Preterm Birth and the Metabolic Syndrome in Adult Life: A Systematic Review and Meta-analysis

Parkinson, James; Hyde, Matthew J.; Gale, Chris; Santhakumaran, Shalini; Modi, Neena

doi:10.1542/peds.2012-2177

Cited by 366 publications

(326 citation statements)

References 76 publications

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“…6 We found no interaction between sex and early or late preterm birth on adult BP. One possible reason is that the sex interaction may only be present among subjects born at an earlier gestational age, which most previous studies focused on.…”

Section: Discussionmentioning

confidence: 51%

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Ambulatory Blood Pressure and Its Variability in Adults Born Preterm

et al. 2015

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A pproximately 14.9 million babies (11% of all infants born) worldwide are born preterm (<37 weeks) every year.1 Adults born preterm with very low birth weight (VLBW; <1500 g) or very (<32 weeks) or early (<34 weeks) preterm have higher blood pressure (BP) 2-6 and higher rates of hypertension compared with their peers born at term. There is some evidence of a continuous relationship between shorter length of gestation and higher BP. 7,8 Although most studies have relied on office-measured BP, we are aware of 5 studies that used 24-hour ambulatory BP (ABP) in adults born preterm. Those studies show either elevated BP 9-13 or hypertension, 9 and all are limited to adults born preterm at VLBW or very or extremely (<28 weeks) preterm, comprising the extreme 1% to 1.5% of newborns. Although 24-hour ABP predicts cardiovascular events better than office-measured BP, 14,15 it has not been studied across the entire range of preterm births.In addition to mean BP levels, previous studies have highlighted BP variability as a key factor underlying the progression of organ damage 16 and triggering vascular events. 15 It is also correlated with the development of hypertensive left ventricular hypertrophy. 17 BP variability is studied less often in adults born preterm. We hypothesized that preterm birth, across its entire range, is associated with elevated levels and larger variability of ABP in young adults. MethodsThis study is part of the ESTER (Preterm Birth and Early Life Programming of Adult Health and Disease) study, 18 a case-cohort study with subjects recruited through Northern Finland Birth Cohort Abstract-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 early preterm (<34 weeks), 72 born late preterm (34-36 weeks), and 103 controls (≥37 weeks). Sleep was confirmed with accelerometry in 72.4% of subjects. The 24-hour systolic BP of adults born early preterm was 5.5 mm Hg higher (95% confidence interval, 1.9-9.3), awake systolic BP was 6.4 mm Hg higher (95% confidence interval, 2.8-10.1), and sleeping systolic BP was 2.9 mm Hg higher (95% confidence interval 0.3-7.5) when adjusted for age, sex, and use of accelerometry. The differences remained similar when adjusted for height, body mass index, physical activity, smoking, parental education, maternal body mass index, smoking during pregnancy, and gestational diabetes mellitus and attenuated slightly when adjusted for maternal hypertensive pregnancy disorders. Adults born early preterm also had higher BP variability as indicated by higher individual standard deviations of systolic BP and diastolic BP. Although our results were consistent with a dose-response relationship between shorter gestation and higher BP, the difference between the late preterm and term groups was not ...

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Section: Discussionmentioning

confidence: 51%

“…1 Adults born preterm with very low birth weight (VLBW; <1500 g) or very (<32 weeks) or early (<34 weeks) preterm have higher blood pressure (BP) [2][3][4][5][6] and higher rates of hypertension compared with their peers born at term. There is some evidence of a continuous relationship between shorter length of gestation and higher BP.…”

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confidence: 99%

Ambulatory Blood Pressure and Its Variability in Adults Born Preterm

et al. 2015

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“…Compared with healthy term infants, preterm infants are born physiologically immature, nutritionally compromised, growth restricted and at risk of long-term complications (1)(2)(3) . The optimal nutrition for preterm infants is to be fed human breast milk (4,5) , and to mirror the growth and development of the age-matched healthy fetus.…”

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confidence: 99%

Preterm human milk composition: a systematic literature review

et al. 2016

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There are wide variations in the macronutrient values adopted by neonatal intensive care units and industry to fortify milk in efforts to achieve recommended intakes for preterm infants. Contributing to this is the variation in macronutrient composition of preterm milk between and within mothers and the variable quality of milk analyses used to determine the macronutrient content of milk. We conducted a systematic review of the literature using articles published in English between 1959 and 2013 that reported the concentrations of one or more macronutrients or energy content in human preterm milk, sampled over a representative 24-h period. Searched medical databases included Ovid Medline, Scopus, CINAHL and the Cochrane Library. Results are presented as mean values and ranges for each macronutrient during weeks 1-8 of lactation, and preferred mean values (g/100 ml) for colostrum (week 1) and mature milk (weeks 2-8; protein: 1·27, fat: 3·46, lactose: 6·15 and carbohydrate: 7·34), using data from studies employing the highest-quality analyses. Industry-directed fortification practices using these mean values fail to meet protein targets for infants weighing <1000 g when the fortified milk is fed <170-190 ml/kg per d, and the protein:energy ratio of the fortified milk is inadequate. This study aimed to provide additional information to industry in order to guide their future formulation of breast milk fortifiers. Quality macronutrient analyses of adequately sampled preterm breast milk would improve our understanding of the level of fortification needed to meet recommended protein and energy intakes and growth targets, as well as support standardised reporting of nutritional outcomes.

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“…At least those born smallest and most immature show as children and adults more pronounced cardiovascular risk factors, for example increased blood pressure (BP), [5][6][7][8][9][10][11][12][13][14][15][16][17] reduced glucose tolerance, 7,11 and increased insulin resistance, 7,8,18 compared with those born at term. As to plasma lipids, the results are mixed.…”

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confidence: 99%

Cardiovascular Risk Factors in Adolescents Born Preterm

Sipola-Leppänen¹,

Vääräsmäki

Tikanmäki³

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Adolescents and adults born early preterm have higher blood pressure and altered glucose metabolism compared with their term born peers. Evidence of an atherogenic lipid profile is inconsistent. Whether these risks apply to those born less preterm is not known. WHAT THIS STUDY ADDS:In adolescence, girls have higher blood pressure and boys a more atherogenic lipid profile than their term born peers. Overall, our results are consistent with a dose-response relationship between shorter length of gestation and increasing levels of cardiovascular risk factors. abstract 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 populationbased Northern Finland Birth Cohort 1986. Of these, 79 (1.2%) were born at ,34 gestational weeks (early preterm), 238 (3.6%) at 34 to 36 weeks (late preterm), and 6325 at term (controls).RESULTS: Girls born early preterm had 6.7 mm Hg (95% confidence interval: 3.1-10.2) higher systolic blood pressure (BP) and 3.5 mm Hg (1.1-5.8) higher diastolic BP, but no difference in serum lipid levels compared with control girls. Boys showed no differences in BP, but boys born early preterm had 6.7% (0.2%-13.7%) higher total cholesterol, 11.7% (2.1%-22.3%) higher low-density lipoprotein cholesterol, and 12.3% (3.1%-22.4%) higher apolipoprotein B concentrations. The differences were similar (BP) or stronger (lipids) when adjusted for maternal smoking, birth weight SD score, parental education, pubertal stage, BMI, and lifestyle. There were similar associations with length of gestation as a continuous variable. Accordingly, mean differences between late preterm and controls were in the same direction but weaker, although most were not statistically significant. CONCLUSIONS:Preterm birth was associated with elevated BP in adolescent girls and an atherogenic lipid profile in boys. Because these associations were strongest among those born early preterm, our findings are consistent with a dose-response relationship between shorter length of gestation and cardiovascular risk factors. Dr Sipola-Leppänen carried out initial analyses and drafted the initial manuscript; Drs Vääräsmäki and Kajantie carried out initial analyses, reviewed and revised the manuscript, and supervised the writing process; Drs Tikanmäki, Hovi, and Miettola reviewed and revised the manuscript; Drs Ruokonen, Pouta, and Järvelin coordinated and supervised data collection and critically reviewed the manuscript; and all authors approved the final manuscript as submitted.www.pediatrics.org/cgi

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Preterm Birth and the Metabolic Syndrome in Adult Life: A Systematic Review and Meta-analysis

Cited by 366 publications

References 76 publications

Ambulatory Blood Pressure and Its Variability in Adults Born Preterm

Ambulatory Blood Pressure and Its Variability in Adults Born Preterm

Preterm human milk composition: a systematic literature review

Cardiovascular Risk Factors in Adolescents Born Preterm

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