Preterm birth and maternal smoking in pregnancy are strong risk factors for aortic narrowing in adolescence

Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden.
Acta Paediatrica (Impact Factor: 1.67). 09/2008; 97(8):1080-5. DOI: 10.1111/j.1651-2227.2008.00890.x
Source: PubMed


Preterm transition from foetal to neonatal circulation might permanently alter aortic growth and development. To test this hypothesis, we measured aortic dimensions in adolescents born very preterm.
Eighty-six healthy 15-year-old subjects were studied; 45 born very preterm at an average gestational age of 28 weeks (birth weight < 1500 g) and 41 controls born at term. Using a pulse-gated Fiesta sequence on a 1.5T MR-scanner, 25 images were collected within the heart cycle at several levels of the descending aorta. End-diastolic cross-sectional areas were semi-automatically calculated using an active contour model.
Subjects born preterm had narrower aortic lumen. The difference was 16% in the thoracic and 19% in the abdominal aorta after adjustment for body surface area and gender (p < 0.001). Maternal smoking in pregnancy was also found to be an independent risk factor for aortic narrowing in the offspring (difference 10%-13% throughout the aorta vs. offspring to nonsmoking mothers). Adolescents born preterm had higher systolic and diastolic blood pressures; however, blood pressures did not correlate with aortic size or maternal smoking during pregnancy.
Very preterm birth and exposure to maternal smoking in foetal life are independent and strong risk factors for general aortic narrowing 15 years after birth.

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    • "Tonic elevation of sympathetic activity and / or parasympathetic withdrawal may precede development of clinically overt hypertension [20,21] and cardiac hypertrophy [22], alter angiogenesis and vascular remodelling [23,24], contribute to the evolution of diabetes [25,26] and underlie sudden cardiac death [27]. The altered sympatho-vagal balance that we report here may therefore underlie the association between preterm birth and these later adverse cardiovascular outcomes [2,4,5,28,29]. "
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    ABSTRACT: Globally, 11% of infants are born preterm. In adulthood, individuals born preterm are at increased risk of cardiovascular morbidity and mortality, but the mechanistic basis of this remains unknown. Clinically overt cardiovascular disease may be preceded by altered cardiac autonomic activity characterised by increased sympathetic activity and/or reduced parasympathetic activity. Thus, altered cardiac autonomic activity in survivors of preterm birth may underlie later cardiovascular risk. To investigate the impact of gestational age on cardiac autonomic activity in juvenile and adult sheep. Singleton-bearing ewes were randomised antenatally to spontaneous term birth (TC; n=73) or corticosteroid induced preterm birth (PT; n=60). Cardiac autonomic modulation was assessed using heart rate variability analysis in juvenile and adult offspring. Preterm birth in adult males was associated with altered sympatho-vagal modulation (LFnu: PT 64±4 vs. TC 49±4, p<0.05; LogLF/HF: PT 1.8±0.1 vs. TC 1.5±0.1, p<0.05) and reduced parasympathetic modulation (LogRMSSD: PT 2.9±0.2 vs. TC 3.4±0.1, p<0.05; LogNN50: PT 0.3±0.4 vs. TC 1.6±0.4, p<0.05). Within the range of term birth, each one-day increment in gestational age was associated with a decrement in LFnu in juvenile females and with a decrement in LFnu and LF/HF ratio, but an increment in RMSSD and NN50 in adult females. Cardiac autonomic function in adult sheep is affected in a sex-specific manner by gestational age at birth, even within the term range. Altered cardiac autonomic function may contribute to increased later cardiovascular morbidity in those born preterm.
    Full-text · Article · Dec 2013 · PLoS ONE
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    • "Differently from Anna-Karin et al., we have only evaluated term newborns, by considering all the parameter able to influence the relationship. At a linear analysis, smoking increased abdominal aorta intima-media thickness [24], probably through endocrine modifications, involving serum insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels and actions [23] or by inducing a long-lasting " reprogramming " of the blood pressure control mechanisms [25], but the evaluation was not confirmed after adjustment for confounding variables. Nevertheless, as the hypothesis of Anna-Karin et al. about "
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    ABSTRACT: Aim. To evaluate the influence of selected maternal and neonatal characteristics on aorta walls in term, appropriately grown-for-gestational age newborns. Methods. Age, parity, previous abortions, weight, height, body mass index before and after delivery, smoking, and history of hypertension, of diabetes, of cardiovascular diseases, and of dyslipidemia were all assessed in seventy mothers. They delivered 34 males and 36 females healthy term newborns who underwent ultrasound evaluation of the anteroposterior infrarenal abdominal aorta diameter (APAO), biochemical profile (glucose, insulin, total cholesterol, HDL and LDL cholesterol, triglycerides, fibrinogen, and D-dimers homeostasis model assessment [HOMAIR]index), and biometric parameters. Results. APAO was related to newborn length (r = +0.36; P = 0.001), head circumference (r = +0.37; P = 0.001), gestational age (r = +0.40, P = 0.0005), HOMA index (r = +0.24; P = 0.04), and D-dimers (r = +0.33, P = 0.004). Smoke influenced APAO values (odds ratio: 1.80; confidence interval 95%: 1.05–3.30), as well as diabetes during pregnancy (r = +0.42, P = 0.0002). Maternal height influenced neonatal APAO (r = +0.47, P = 0.00003). Multiple regression analysis outlined neonatal D-dimers as still significantly related to neonatal APAO values. Conclusions. Many maternal and neonatal characteristics could influence aorta structures. Neonatal D-dimers are independently related to APAO.
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