Low birth weight (LBW) and preterm birth (< 37 completed weeks’ gestation) are potential risk factors for hip osteoarthritis (OA) that requires total hip arthroplasty (THA) in adulthood, according to a recent systematic review.1
Hip OA is common: symptoms develop in one in four persons. End-stage disease is treated by THA, which imposes significant financial burdens on health systems worldwide. In Australia, where this study was conducted, nearly one in eight persons eventually undergoes THA. This number has been rising steadily, with an increase of 65% from 2003 to 2015.
In developed countries, a substantial number of infants are born with LBW. In Australia, 6.2% of infants are born with LBW and 8% are born preterm. In the United States, the prevalence of LBW is 8% and preterm births is 12%. As the average age of mothers in developed countries rises, a steady increase in the number of LBW and preterm infants is also expected, since older mothers are at higher risk for delivering LBW and preterm babies than mothers aged 20 to 34 years. The survival rate of LBW and preterm infants has also increased almost 80% in the past 30 years.
Hussain and colleagues at the School of Public Health and Preventative Medicine at Monash University in Melbourne, Australia, conducted a systematic literature search, which examined the available evidence for an association between OA and LBW or preterm birth. The researchers searched Ovid Medline, CINAHL, and EMBASE databases between January 1947 and August 2017.
The risk of bias was determined using the National Heart Lung and Blood Institute quality assessment tool for observational studies. Researchers then evaluated the potential causation based on the Bradford Hill criteria, commonly used to assess the adequacy of evidence for a causal relationship between an exposure and a consequence. Lastly, an economic evaluation was undertaken to estimate the costs associated with THA that are likely attributable to LBW or preterm birth in Australia.
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1. Hussain SM, Ackerman IN, Wang Y, Zomer E, Cicuttini FM. Could low birth weight and preterm birth be associated with significant burden of hip osteoarthritis? A systematic review. Arthritis Res Ther. 2018;20:121. doi: 10.1186/s13075-018-1627-7.