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

Yoshida-Montezuma, Yulika; Stone, Erica; Iftikhar, Sadaf; Rubeis, Vanessa De; Andreacchi, Alessandra T.; Keown‐Stoneman, Charles; Mbuagbaw, Lawrence; Brown, Hilary; Souza, Russell J. de; Anderson, Laura N.

doi:10.1111/ppe.12831

Cited by 19 publications

(11 citation statements)

References 84 publications

(309 reference statements)

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“…In population-based studies, a 2-fold increase in the prevalence of type 2 diabetes has been noted by 40 to 60 years of age in infants born preterm [ 23 , 26 ]. In a recent meta-analysis, infants born preterm had a higher risk of diabetes and hypertension as adults [ 27 ]. Early diagnosis and management of prediabetes would contribute not only to decrease the disease progression towards type 2 diabetes [ 28 ] but also in reducing cardiovascular morbidity in these infants [ 29 ].…”

Section: Risk For Cardiovascular Diseasementioning

confidence: 99%

Cardiovascular Morbidities in Adults Born Preterm: Getting to the Heart of the Matter!

Kumar

2022

Children

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Advances in perinatal and neonatal care have led to improved survival of preterm infants into adulthood. However, the shift in focus to long-term health in adults born preterm requires a clear understanding of the impact of prematurity on developing organ systems and the development of adult-oriented disease. A less well-recognized area of risk for surviving preterm infants is their cardiometabolic health. Epidemiologic evidence has linked preterm birth to the development of systemic hypertension, type 2 diabetes, metabolic syndrome, heart failure, and ischemic heart disease. Of more significant concern is that the risk of cardiometabolic disorders is higher in adults born preterm compared to full-term infants. The interconnected nature of the cardio-pulmonary system means worsening morbidity and mortality in adults born preterm. Addressing the problems of adults born preterm holistically would help promote cardiovascular health, wellness, and quality of life over their lifetime. Recognizing that adults born preterm are a unique subset of the population is a challenge in the current healthcare environment. Addressing issues relevant to adults born preterm in the clinically and research domain, using technology to characterize cardiopulmonary physiology and exercise tolerance, developing screening tools for early diagnosis and treatment, and robust follow-up of these infants with access to longitudinal data would improve both the quality and longevity of life in adults born preterm.

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Section: Risk For Cardiovascular Diseasementioning

confidence: 99%

Cardiovascular Morbidities in Adults Born Preterm: Getting to the Heart of the Matter!

Kumar

2022

Children

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“…However, studies on growth in preterm cohorts across key stages of growth development [ 33 ] and at more advanced GA 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 , 36 , 37 ]. These include 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.…”

Section: Introductionmentioning

confidence: 99%

Gestational age at birth and body size from infancy through adolescence: An individual participant data meta-analysis on 253,810 singletons in 16 birth cohort studies

et al. 2023

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Background Preterm birth is the leading cause of perinatal morbidity and mortality and is associated with adverse developmental and long-term health outcomes, including several cardiometabolic risk factors and outcomes. However, evidence about the association of preterm birth with later body size derives mainly from studies using birth weight as a proxy of prematurity rather than an actual length of gestation. We investigated the association of gestational age (GA) at birth with body size from infancy through adolescence. Methods and findings We conducted a two-stage individual participant data (IPD) meta-analysis using data from 253,810 mother–child dyads from 16 general population-based cohort studies in Europe (Denmark, Finland, France, Italy, Norway, Portugal, Spain, the Netherlands, United Kingdom), North America (Canada), and Australasia (Australia) to estimate the association of GA with body mass index (BMI) and overweight (including obesity) adjusted for the following maternal characteristics as potential confounders: education, height, prepregnancy BMI, ethnic background, parity, smoking during pregnancy, age at child’s birth, gestational diabetes and hypertension, and preeclampsia. Pregnancy and birth cohort studies from the LifeCycle and the EUCAN-Connect projects were invited and were eligible for inclusion if they had information on GA and minimum one measurement of BMI between infancy and adolescence. Using a federated analytical tool (DataSHIELD), we fitted linear and logistic regression models in each cohort separately with a complete-case approach and combined the regression estimates and standard errors through random-effects study-level meta-analysis providing an overall effect estimate at early infancy (>0.0 to 0.5 years), late infancy (>0.5 to 2.0 years), early childhood (>2.0 to 5.0 years), mid-childhood (>5.0 to 9.0 years), late childhood (>9.0 to 14.0 years), and adolescence (>14.0 to 19.0 years). GA was positively associated with BMI in the first decade of life, with the greatest increase in mean BMI z-score during early infancy (0.02, 95% confidence interval (CI): 0.00; 0.05, p < 0.05) per week of increase in GA, while in adolescence, preterm individuals reached similar levels of BMI (0.00, 95% CI: −0.01; 0.01, p 0.9) as term counterparts. The association between GA and overweight revealed a similar pattern of association with an increase in odds ratio (OR) of overweight from late infancy through mid-childhood (OR 1.01 to 1.02) per week increase in GA. By adolescence, however, GA was slightly negatively associated with the risk of overweight (OR 0.98 [95% CI: 0.97; 1.00], p 0.1) per week of increase in GA. Although based on only four cohorts (n = 32,089) that reached the age of adolescence, data suggest that individuals born very preterm may be at increased odds of overweight (OR 1.46 [95% CI: 1.03; 2.08], p < 0.05) compared with term counterparts. Findings were consistent across cohorts and sensitivity analyses despite considerable heterogeneity in cohort characteristics. However, residual confounding may be a limitation in this study, while findings may be less generalisable to settings in low- and middle-income countries. Conclusions This study based on data from infancy through adolescence from 16 cohort studies found that GA may be important for body size in infancy, but the strength of association attenuates consistently with age. By adolescence, preterm individuals have on average a similar mean BMI to peers born at term.

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“…Confounding variables were selected a priori based on previous literature 11 and conceptualized using a directed acyclic graph (eFigure 2 in the Supplement) that included maternal, perinatal, child, and sociodemographic characteristics hypothesized to be associated with both gestational age at birth and child's CMR but not on the causal pathway. Confounding variables were maternal age at birth, ethnicity, prepregnancy BMI, prepregnancy diabetes, prepregnancy hypertension, gestational diabetes, gestational hypertension, preeclampsia or eclampsia, venous thromboembolism, annual family income, and family history of cardiometabolic conditions or risk factors.…”

Section: Confounding Variablesmentioning

confidence: 99%

“…8 Size for gestational age, a measure that incorporates infant size at birth, has also been acknowledged as having an impact for health later in life through altered childhood growth and overweight status. 9,10 A systematic review 11 examining the association between late preterm birth and cardiometabolic health outcomes suggested that children younger than 18 years who were born late preterm vs term were at increased risk of diabetes (pooled adjusted risk ratio from 9 studies: 1.24 [95% CI, 1.17-1.32]) and hypertension (pooled adjusted risk ratio from 11 studies: 1.21 [95% CI, 1.13-1.30]). Studies 12,13 have also found that adults born late preterm compared with term had high levels of cardiometabolic risk (CMR) factors, including higher body fat percentage, higher blood pressure, metabolic syndrome, and stroke.…”

Section: Introductionmentioning

confidence: 99%

Association of Late Preterm Birth and Size for Gestational Age With Cardiometabolic Risk in Childhood

et al. 2022

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

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 19 publications

References 84 publications

Cardiovascular Morbidities in Adults Born Preterm: Getting to the Heart of the Matter!

Cardiovascular Morbidities in Adults Born Preterm: Getting to the Heart of the Matter!

Gestational age at birth and body size from infancy through adolescence: An individual participant data meta-analysis on 253,810 singletons in 16 birth cohort studies

Association of Late Preterm Birth and Size for Gestational Age With Cardiometabolic Risk in Childhood

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