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


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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Available from: Christopher Gale, Nov 18, 2015
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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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