{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T16:19:11Z","timestamp":1790957951424,"version":"4.1.0"},"reference-count":37,"publisher":"Korean Society of Epidemiology","license":[{"start":{"date-parts":[[2023,3,3]],"date-time":"2023-03-03T00:00:00Z","timestamp":1677801600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Sanqin Academic Innovation Team in Shaanxi Province","award":["SQ0157"],"award-info":[{"award-number":["SQ0157"]}]}],"content-domain":{"domain":["e-epih.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol Health"],"abstract":"<jats:p>OBJECTIVES: Observational studies have suggested an association between preterm birth and stroke in late adulthood, but it remains unclear whether the association is causal. The purpose of this study was to evaluate the causal effects of gestational age on stroke and to determine the pathophysiological mechanisms underlying the causal associations.METHODS: Two-sample Mendelian randomization (MR) was performed to assess the causal effects of fetal gestational duration, early preterm birth (EPB), preterm birth, or postterm birth on stroke and its subtypes. Two-step Mendelian randomization (TSMR) and multivariable Mendelian randomization (MVMR) were additionally used to determine the role of common stroke risk factors, including cardiovascular diseases, hypertension, pulmonary impairment, inflammation, and metabolic diseases, in mediating the causal associations between gestational age and stroke and its subtypes.RESULTS: Genetically predicted EPB increased the risk of cardioembolic stroke (CES; odds ratio [OR], 1.115; 95% confidence interval [CI], 1.036 to 1.200; p=0.004) and large artery stroke (LAS; OR, 1.131; 95% CI, 1.031 to 1.241; p=0.009). The TSMR results showed that EPB was associated with a lower forced expiratory volume in the first second and forced vital capacity ratio (FEV1\/FVC) (\u03b2=-0.020; 95% CI, -0.035 to -0.005; p=0.009), which increased the risk of CES and LAS. Further MVMR analysis showed that the associations between EPB and stroke disappeared after adjustment for FEV1\/FVC.CONCLUSIONS: Our data demonstrate that EPB is causally associated with an elevated risk of CES and LAS, and that pulmonary dysfunction mediates the causal impact of EPB on CES and LAS.<\/jats:p>","DOI":"10.4178\/epih.e2023031","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T04:21:43Z","timestamp":1678940503000},"page":"e2023031","update-policy":"https:\/\/doi.org\/10.4178\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Impaired pulmonary function mediates the impact of preterm birth on later-life stroke: a 2-step, multivariable Mendelian randomization study"],"prefix":"10.4178","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7377-8249","authenticated-orcid":true,"given":"Xingzhi","family":"Guo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7851-3805","authenticated-orcid":true,"given":"Peng","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2573-6351","authenticated-orcid":true,"given":"Chen","family":"Hou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9285-5302","authenticated-orcid":true,"given":"Yue","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2318-9232","authenticated-orcid":true,"given":"Rui","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2679","published-online":{"date-parts":[[2023,3,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1649503"},{"key":"ref2","first-page":"2982","volume-title":"Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 Study","author":"Roth","year":"2020"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/s2214-109x(18)30451-0"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.104.528356"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-014-9892-5"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.120.033797"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-0716-1138-8_2"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002947"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2019.02.041"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.14611"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.1511"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1007\/s00281-020-00803-2"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1111\/apa.15030"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.congress-2018.pa560"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-021-00757-1"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-019-11881-8"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajhg.2014.02.012"},{"key":"ref18","first-page":"524","volume-title":"Multiancestry genome-wide association study of 520,000 subjects identifies 32 loci associated with stroke and stroke subtypes","author":"Malik","year":"2018"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003062"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1038\/ng.2797"},{"key":"ref21","first-page":"501","volume-title":"Genome-wide meta-analysis identifies 11 new loci for anthropometric traits and provides insights into genetic architecture","author":"Berndt","year":"2013"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1093\/hmg\/ddy271"},{"key":"ref23","first-page":"1412","volume-title":"Genetic analysis of over 1 million people identifies 535 new loci associated with blood pressure traits","author":"Evangelou","year":"2018"},{"key":"ref24","first-page":"691","volume-title":"Genome analyses of &gt; 200,000 individuals identify 58 loci for chronic inflammation and highlight pathways that link inflammation and complex disorders","author":"Ligthart","year":"2018"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-018-0171-3"},{"key":"ref26","first-page":"2941","volume-title":"Genome-wide association analyses identify 143 risk variants and putative regulatory mechanisms for type 2 diabetes","author":"Xue","year":"2018"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.7554\/elife.34408"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyac085"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyx034"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-017-0255-x"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-018-0099-7"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2020.105187"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2009.04.004"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.3390\/jcm6010004"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1016\/s2352-4642(18)30064-6"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-2600(21)00508-7"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1080\/15412555.2018.1464551"}],"container-title":["Epidemiology and Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-epih.org\/upload\/pdf\/epih-45-e2023031.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-epih.org\/journal\/view.php?doi=10.4178\/epih.e2023031","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-epih.org\/upload\/pdf\/epih-45-e2023031.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T04:56:16Z","timestamp":1708404976000},"score":1,"resource":{"primary":{"URL":"http:\/\/e-epih.org\/journal\/view.php?doi=10.4178\/epih.e2023031"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,3]]},"references-count":37,"URL":"https:\/\/doi.org\/10.4178\/epih.e2023031","relation":{},"ISSN":["2092-7193"],"issn-type":[{"value":"2092-7193","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,3]]},"assertion":[{"value":"2022-10-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-03","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}}]}}