Article

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

Section of Neonatal Medicine, Department of Medicine, Imperial College London, London SW10 9NH, United Kingdom.
PEDIATRICS (Impact Factor: 5.47). 03/2013; 131(4). DOI: 10.1542/peds.2012-2177
Source: PubMed

ABSTRACT

Background and Aims Preterm birth is associated with raised blood pressure (BP) and other features of the metabolic syndrome in later life, but effect sizes and biological mechanisms are unknown. We conducted a meta-analysis to address these associations in adult life.
Methods We performed a systematic review and meta-analysis of studies in which metabolic syndrome associated indices were compared in adults (≥18 years of age) born preterm (< 37 weeks gestation) and at term (37–42 weeks gestation). Outcome measures included; systolic blood pressure (SBP), diastolic blood pressure (DBP), BMI, percentage fat mass and fasting plasma levels of lipids, glucose and insulin.
Results Data from 27 studies and 306,123 adults (16,094 preterm, 290,029 term) were included, with an average outcome age of 26.1 years. In adults, preterm compared with full-term birth was associated with significantly higher SBP (mean difference [95% confidence interval]: 4.2mmHg [2.7, 5.7], p<0.001), DBP (2.7mmHg [1.2, 4.2], p<0.001) and low density lipoprotein (LDL) (0.14mmol/L [0.05, 0.22], p=0.01). Meta-regression revealed a significant gender effect, with 3.0mmHg greater SBP in preterm compared to term women than in preterm-term men (95%CI: 1.3, 4.7, p=0.002); for DBP this difference was 2.1mmHg greater (0.6, 3.6, p=0.009).
Conclusions Preterm compared to term birth, is associated with higher blood pressure and LDL in adult life. Women born preterm appear to be at greater risk than men born preterm. Follow-up of older subjects born preterm will be required to determine if the effects we observe are exacerbated by age.

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    • "However, studies were heterogeneous in methods of selecting on preterm birth, and there is a mix of those who were appropriate for gestational age and those small for gestational age that does not clearly tease apart the effect of gestational age from fetal growth. In the subgroup analyses, the authors found that the blood pressure association was stronger among studies that recruited based on gestational age rather than birth weight [17]. The Cardiovascular Risk in Young Finns Study was one of the largest cohorts to try to tease these aspects apart. "
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    ABSTRACT: Although cardiovascular disease has traditionally been viewed as a condition of aging individuals, increasing focus has turned to its developmental origins. Since birth weight has been related to cardiovascular disease risk, research into factors such as gravid conditions that affect fetal growth have grown. Associations between maternal diabetes and childhood obesity from sibling studies suggest a causal role, but prospective studies of gestational diabetes remain mixed. Preeclampsia and increased offspring blood pressure have been consistently observed, but evidence for other cardiovascular outcomes is lacking. While maternal obesity is associated with childhood obesity, causality remains unclear and paternal obesity should be investigated as an independent risk factor. Environmental chemical exposures in utero, particularly obesogens, are now emerging as another concern, as is conception via infertility treatment. Few studies have investigated the subclinical measures of endothelial function or atherosclerosis, and more research in these areas may help to reveal the underlying pathogenesis.
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    ABSTRACT: Background: In 2010, there were an estimated 15 million preterm births worldwide (<37 wk gestation). Survivors are at risk of adverse outcomes, and burden estimation at global and regional levels is critical for priority setting. Methods: Systematic reviews and meta-analyses were undertaken to estimate the risk of long-term neurodevelopmental impairment for surviving preterm babies according to the level of care. A compartmental model was used to estimate the number of impaired postneonatal survivors following preterm birth in 2010. A separate model (DisMod-MR) was used to estimate years lived with disability (YLDs) for the global burden of disease 2010 study. Disability adjusted life years (DALYs) were calculated as the sum of YLDs and years of life lost (YLLs). Results: In 2010, there were an estimated 13 million preterm births who survived beyond the first month. Of these, 345,000 (2.7%, uncertainty range: 269,000–420,000) were estimated to have moderate or severe neurodevelopmental impairment, and a further 567,000 (4.4%, (445,000–732,000)) were estimated to have mild neurodevelopmental impairment. Many more have specific learning or behavioral impairments or reduced physical or mental health. Fewest data are available where the burden is heaviest. Preterm birth was responsible for 77 million DALYs, 3.1% of the global total, of which only 3 million were YLDs. Conclusion: Most preterm births (>90%) survive without neurodevelopmental impairment. Developing effective means of prevention of preterm birth should be a longer term priority, but major burden reduction could be made immediately with improved coverage and quality of care. Improved newborn care would reduce mortality, especially in low-income countries and is likely to reduce impairment in survivors, particularly in middle-income settings.
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