Former Very Preterm Infants Show an Unfavorable Cardiovascular Risk Profile at a Preschool Age

Abstract

Cardiovascular disease is the leading cause of death worldwide. Evidence points towards an unfavorable cardiovascular risk profile of former preterm infants in adolescence and adulthood. The aim of this study was to determine whether cardiovascular risk predictors are detectable in former very preterm infants at a preschool age. Five- to seven-year-old children born at <32 weeks’ gestational age were included in the study. Same-aged children born at term served as controls. Basic data of study participants were collected by means of follow-up databases and standardized questionnaires. At study visit, anthropometric data, blood pressure readings and aortic intima-media thickness were assessed. Blood samples were obtained after an overnight fast. In comparison to children born at term, former preterm infants had higher systolic and diastolic blood pressure readings (odds ratio [95% confidence interval] per 1-SD higher blood pressure level 3.2 [2.0–5.0], p<0.001 and 1.6 [1.1–1.2], p = 0.008), fasting glucose levels (OR [95% CI] 5.2 [2.7–10.1], p<0.001), homeostasis model assessment index (OR [95% CI] 1.6 [1.0–2.6], p = 0.036), and cholesterol levels (OR [95% CI] 2.1 [1.3–3.4], p = 0.002). Systolic prehypertension (23.7% vs. 2.2%; OR [95% CI] 13.8 [3.1–60.9], p = 0.001), elevated glucose levels (28.6% vs. 5.9%; OR [95% CI] 6.4 [1.4–28.8], p = 0.016), and hypercholesterolemia (77.4% vs. 52.9%; OR [95% CI] 3.0 [1.3–7.1], p = 0.010) were significantly more prevalent in the preterm group. As former very preterm infants display an unfavorable cardiovascular risk profile already at a preschool age, implementation of routine cardiovascular follow-up programs might be warranted.

Gender disparities in preterm neonatal outcomes

“…Former preterm infants have an unfavourable cardiac profile compared to term‐born counterparts as measured by persistently abnormal neonatal echocardiography findings . They also have higher blood pressure, higher fasting blood glucose and higher blood cholesterol in the preschool period , with an increased risk of adult cerebrovascular disease . Very low birthweight (<1.5 kg) male neonates have lower blood pressures than females on day 1 of life , and extremely preterm males are more likely to require treatment for hypotension within the first week of life .…”

Prevalence of diabetes and obesity in association with prematurity and growth restriction

“…In a study of cardiovascular risk factors in preschool aged children who were born prematurely, Posod et al found that children born prematurely had higher cholesterol levels (OR 2.1), higher systolic and diastolic blood pressures, higher fasting glucose levels, and indicators of insulin resistance. The authors concluded that preterm infants have an unfavorable cardiovascular risk as early as preschool age 79. In a meta-analysis of 27 studies, Parkinson et al reviewed markers of metabolic syndrome in 17,030 adults who were born prematurely and were compared with 295,261 adults who were born at term.…”

Male infertility as a window to health

“…Children conceived through in vitro fertilization and intracytoplasmic sperm injection (ICSI) have been found to have higher rates of cryptorchidism and hypospadias, as well as higher rates of preterm birth and low birth weight (20). Preterm babies are then found to be at higher risk for a variety of systemic diseases, including cardiovascular disease (21) and both type 1 and type 2 diabetes mellitus (22). In addition, studies of semen quality in young men conceived via ICSI have demonstrated lower median sperm concentrations and total sperm counts compared with their spontaneously conceived peers (23).…”