 705 children alive at 10yr (8492 preterm, 4.4%) born without malformations...

Background Preterm born young adults have elevated risks of individual respiratory, neuropsychiatric and cardiovascular diseases. However, the risk of chronic disease multimorbidity (the co-occurrence of ≥2 chronic, non-communicable diseases in one person) in preterm born individuals is unclear. We examined the risks of chronic disease multimorbidi...

Importance Spontaneous adverse reaction reports of sudden hearing loss have been observed and a population-based cohort study conducted in Israel showed an increase in the incidence of sudden sensorineural hearing loss (SSNHL) following vaccination with messenger RNA COVID-19 vaccine BNT162b2 (Pfizer-BioNTech). However, in this setting, possibility...

Preterm birth at very low birth weight (VLBW, < 1500 g) is associated with an accumulation of cardiovascular and metabolic risk factors from childhood at least to middle age. Small-scale studies suggest that this could partly be explained by increased visceral or ectopic fat. We performed magnetic resonance imaging on 78 adults born preterm at VLBW...

Importance: Reports of myocarditis after SARS-CoV-2 messenger RNA (mRNA) vaccination have emerged. Objective: To evaluate the risks of myocarditis and pericarditis following SARS-CoV-2 vaccination by vaccine product, vaccination dose number, sex, and age. Design, setting, and participants: Four cohort studies were conducted according to a comm...

Objectives To assess radiographic brain abnormalities and investigate volumetric differences in adults born preterm at very low birth weight (VLBW; < 1500 g), using siblings as controls. Study design We recruited 79 adult same-sex sibling pairs with one born preterm at VLBW and the sibling at term. We acquired three Tesla brain MRIs from the 78 pr...

Background: Children and adults born very low birthweight (VLBW, <1500 g) at preterm gestations have lower bone mineral density (BMD) and/or bone mineral content (BMC) than those born at term, but causality remains unknown. Objectives: Our aim was to assess BMD and BMC in adults born at VLBW in a sibling comparison setting to account for shared...

Background This study examined differences in ADHD symptoms and diagnosis between preterm and term-born adults (≥18 years), and tested if ADHD is related to gestational age, birth weight, multiple births, or neonatal complications in preterm borns. Methods (1) A systematic review compared ADHD symptom self-reports and diagnosis between preterm and...

Background People who were born prematurely have high risks of many individual diseases and conditions in the early part of the life course. However, our knowledge of the burden of multiple diseases (multimorbidity) among prematurely born individuals is limited. We aimed to investigate the risk and patterns of chronic disease multimorbidity in adol...

Aim Preterm birth(<37 gestational weeks) is associated with numerous adversities, however, data on positive developmental outcomes remain limited. We examined if preterm and term born(≥37 gestational weeks) adults differ in dispositional optimism/pessimism, a personality trait associated with health and wellbeing. We assessed if birth weight z-scor...

Context: There is a lack of research on individual perceptions of social experiences and social relationships among very preterm (VP) adults compared with term-born peers. Objective: To investigate self-perceived social functioning in adults born VP (<32 weeks' gestation) and/or with very low birth weight (VLBW) (<1500g) compared with term-born...

Background We evaluated pubertal growth and pubertal timing of participants born preterm compared to those born at term. Methods In the ESTER Preterm Birth Study, we collected growth data and measured final height of men/women born very or moderately preterm (<34 gestational weeks, n = 52/55), late preterm (34–<37 weeks, 94/106), and term (≥37 wee...

Aims In previous reports, cardiotocographic (CTG) fetal heart rate (FHR) monitoring has shown only limited benefits in decreasing adverse perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). The aim of the present study was to evaluate whether an association exists between the recently reported ZigZag pattern (FHR b...

Importance Birth before 32 weeks’ gestation (very preterm [VPT]) and birth weight below 1500 g (very low birth weight [VLBW]) have been associated with lower cognitive performance in childhood. However, there are few investigations of the association of neonatal morbidities and maternal educational levels with the adult cognitive performance of ind...

Objectives: Recent studies suggest that intrapartum ZigZag pattern of fetal heart rate (FHR) is significantly associated with cord blood acidaemia and neonatal complications. For the clinical significance of this pattern, it is mandatory that ZigZag episodes in cardiotocographic (CTG) recording are correctly identified. The aim of the present study...

Introduction: The aim of the present study was to identify possible associations of fetal heart rate (FHR) patterns during the last 2 hours of labor with fetal asphyxia expressed by umbilical artery acidemia at birth and with neonatal complications in a large obstetric cohort. Material and methods: Cardiotocographic (CTG) recordings from 4988 sin...

Objective Being born preterm is related to adverse health effects later in life. We studied whether preterm birth predicts the risk of migraine. Methods In this nationwide register study, we linked data from six administrative registers for all 235,624 children live-born in Finland (January 1987 to September 1990) and recorded in the Finnish Medic...

Introduction: The aim of the present study was to identify possible associations of fetal heart rate (FHR) patterns during the last 2 hours of labor with fetal asphyxia expressed by umbilical artery acidemia at birth and with neonatal complications in a large obstetric cohort. Material and methods: Cardiotocographic recordings from 4988 singleto...

Background: Of all newborns, 1%-2% are born very preterm (VP; <32 weeks) or with very low birthweight (VLBW; ≤1500 g). Advances in prenatal and neonatal care have substantially improved their survival, and the first generations who have benefited from these advances are now entering middle age. While most lead healthy lives, on average these adult...

Background The introduction of biologics has transformed care for children with systemic juvenile idiopathic arthritis (SJIA). Differences in treatment approaches between countries and how they have changed over time are not well studied. Objectives We contrast the initial features, treatment and 12-month outcome in SJIA across 10 JIA registers in...

Chronotype is the temporal preference for activity and sleep during the 24 h day and is linked to mental and physical health, quality of life, and mortality. Later chronotypes, so-called “night owls”, consistently display poorer health outcomes than “larks”. Previous studies have suggested that preterm birth (<37 weeks of gestation) is associated w...

This study examines cognitive functioning in adults born across the range of prematurity with appropriate or small for gestational age (SGA) birth weight compared with full-term controls. ESTER Preterm Birth Study participants without severe disabilities, comprising 133 early preterm (<34 weeks, 17% SGA), 241 late preterm (34 + 0–36 + 6 weeks, 13%...

Background: Preterm birth predisposes to child protection action in the form out-of-home care. The impact of the degree of preterm birth on the likelihood for OHC placement(s) and their timing is unknown. Methods: This population-based register-linkage study assessed the likelihood of OHC placement in different gestational age groups using multi...

Background A preterm newborn has an immature immune system. Although preterm birth is associated with autoimmune hypothyreosis, it is unclear, whether it also could lead to an overall increased risk of autoimmune disease. Objective We assessed whether a shorter gestation increases the risk of special reimbursement for medication for hypothyreosis,...

OBJECTIVE: To provide further knowledge about the longitudinal association between sleep duration and overweight in infants. STUDY DESIGN: The data for this study are from the CHILD-SLEEP birth cohort (n = 1679). The sleep data are based on parent-reported total sleep duration collected at 3, 8, 18, and 24 months. For a subgroup of 8-month old par...

Background: Maximal expiratory airflow peaks early in the third decade of life, then gradually declines with age. The pattern of airflow through adulthood for individuals born very preterm (at <32 weeks' gestation) or with very low birthweight (<1501 g) is unknown. We aimed to compare maximal expiratory airflow in these individuals during late ado...

Objectives Adults born preterm at very low birthweight (VLBW; <1500 g) have a non-optimal cardiometabolic risk factor profile. Since higher protein intake during the first weeks of life predicted a healthier body composition in adulthood in our previous studies, we hypothesized that it would also predict a favorable cardiometabolic profile. Study...

Very preterm birth, before the gestational age (GA) of 32 weeks, increases the risk of obstructed airflow in adulthood. We examined whether all preterm births (GA<37 weeks) are associated with poorer adult lung function and whether any associations are explained by maternal, early life/neonatal, or current life factors. Participants of the ESTER Pr...

The error bars show mean differences (95% confidence intervals) with controls in each gestational age group. Black line indicates zero difference from control. (TIF)

Description of variables and their subgroupings. The ESTER birth cohort (births in Northern Finland during 1985–89); clinical examination during 2009–11. (DOCX)

Mean difference (95% CI) in lung function z-scores, compared with full-term controls: sensitivity analyses. (DOCX)

Univariate comparisons of spirometry data and lung health between gestational age groups. (DOCX)

Individual effect of each covariate association with lung function as zFVC, zFEV1, and zFEV1/FVC. (DOCX)

Background Individuals born preterm are at risk for later developmental problems and long‐term morbidities. There is conflicting evidence regarding musculoskeletal pain in young adulthood. We investigated the prevalence of self‐reported musculoskeletal pain in young adults born across the range of preterm birth compared with a term‐born reference g...

A preference for eveningness (being a “night owl”) and preterm birth (<37 weeks of gestation) are associated with similar adversities, such as elevated blood pressure, impaired glucose regulation, poorer physical fitness, and lower mood. Yet, it remains unclear if and how preterm birth is associated with circadian preference. The aim of this study...

Background: Parents of very or extremely low birth weight infants have fewer subsequent children after preterm birth. Whether this applies to parents of less preterm infants is unknown. Methods: In this nationwide cohort study, we identified all 230 308 traceable (>99%) singletons (9983 preterm, 4.3%) live born in Finland between January 1, 1987...

Epidemiological studies and animal models suggest that early postnatal nutrition and growth can influence adult health. However, few human studies have objective recordings of early nutrient intake. We studied whether nutrient intake and growth during the first 9 weeks after preterm birth with very low birth weight (VLBW, <1500 g) predict total ene...

Low birth weight and chronic low-grade inflammation have been significantly associated with an increased risk of cardiovascular disease (CVD) (1,2). C-reactive protein (CRP) is a highly sensitive biomarker that is used to detect the inflammation associated with predictive factors related to CVD, such as atherogenesis or atherosclerosis (3). Adults...

Background Preterm birth (<37 gestational weeks) poses a risk of poorer neurocognitive functioning. Faster growth after preterm birth predicts better cognitive abilities and can be promoted through adequate nutrition, but it remains unknown whether variations in nutrient intakes translate into long-term benefits for neurodevelopment. Methods In 86...

Total energy intake and energy intake from human milk from birth to 3 weeks, 3 to 6 weeks, and 6 to 9 weeks of age, and adult IQ, presented separately for those with and without specific neonatal complications and illnesses, in individuals born with very low birth weight (<1500g). (PDF)

Executive functioning, attention, and memory in very low birth weight (<1500g) adults. (PDF)

Intake of carbohydrates, protein, and fats from birth to 3 weeks, 3 to 6 weeks, and 6 to 9 weeks of age, and IQ, VIQ, and PIQ in young adulthood, in individuals born with very low birth weight (<1500g).a (PDF)

Context: Preterm birth increases the risk for mental disorders in adulthood, yet findings on self-reported or subclinical mental health problems are mixed. Objective: To study self-reported mental health problems among adults born preterm at very low birth weight (VLBW; ≤1500 g) compared with term controls in an individual participant data meta-...

Visual processing problems may be one underlying factor for cognitive impairments related to autism spectrum disorders (ASDs). We examined associations between ASD-traits (Autism-Spectrum Quotient) and visual processing performance (Rey–Osterrieth Complex Figure Test; Block Design task of the Wechsler Adult Intelligence Scale-III) in young adults (...

Background: Early life stress, such as painful and stressful procedures during neonatal intensive care after preterm birth, can permanently affect physiological, hormonal and neurobiological systems. This may contribute to altered programming of the hypothalamic-pituitary-adrenal axis (HPAA) and provoke changes in HPAA function with long-term heal...

Adults born preterm at very low birth weight (VLBW; <1500 g) have higher blood pressure than those born at term. It is not known whether all VLBW adults are at risk or whether higher blood pressure could be attributed to some of the specific conditions underlying or accompanying preterm birth. To identify possible risk or protective factors, we com...

Background and objectives: Lung function attained in young adulthood is 1 of the strongest predictors of obstructive airways disease in later life. Adults born preterm at very low birth weight (VLBW; <1500 g) who have experienced bronchopulmonary dysplasia (BPD) have reduced lung function. We studied the association of lung function in young adult...

Faster growth after preterm birth benefits long-term cognitive functioning. Whether these benefits extend to mental health remains largely unknown. We examined if faster growth in infancy is associated with better self-reported mental health in young adults born preterm at very low birth weight (VLBW) (<1500g). As young adults, participants of the...

Suboptimal nutrition during fetal life and early childhood may be important in early programming of health and disease. Preterm infants born with very low birth weight (VLBW; <1500 g) frequently receive inadequate neonatal nutrition; the long-term consequences are poorly known. We evaluated the association between early macronutrient intake and bod...

Adults who were born preterm with a very low birth weight have higher blood pressure and impaired glucose regulation later in life compared with those born at term. We investigated cardiometabolic risk factors in young adults who were born at any degree of prematurity in the Preterm Birth and Early Life Programming of Adult Health and Disease (ESTE...

Background. Adults born extremely preterm appear to have more difficulty managing the stresses of early adulthood than their term-born peers. Objective. To examine the effects of being born at extremely low birth weight (ELBW; birth weight < 1000 g) versus at full term on cardiovascular responses to stress. Method. Cardiovascular responses were eli...

Young adults born preterm at very low birth weight start families later. Whether less severe immaturity affects adult social outcomes is poorly known. The study "Preterm birth and early life programming of adult health and disease" (ESTER, 2009-2011) identified adults born early preterm (<34 weeks' gestation, N = 149), late preterm (≥34 to <37 week...

Adults born preterm have higher blood pressure (BP) than those born at term. Most studies have focused on preterm birth, and few have assessed BP variability, an independent risk factor of cardiovascular disease. We studied the association of preterm birth with 24-hour ambulatory BP, measured by an oscillometric device, in 42 young adults born earl...

Unimpaired adults born preterm at very low birth weight (<1500 g) consistently have lower conditioning physical activity than those born at term. We used wrist-worn accelerometers to measure objectively physical activity in 57 very low birth weight and 47 control subjects aged 25 years. We found no difference in any physical activity measures. Copy...

Objectives: We examined whether adults born preterm at very low birth weight (VLBW; <1500 g) differ from term-born adults in autism-spectrum traits, and whether among VLBW adults, growth in infancy is associated with these traits. Methods: A total of 110 VLBW and 104 term-born adults of the Helsinki Study of Very Low Birth Weight Adults complete...

Context: Preterm birth is associated with an increased risk of type 2 diabetes in adult life. The mechanisms are poorly known. Objective: We studied insulin sensitivity and secretion in adults born preterm at very low birth weight (VLBW; < 1500 g). Design: Longitudinal Birth Cohort Study (Helsinki Study of Very Low Birth Weight Adults). Setti...

Background and aims Preterm birth with very low birth weight. Methods We studied the association of preterm birth with 24-hour ambulatory BP and variabilityof BP in 42 young adults (mean age 23.2y) born early preterm (=37 weeks) in Northern Finland population. Wake and sleep period were distinguished with accelerometry in 72.4% of subjects, and for...

Background Prematurity is associated with a higher incidence of hypertension and glucose metabolism during childhood and young adulthood. This may be due to circumstances during fetal and early postnatal life or to confounders such as unhealthy lifestyle in childhood home. The confounder explanation would gain support if preterm birth would predict...

Background Prematurity postpones the birth of a subsequent sibling. This phenomenon is strongest in mothers with long prior interbirth interval, a proxy of fertility problems. Aim We assessed whether a history of miscarriages explains the postponed birth of next sibling after preterm birth. Methods We obtained pregnancy and newborn data from Finnis...

Background Preterm birth and maternal gestational disorders may adversely impact the pulmonary health of offspring. Aims To examine whether exposure to common conditions during fetal-life (preterm birth, gestational hypertension, gestational diabetes) predicts poorer lung function in young adults. Methods The ESTER study is a case-control cohort st...

Objectives: To examine whether faster growth from birth to term (40 postmenstrual weeks) and during the first year thereafter was associated with better neurocognitive abilities in adults born preterm with very low birth weight (VLBW; <1500 g). Study design: Weight, length, and head circumference data of 103 VLBW participants of the Helsinki Stu...

Background: Adolescents and adults born as small preterm infants show more pronounced risk factors of cardiovascular disease. Whether similar risks apply across all degrees of preterm birth is poorly known. Methods: We studied the association between preterm birth and cardiovascular risk factors in 6642 16-year-old adolescents of the population-...

Adults born preterm at very low birth weight (VLBW; ≤1500g) have high levels of cardiovascular risk factors and altered responses to psychosocial stress including higher blood pressure and lower cortisol Our aim was to investigate epinephrine (E), norepinephrine (NE) and heart rate (HR) responses to psychosocial stress in adults born preterm at VLB...

The first infants to experience modern pre- and neonatal care are now in their thirties, an age at which the incidence of cardiometabolic disease is low. However, data from cohorts born preterm prior to the introduction of modern care suggest an increased risk of type 2 diabetes. For young adult cohorts of former very small or very preterm infants,...

Preterm birth at very low birth weight (VLBW; <1500 g) is associated with cardiometabolic risk factors and reduced bone mineral density (BMD) in the adult offspring. Preeclampsia is a frequent cause of preterm birth and is also associated with cardiometabolic risk factors in the offspring. Whether it is associated with BMD is not known. We evaluate...

People born preterm at very low birth weight (VLBW, ≤1500g) have higher rates of risk factors for adult-onset diseases, including cardiovascular diseases and type 2 diabetes. These risks may be mediated through epigenetic modification of genes that are critical to normal growth and development. We measured the methylation level of an imprinted insu...

Differences in methylation fractions at different IGF2AS and IGF2_05 CpG units between VLBW and control subjects by linear regression, and effects of covariates [B, 95% confidence interval (CI), and P] adjusted for in the model. (RTF)

Background: Young adults born preterm at very low birth weight (VLBW, ≤1500 g) have higher levels of cardiovascular risk factors, including impaired glucose regulation, than their term-born peers. This could be mediated through altered hypothalamic-pituitary-adrenal axis (HPAA) response to stress. Objective: To compare HPAA, glucose and insulin...

Osteocalcin (OC), a bone-derived protein, has been implicated in the regulation of glucose and energy metabolism. Young adults born with very low birth weight (VLBW) have altered glucose regulation and lower bone mineral density (BMD) compared with those born at term. The aim of this study was to explore the association between bone and glucose met...

Background Adults born preterm at very low birth weight (VLBW ≤ 1500g) have increased risk factors for cardiovascular diseases including high blood pressure and impaired glucose regulation. Non-optimal lipoprotein profile is generally also likely to affect the increased cardiovascular risk, but lipoprotein subclass level data on adults born at VLBW...

Preterm birth at very low birth weight (VLBW; <1500g) is associated with cardiometabolic risk factors and reduced bone mineral density (BMD) in the adult offspring. Pre-eclampsia (PE) is a frequent cause of preterm birth and is also associated with cardiometabolic risk factors in the offspring. Whether it is associated with BMD is not known. To stu...

Background and objective: Adults born preterm score lower on performance-based tests of executive functioning (EF) than their term-born peers. These test scores do not necessarily translate to application of these skills in an everyday environment. The objective of the study was to test differences between very low birth weight (VLBW; <1500 g) adu...

Backround and aims Adolescents born at very low birth weight (< 1500g, VLBW) have higher rates of respiratory symptoms and reduced lung function as compared with those born at term. Only few studies, however, have extended to adult life. We studied the association of preterm birth at VLBW with lung function in young adults. Methods We used spiromet...

Background: Shorter leucocyte telomere length (LTL) is a promising marker of biological ageing. It is predicted by cumulative adverse conditions throughout life course, but few studies have data from the prenatal period when most developmental processes and cell replication take place. We studied whether body size at birth and underlying factors i...