Cardiovascular risk factors in those born preterm – systematic review and meta-analysis

Abstract

Emerging evidence demonstrates a link between preterm birth (PTB) and later life cardiovascular disease (CVD). We conducted a systematic review and meta-analysis to compare conventional CVD risk factors between those born preterm and at term. PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. The review protocol is registered in PROSPERO (CRD42018095005). CVD risk factors including systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index, lipid profile, blood glucose, and fasting insulin among those born preterm (<37 weeks’ gestation) were compared with those born at term (≥37 weeks’ gestation). Subgroup analyses based on gender, age, gestational at birth (<32 weeks’ gestation and <28 weeks’ gestation), and PTB associated with small for gestational age or average for gestational age were also performed. Fifty-six studies provided data on 308,987 individuals. Being born preterm was associated with 3.26 mmHg (95% confidence interval [CI] 2.08 to 4.44) higher mean SBP and 1.32 mmHg (95% CI: 0.61 to 2.04) higher mean DBP compared to being born at term. Subgroup analyses demonstrated that SBP was higher among (a) preterm compared to term groups from early adolescence until adulthood; (b) females born preterm but not among males born preterm compared to term controls; and (c) those born at <32 weeks or <28 weeks compared to term. Our meta-analyses demonstrate higher SBP and DBP among those born preterm compared to term. The difference in SBP is evident from early adolescence until adulthood.

The association between late preterm birth and cardiometabolic conditions across the life course: A systematic review and meta‐analysis

“…35,65 This is consistent with systematic reviews investigating any preterm birth and cardiometabolic risk where no differences were found between adolescents born preterm compared to the term for most risk factors other than blood pressure. 15 Late preterm birth was inversely associated with BMI in children which were not consistent with our hypothesis of increased cardiometabolic risk across the life course, but this may be explained by the young age at the outcome for the BMI studies (most were among children <7 years). It is possible that an association between late preterm birth and obesity might emerge in later life but we only identified two studies of adults.…”

“… 35 , 65 This is consistent with systematic reviews investigating any preterm birth and cardiometabolic risk where no differences were found between adolescents born preterm compared to the term for most risk factors other than blood pressure. 15 …”

“…Very preterm infants experience a high rate of morbidity and mortality in the first year of life and developmental and cardiovascular adversity later in life. 11 , 12 , 13 Systematic reviews have revealed that overall preterm birth (<37 weeks) is associated with increased blood pressure 14 , 15 , 16 and diabetes risk 14 , 17 , 18 in adults, but results for fat mass or body mass index (BMI) 14 , 15 , 19 and cholesterol 14 , 15 , 19 have been inconsistent or null. Late preterm birth may also confer negative consequences across the life course, 20 but there is limited evidence from the systematic reviews focused on this group.…”

Gestational age at birth and body size from infancy through adolescence: findings from analyses of individual data on 253,810 singletons in 16 birth cohort studies

“…Previous studies (26–28, 77) and a meta-analysis (35) have shown consistent results for the association of GA with BMI in childhood with lower BMI in preterm children compared with full term peers, although several methodological issues should be taken into account when interpreting these findings. In contrast, surprisingly few studies have examined the association of GA with later overweight, particularly in childhood.…”

“…However, studies on growth in preterm cohorts across key stages of growth development (33) and at more advanced gestational age are scarce (10, 20, 34). Several methodological considerations and sample characteristics complicate the interpretation and comparability of findings on the relationship between GA with later body size (5, 6, 35–37). This includes differences in study design; using birth weight as a proxy for GA; sample size; age at outcome; conditions under which variables are examined; type of statistical analysis; and availability of confounders.…”