Impact of Fetal Growth and Preterm Birth on the Retinal Microvasculature in Mid‐Adulthood

Hussain, Sultana Monira; Kähönen, Mika; Raitakari, Olli T.; Skilton, Michael R.; Witt, Nicholas; Chaturvedi, Nish; Hutri‐Kähönen, Nina; Lehtimäki, Terho; Vaahtoranta-Lehtonen, Hanna; Juonala, Markus; Wijetunge, S; Hughes, Alun D.; Thom, Simon; Metha, Andrew; Tapp, Robyn J.

doi:10.1111/micc.12197

Cited by 12 publications

(18 citation statements)

References 38 publications

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“…Aside from the many disadvantageous outcomes from premature birth, both premature birth and low birth weight have been associated with cardiometabolic dysfunction, including overweight in adolescence and adulthood, dyslipidemia, insulin resistance, endothelial and glomerular dysfunction. [100-103] As shown before, exposure during childhood is associated with aberrant growth patterns inducing overweight and obesity and early signs of cardiovascular and metabolic dysfunction, including glomerular and endothelial dysfunction, increased blood pressure and increased insulin resistance. Together with the earlier mentioned cellular changes both fetal and childhood exposure to phthalates and bisphenols may give rise to an increased risk for cardiovascular and metabolic disease in adulthood.…”

Section: Discussionmentioning

confidence: 93%

Effects of early exposure to phthalates and bisphenols on cardiometabolic outcomes in pregnancy and childhood

Philips¹,

Jaddoe

Trasande

2017

Reproductive Toxicology

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Pregnant women are exposed to various chemicals, including endocrine-disrupting chemicals (EDCs) such as phthalates and bisphenols. Increasing evidence suggests that early life exposures to phthalates and bisphenols may contribute to cardiometabolic risks. The aim of this narrative review was to summarize current knowledge of the effects of fetal and childhood exposure to phthalates and bisphenols on child growth and child cardiometabolic outcomes and the effects on maternal outcomes. In total, 54 studies were identified and included. The majority of studies found effects of phthalates and bisphenols on maternal, child growth, and cardiometabolic outcomes. Currently results suggest that early life exposure to phthalates and bisphenols may have a substantial influence on perinatal and postnatal cardiometabolic programming. In a large part of the investigated outcomes studies show contradictory results. However, the majority of the existing evidence is based on non-cohort studies with single samples neglecting time-variant effects and complicating conclusions regarding causal inference. More studies are needed investigating the mechanisms and its potential interactions.

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Section: Discussionmentioning

confidence: 93%

Effects of early exposure to phthalates and bisphenols on cardiometabolic outcomes in pregnancy and childhood

Philips¹,

Jaddoe

Trasande

2017

Reproductive Toxicology

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“…A study by Lazdam et al assessed a sample of 71 participants born preterm and showed that offspring of a hypertensive pregnancy had increased carotid IMT and 30% lower FMD at age 24 years. 34 The present study excluded those born preterm and small for gestational age from the main analysis, as it has been demonstrated that being born small for gestational age and in particular preterm birth are associated with changes in the retinal microvascular, 35 cardiac structure, IMT, and FMD. 18 So although impaired fetal growth and preterm birth contribute to the mechanisms of early vascular changes, they are not the primary mechanistic link responsible for the observed abnormalities among offspring of HDP in the present study.…”

Section: Discussionmentioning

confidence: 99%

Cardiometabolic Health Among Adult Offspring of Hypertensive Pregnancies: The Cardiovascular Risk in Young Finns Study

Tapp

Hughes

Kähönen

et al. 2018

JAHA

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BackgroundCardiometabolic health among adult offspring of hypertensive disorders of pregnancy (HDP) is relatively unknown. We hypothesized that offspring of HDP would have abnormalities in the retinal microvasculature and cardiac structure by midadulthood.Methods and ResultsThe Cardiovascular Risk in Young Finns Study included randomly selected children from 5 Finnish university cities. The mean age of participants was 40 years (range 34–49 years) at the time of retinal photography and cardiac assessment. Offspring born ≥37 weeks of gestation and appropriate for gestational age (n=1006) were included. Offspring of HDP had higher systolic blood pressure (β=4.68, P<0.001), body mass index (β=1.25, P=0.009), and waist circumference (β=0.25, P=0.042), compared with offspring of normotensive pregnancies. However, no differences in fasting glucose, insulin, lipid profile, carotid intima media thickness, or brachial artery flow‐mediated dilatation were shown. Retinal arteriolar diameters were narrower (β=−0.43, P=0.009) and longer (β=32.5, P=0.023) and the arteriolar length‐to‐diameter ratio was higher (β=2.32, P=0.006) among offspring of HDP, after adjustment for age and sex. Left atrial volume indexed to body surface area (β=1.34, P=0.040) was increased. Adjustment for the confounding effects of birth weight, body mass index, smoking and socioeconomic status, and the mediating effect of hypertension had little impact on the associations.ConclusionsAbnormalities of the retinal microvasculature and cardiac structure are seen in offspring of HDP in midadulthood. These findings may need to be considered in future primary prevention strategies of cardiovascular disease among offspring of HDP.

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“…These parameters have also been associated with altered microvascular geometry with very pre‐term infants exhibiting increased venular tortuosity and reduced branching independent of retinopathy of prematurity . Data from the Cardiovascular Risk in Young Finns Study found in addition to arteriolar narrowing, that preterm birth and small for gestational age (SGA) was associated with increased arteriolar tortuosity with stronger associations for those born preterm . Gishti et al also found that infants born pre‐term, particularly those who had accelerated growth rate in the first 24 months of life, had narrower retinal arteriolar calibre compared with term‐born children.…”

Section: Paediatric Retinal Vascular Calibre Association With Prenatamentioning

confidence: 94%

“…Low birth weight and pre‐term birth have also been associated with arteriolar narrowing in both childhood and middle age . Kandasamy et al conversely found increased arteriolar and venular diameters in low birth weight infants however only recruited a small cohort of 24 infants.…”

Section: Paediatric Retinal Vascular Calibre Association With Prenatamentioning

confidence: 99%

Review of paediatric retinal microvascular changes as a predictor of cardiovascular disease

Newman

Andrew

Casson

2016

Clinical Exper Ophthalmology

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Recent studies have supported the hypothesis that exposure to established cardiovascular risk factors in early life predisposes to the development of adult cardiovascular disease. Retinal imaging is an emerging technique which facilitates non-invasive, accurate and reproducible assessment of the retinal microvasculature. The assessment may be in the form of static vascular calibre measurements and assessment of the vascular geometry or dynamic structural and functional assessments. Paediatric retinal microvascular changes are reported in response to elevated blood pressure, type 1 diabetes, increasing adiposity, diet, physical activity, systemic inflammation, metabolic peptides, family history and prenatal factors. The resultant microvascular changes have been linked to subclinical and overt cardiovascular, cerebrovascular and metabolic disease states in the adult population. Still missing however is longitudinal evidence showing the persistence of retinal microvascular alterations into adulthood. Future studies will enable retinal microvascular assessment to further evaluate the pathogenesis of disease states and response to intervention. The data obtained will also aid in expanding the clinical utility of retinal imaging as a cardiovascular risk prediction and monitoring tool and supplement existing recommendations to reduce cardiovascular morbidity and mortality.

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Impact of Fetal Growth and Preterm Birth on the Retinal Microvasculature in Mid‐Adulthood

Abstract: This study demonstrated that being born SGA and in particular preterm birth are associated with changes in retinal microvascular architecture. The prenatal and immediate postnatal environment may contribute to the mechanisms.

Cited by 12 publications

References 38 publications

Effects of early exposure to phthalates and bisphenols on cardiometabolic outcomes in pregnancy and childhood

Effects of early exposure to phthalates and bisphenols on cardiometabolic outcomes in pregnancy and childhood

Cardiometabolic Health Among Adult Offspring of Hypertensive Pregnancies: The Cardiovascular Risk in Young Finns Study

Review of paediatric retinal microvascular changes as a predictor of cardiovascular disease

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