Impact of very preterm birth and post-discharge growth on cardiometabolic outcomes at school age: a retrospective cohort study

Abstract

Background Adverse metabolic outcomes later in life have been reported among children or young adults who were born as preterm infants. This study was conducted to examine the impact of very preterm/very low birth weight (VP/VLBW) birth and subsequent growth after hospital discharge on cardiometabolic outcomes such as insulin resistance, fasting glucose, and systolic and diastolic blood pressure (BP) among children at 6–8 years of age. Methods This retrospective cohort study included children aged 6–8 years and compared those who were born at < 32 weeks of gestation or weighing < 1,500 g at birth (n = 60) with those born at term (n = 110). Body size, fat mass, BP, glucose, insulin, leptin, adiponectin, and lipid profiles were measured. Weight-for-age z-score changes between discharge and early school-age period were also calculated, and factors associated with BP, fasting glucose, and insulin resistance were analyzed. Results Children who were born VP/VLBW had significantly lower fat masses, higher systolic BP and diastolic BP, and significantly higher values of fasting glucose, insulin, and homeostatic model assessment of insulin resistance (HOMA-IR), compared to children born at term. VP/VLBW was correlated with HOMA-IR and BPs after adjusting for various factors, including fat mass index and weight-for-age z-score changes. Weight-for-age z-score changes were associated with HOMA-IR, but not with BPs. Conclusions Although children aged 6–8 years who were born VP/VLBW showed significantly lower weight and fat mass, they had significantly higher BPs, fasting glucose, HOMA-IR, and leptin levels. The associations of VP/VLBW with cardiometabolic factors were independent of fat mass and weight gain velocity.

Association of preterm birth with poor metabolic outcomes in schoolchildren

“…Adverse metabolic outcomes have been reported among children or young adults born preterm, and in very preterm or extremely preterm infants, cardiometabolic changes typically begin during infancy or school age 1 . However, controversies stillremain on the subject.…”

“… 28 In a retrospective evaluation at 6–8 years of age, 60 children born < 30 weeks or with birth weight < 1500 g showed higher values of fasting glucose, insulin, and insulin resistance (HOMA-IR) compared to children born at term. 1 …”

“…Adverse metabolic outcomes have been reported among children or young adults born preterm infants. 1 Adults who were born prematurely may present elevated blood pressure, abnormalities in glucose tolerance profiles, higher total body fat mass, and increased risk for obesity in comparison with the ones who were born after a full-term pregnancy. 2 Low birth weight is a consequence of either a compromised environment during intrauterine life or preterm interruption of gestation.…”