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Sixtus RP, Gray C, Berry MJ, Dyson RM. Preterm-born individuals: a vulnerable population at risk of cardiovascular morbidity and mortality during thermal extremes? Exp Physiol 2023; 108:1011-1025. [PMID: 37084061 PMCID: PMC10988436 DOI: 10.1113/ep091152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/03/2023] [Indexed: 04/22/2023]
Abstract
NEW FINDINGS What is the topic of this review? Thermal extremes disproportionately affect populations with cardiovascular conditions. Preterm birth, across all gestational age ranges below 37 weeks, has been identified as a non-modifiable risk factor for cardiovascular disease. The hypothesis is presented that individuals born preterm are at an increased risk of cardiovascular morbidity and mortality during thermal extremes. What advances does it highlight? Cardiovascular stress tests performed in preterm-born populations, from infancy through adulthood, highlight a progression of cardiovascular dysfunction accelerating through adolescence and adulthood. This dysfunction has many similarities with populations known to be at risk in thermal extremes. ABSTRACT Preterm-born individuals are a uniquely vulnerable population. Preterm exposure to the extrauterine environment and the (mal)adaptations that occur during the transitional period can result in alterations to their macro- and micro-physiological state. The physiological adaptations that increase survival in the short term may place those born preterm on a trajectory of lifelong dysfunction and later-life decompensation. Cardiovascular compensation in children and adolescents, which masks this trajectory of dysfunction, is overcome under stress, such that the functional cardiovascular capacity is reduced and recovery impaired following physiological stress. This has implications for their response to thermal stress. As the Anthropocene introduces greater changes in our environment, thermal extremes will impact vulnerable populations as yet unidentified in the climate change context. Here, we present the hypothesis that individuals born preterm are a vulnerable population at an increased risk of cardiovascular morbidity and mortality during thermal extremes.
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Affiliation(s)
- Ryan Phillip Sixtus
- Department of Paediatrics and Child HealthUniversity of OtagoWellingtonNew Zealand
| | - Clint Gray
- Department of Paediatrics and Child HealthUniversity of OtagoWellingtonNew Zealand
| | - Mary Judith Berry
- Department of Paediatrics and Child HealthUniversity of OtagoWellingtonNew Zealand
| | - Rebecca Maree Dyson
- Department of Paediatrics and Child HealthUniversity of OtagoWellingtonNew Zealand
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Duke JW, Lewandowski AJ, Abman SH, Lovering AT. Physiological aspects of cardiopulmonary dysanapsis on exercise in adults born preterm. J Physiol 2022; 600:463-482. [PMID: 34961925 PMCID: PMC9036864 DOI: 10.1113/jp281848] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023] Open
Abstract
Progressive improvements in perinatal care and respiratory management of preterm infants have resulted in increased survival of newborns of extremely low gestational age over the past few decades. However, the incidence of bronchopulmonary dysplasia, the chronic lung disease after preterm birth, has not changed. Studies of the long-term follow-up of adults born preterm have shown persistent abnormalities of respiratory, cardiovascular and cardiopulmonary function, possibly leading to a lower exercise capacity. The underlying causes of these abnormalities are incompletely known, but we hypothesize that dysanapsis, i.e. discordant growth and development, in the respiratory and cardiovascular systems is a central structural feature that leads to a lower exercise capacity in young adults born preterm than those born at term. We discuss how the hypothesized system dysanapsis underscores the observed respiratory, cardiovascular and cardiopulmonary limitations. Specifically, adults born preterm have: (1) normal lung volumes but smaller airways, which causes expiratory airflow limitation and abnormal respiratory mechanics but without impacts on pulmonary gas exchange efficiency; (2) normal total cardiac size but smaller cardiac chambers; and (3) in some cases, evidence of pulmonary hypertension, particularly during exercise, suggesting a reduced pulmonary vascular capacity despite reduced cardiac output. We speculate that these underlying developmental abnormalities may accelerate the normal age-associated decline in exercise capacity, via an accelerated decline in respiratory, cardiovascular and cardiopulmonary function. Finally, we suggest areas of future research, especially the need for longitudinal and interventional studies from infancy into adulthood to better understand how preterm birth alters exercise capacity across the lifespan.
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Affiliation(s)
- Joseph W. Duke
- Northern Arizona University, Department of Biological Sciences, Flagstaff, AZ, USA
| | - Adam J. Lewandowski
- University of Oxford, Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Steven H. Abman
- University of Colorado Anschutz School of Medicine, Department of Pediatrics, Aurora, CO, USA
- Pediatric Heart Lung Center, Children’s Hospital Colorado, Aurora, CO, USA
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3
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Harris SL, Bray H, Troughton R, Elliott J, Frampton C, Horwood J, Darlow BA. Cardiovascular Outcomes in Young Adulthood in a Population-Based Very Low Birth Weight Cohort. J Pediatr 2020; 225:74-79.e3. [PMID: 32553866 DOI: 10.1016/j.jpeds.2020.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess differences in left heart structure and function, and endothelial function in a national cohort of very low birth weight (VLBW) young adults and term-born controls. STUDY DESIGN The New Zealand VLBW study is a prospective, population-based, longitudinal cohort study which included all infants born <1500 g in 1986. The VLBW cohort (n = 229; 71% of survivors) and term-born controls (n = 100), were assessed at age 26-30 years. Measures of left heart structure and function were evaluated by echocardiography, vascular function was assessed using blood pressure, reactive hyperemia index, and arterioventricular coupling by calculating left ventricular (LV) and arterial elastance. RESULTS Compared with controls, those born VLBW had smaller LVs, even when indexed for body surface area (mean LV mass, 89.7 ± 19.3 g/m2 vs 95.0 ± 22.3 g/m2 [P = .03]; LV end-diastolic volume, 58.3 ± 10.9 mL/m2 vs 62.4 ± 12.4 mL/m2 [P = .002]; and LV end-systolic volume, 20.8 ± 4.9 mL/m2 vs 22.6 ± 5.8 mL/m2 [P = .004]). VLBW participants had lower stroke volume (median, 37.2 mL/m2 [IQR, 33-42 mL/m2] vs median, 40.1 mL/m2 [IQR, 34-45 mL/m2]; P = .0059) and cardiac output (mean, 4.8 ± 1.2 L/min vs 5.1 ± 1.4 L/min; P = .03), but there was no difference in ejection fraction. The VLBW group had higher LV elastance (3.37 ± 0.88 mm Hg/mL vs 2.86 ± 0.75 mm Hg/mL; P < .0001) and arterial elastance (1.84 ± 0.4 vs 1.6 ± 0.4; P < .0001) and lower reactive hyperemia index (0.605 ± 0.28 vs 0.688 ± 0.31; P = .041). These measures were influenced by birth weight and sex, but we found limited associations with other perinatal factors. CONCLUSIONS Being born preterm and VLBW is associated with differences in cardiovascular structure and function in adulthood. This population may be more vulnerable to cardiovascular pathology as they age. TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN12612000995875.
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Affiliation(s)
- Sarah L Harris
- Department of Pediatrics, University of Otago, Christchurch, New Zealand.
| | - Helen Bray
- Christchurch Women's Hospital, Christchurch, New Zealand
| | - Richard Troughton
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - John Elliott
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Chris Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - John Horwood
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Brian A Darlow
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
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Lombardo P, Nguyen VB, Flores TJ, Sutherland MR, Nitsos I, Allison BJ, Parkington H, Tare M, Harding R, De Matteo R, Schneider M, Polglase GR, Black MJ. Early impact of moderate preterm birth on the structure, function and gene expression of conduit arteries. Exp Physiol 2020; 105:1256-1267. [PMID: 32436635 DOI: 10.1113/ep088117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 05/19/2020] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? What is the immediate impact of moderate preterm birth on the structure and function of major conduit arteries using a pre-clinical sheep model? What is the main finding and its importance? Postnatal changes in conduit arteries, including a significant decrease in collagen within the thoracic aortic wall (predominately males), narrowed carotid arteries, reduced aortic systolic blood flow, and upregulation of the mRNA expression of cell adhesion and inflammatory markers at 2 days of age in preterm lambs compared to controls, may increase the risk of cardiovascular impairment in later life. ABSTRACT The aim of this work was to compare the structure and function of the conduit arteries of moderately preterm and term-born lambs and to determine whether vascular injury-associated genes were upregulated. Time-mated ewes were induced to deliver either preterm (132 ± 1 days of gestation; n = 11 females and n = 10 males) or at term (147 ± 1 days of gestation; n = 10 females and n = 5 males). Two days after birth, ultrasound imaging of the proximal ascending aorta, main, right and left pulmonary arteries, and right and left common carotid arteries was conducted in anaesthetized lambs. Lambs were then killed and segments of the thoracic aorta and left common carotid artery were either snap frozen for real-time PCR analyses or immersion-fixed for histological quantification of collagen, smooth muscle and elastin within the medial layer. Overall there were few differences in vascular structure between moderately preterm and term lambs. However, there was a significant decrease in the proportion of collagen within the thoracic aortic wall (predominantly in males), narrowing of the common carotid arteries and a reduction in peak aortic systolic blood flow in preterm lambs. In addition, there was increased mRNA expression of the cell adhesion marker P-selectin in the thoracic aortic wall and the pro-inflammatory marker IL-1β in the left common carotid artery in preterm lambs, suggestive of postnatal vascular injury. Early postnatal differences in the function and structure of conduit arteries and evidence of vascular injury in moderately preterm offspring may place them at greater risk of cardiovascular impairment later in life.
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Affiliation(s)
- Paul Lombardo
- Department of Medical Imaging and Radiation Sciences, Monash University, Victoria, Clayton, Australia
| | - Vivian B Nguyen
- Department of Anatomy and Developmental Biology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Tracey J Flores
- Department of Anatomy and Developmental Biology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Megan R Sutherland
- Department of Anatomy and Developmental Biology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Ilias Nitsos
- The Ritchie Centre, Department of Obstetrics & Gynaecology, Monash University and Hudson Institute of Medical Research, Victoria, Clayton, Australia
| | - Beth J Allison
- The Ritchie Centre, Department of Obstetrics & Gynaecology, Monash University and Hudson Institute of Medical Research, Victoria, Clayton, Australia
| | - Helena Parkington
- Department of Physiology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Marianne Tare
- Department of Physiology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Richard Harding
- Department of Anatomy and Developmental Biology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Robert De Matteo
- Department of Anatomy and Developmental Biology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Monash University, Victoria, Clayton, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Department of Obstetrics & Gynaecology, Monash University and Hudson Institute of Medical Research, Victoria, Clayton, Australia
| | - M Jane Black
- Department of Anatomy and Developmental Biology and the Biomedicine Discovery Institute, Monash University, Victoria, Clayton, Australia
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5
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Increased aortic wave reflection contributes to higher systolic blood pressure in adolescents born preterm. J Hypertens 2019; 36:1514-1523. [PMID: 29601410 DOI: 10.1097/hjh.0000000000001719] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the wave reflection characteristics in the aortic arch and common carotid artery of ex-preterm adolescents and assess their relationship to central blood pressure in a cohort followed prospectively since birth. METHODS Central blood pressures, pulse wave velocity, augmentation index, microvascular reactive hyperemia, arterial distensibility, compliance and stiffness index, and also aortic and carotid wave intensity were measured in 18-year-olds born extremely preterm at below 28 weeks' gestation (n = 76) and term-born controls (n = 42). RESULTS Compared with controls, ex-preterm adolescents had higher central systolic (111 ± 11 vs. 105 ± 10 mmHg; P < 0.001) and diastolic blood pressures (73 ± 7 vs. 67 ± 7 mmHg; P < 0.001). Although conventional measures of arterial function and biomechanics such as pulse wave velocity and augmentation index were no different between groups, wave intensity analysis revealed elevated backward compression wave area (-0.39 ± 0.21 vs. -0.29 ± 0.17 W/m/s × 10; P = 0.03), backward compression wave pressure change (9.0 ± 3.5 vs. 6.6 ± 2.5 mmHg; P = 0.001) and reflection index (0.44 ± 0.15 vs. 0.32 ± 0.08; P < 0.001) in the aorta of ex-preterm adolescents compared with controls. These changes were less pronounced in the carotid artery. On multivariable analysis, forward and backward compression wave areas were the only biomechanical variables associated with central systolic pressure. CONCLUSIONS Ex-preterm adolescents demonstrate elevated wave reflection indices in the aortic arch, which correlate with central systolic pressure. Wave intensity analysis may provide a sensitive novel marker of evolving vascular dysfunction in ex-preterm survivors.
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Kuo AH, Li C, Huber HF, Clarke GD, Nathanielsz PW. Intrauterine growth restriction results in persistent vascular mismatch in adulthood. J Physiol 2018; 596:5777-5790. [PMID: 29098705 PMCID: PMC6265527 DOI: 10.1113/jp275139] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/31/2017] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Intrauterine growth restriction (IUGR) increases offspring risk of chronic diseases later in life, including cardiovascular dysfunction. Our prior studies suggest biventricular cardiac dysfunction and vascular impairment in baboons who were IUGR at birth because of moderate maternal nutrient reduction. The current study reveals changes in artery sizes, distensibility, and blood flow pattern in young adult IUGR baboons, which may contribute to cardiac stress. The pattern of abnormality observed suggests that vascular redistribution seen with IUGR in fetal life may continue into adulthood. ABSTRACT Maternal nutrient reduction induces intrauterine growth restriction (IUGR), increasing risks of chronic diseases later in life, including cardiovascular dysfunction. Using ultrasound, we determined regional blood flow, blood vessel sizes, and distensibility in IUGR baboons (8 males, 8 females, 8.8 years, similar to 35 human years) and controls (12 males, 12 females, 9.5 years). The measured blood vessels were larger in size in the males compared to females before but not after normalization to body surface area. Smaller IUGR normalized blood vessel sizes were observed in the femoral and external iliac arteries but not the brachial or common carotid arteries and not correlated significantly with birth weight. Mild decrease in distensibility in the IUGR group was seen in the iliac but not the carotid arteries without between-sex differences. In IUGR baboons there was increased carotid arterial blood flow velocity during late systole and diastole. Overall, our findings support the conclusion that region specific vascular and haemodynamic changes occur with IUGR, which may contribute to the occurrence of later life cardiac dysfunction. The pattern of alteration observed suggests vascular redistribution efforts in response to challenges in the perinatal period may persist into adulthood. Further studies are needed to determine the life course progression of these changes.
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Affiliation(s)
- Anderson H. Kuo
- Department of Radiology and Research Imaging InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Cun Li
- Department of Animal ScienceUniversity of WyomingLaramieWYUSA
- Southwest National Primate Research CenterSan AntonioTXUSA
| | | | - Geoffrey D. Clarke
- Department of Radiology and Research Imaging InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
- Southwest National Primate Research CenterSan AntonioTXUSA
| | - Peter W. Nathanielsz
- Department of Animal ScienceUniversity of WyomingLaramieWYUSA
- Southwest National Primate Research CenterSan AntonioTXUSA
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7
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Le B, Sutherland MR, Black MJ. Maladaptive structural remodelling of the heart following preterm birth. CURRENT OPINION IN PHYSIOLOGY 2018. [DOI: 10.1016/j.cophys.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mohlkert LA, Hallberg J, Broberg O, Rydberg A, Halvorsen CP, Liuba P, Fellman V, Domellöf M, Sjöberg G, Norman M. The Preterm Heart in Childhood: Left Ventricular Structure, Geometry, and Function Assessed by Echocardiography in 6-Year-Old Survivors of Periviable Births. J Am Heart Assoc 2018; 7:e007742. [PMID: 29353231 PMCID: PMC5850168 DOI: 10.1161/jaha.117.007742] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 11/16/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Preterm birth has been associated with increased risk of cardiovascular morbidity in adult life. We evaluated whether preterm birth is associated with deviating cardiac structure and function before school start. METHODS AND RESULTS In total, 176 children aged 6 years and born extremely preterm (EXPT; gestational age of 22-26 weeks) and 134 children born at term (control [CTRL]) were studied. We used echocardiography to assess left heart dimensions, geometry, and functions. Recording and off-line analyses of echocardiographic images were performed by operators blinded to group belonging. Body size, blood pressure, and heart rate were also measured. Rates of family history of cardiovascular disease and sex distribution were similar in the EXPT and CTRL groups. Heart rate and systolic blood pressure did not differ, whereas diastolic blood pressure was slightly higher in EXPT than CTRL participants. After adjusting for body surface area, left ventricular length, width, and aortic valve annulus diameter were 3% to 5% smaller in EXPT than CTRL participants. Left ventricular longitudinal shortening and systolic tissue velocity were 7% to 11% lower, and transversal shortening fraction was 6% higher in EXPT than CTRL participants. The EXPT group also exhibited lower atrial emptying velocities than the CTRL group. Sex, fetal growth restriction, or a patent ductus arteriosus in the neonatal period did not contribute to cardiac dimensions or performance. CONCLUSIONS Six-year-old children born extremely preterm exhibit a unique cardiac phenotype characterized by smaller left ventricles with altered systolic and diastolic functions than same-aged children born at term.
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Affiliation(s)
- Lilly-Ann Mohlkert
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Jenny Hallberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Olof Broberg
- Department of Clinical Sciences, Division of Paediatric Cardiology, Lund University, Lund, Sweden
- Paediatric Heart Center, Skåne University Hospital, Lund, Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - Cecilia Pegelow Halvorsen
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Petru Liuba
- Department of Clinical Sciences, Division of Paediatric Cardiology, Lund University, Lund, Sweden
- Paediatric Heart Center, Skåne University Hospital, Lund, Sweden
| | - Vineta Fellman
- Children's Hospital, University of Helsinki, Helsinki, Finland
- Department of Clinical Sciences, Division of Paediatrics, Lund University Skåne University Hospital, Lund, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - Gunnar Sjöberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Norman
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
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Mohlkert LA, Hallberg J, Broberg O, Hellström M, Pegelow Halvorsen C, Sjöberg G, Edstedt Bonamy AK, Liuba P, Fellman V, Domellöf M, Norman M. Preterm arteries in childhood: dimensions, intima-media thickness, and elasticity of the aorta, coronaries, and carotids in 6-y-old children born extremely preterm. Pediatr Res 2017; 81:299-306. [PMID: 28195589 DOI: 10.1038/pr.2016.212] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/13/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Preterm birth increases risk for adult cardiovascular disease. We hypothesized that arteries in 6-y-old children born preterm are narrower, with thicker intima-media and stiffer than in peers born at term. METHODS Children born extremely preterm (EXP, n = 176, birthweights: 348-1,161 g) and at term (CTRL, n = 174, birthweights: 2,430-4,315 g) were included. Using ultrasonography, we determined diameters of the coronaries (CA), common carotid arteries (CCA) and aorta, the carotid intima media thickness (cIMT), and the stiffness index of the CCA and aorta. RESULTS Arteries were 5-10% narrower in EXP than in CTRL (P < 0.005) but after adjustment for body surface area, diameter differences diminished or disappeared. EXP-children born small for gestational age exhibited similar arterial dimensions as those born appropriate for date. The cIMT was 0.38 (SD = 0.04) mm and did not differ between groups. Carotid but not aortic stiffness was lower in EXP than in CTRL. CONCLUSION In 6-y-old children born extremely preterm, conduit arteries are of similar or smaller size than in controls born at term, and they have no signs of accelerated intima media thickening or arterial stiffening. While these findings are reassuring for these children and their families, the causal pathways from preterm birth to adult cardiovascular disease remain unknown.
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Affiliation(s)
- Lilly-Ann Mohlkert
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Jenny Hallberg
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Olof Broberg
- Department of Clinical Sciences, Division of Pediatric Cardiology, Lund University, and Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
| | - Monica Hellström
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Cecilia Pegelow Halvorsen
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Sjöberg
- Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna-Karin Edstedt Bonamy
- Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Petru Liuba
- Department of Clinical Sciences, Division of Pediatric Cardiology, Lund University, and Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
| | - Vineta Fellman
- Department of Clinical Sciences, Division of Pediatrics, Lund University, and Skåne University Hospital, Lund, Sweden.,Children´s Hospital, University of Helsinki, Helsinki, Finland
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
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Svedenkrans J, Kowalski J, Norman M, Bohlin K. Low Exercise Capacity Increases the Risk of Low Cognitive Function in Healthy Young Men Born Preterm: A Population-Based Cohort Study. PLoS One 2016; 11:e0161314. [PMID: 27548612 PMCID: PMC4993500 DOI: 10.1371/journal.pone.0161314] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/03/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Preterm birth is a risk factor for decreased exercise capacity and impaired cognitive functions in later life. The objective of this study was to disentangle the associations between preterm birth, physical fitness and cognitive performance in young adulthood. METHODS This population-based cohort study included 218,802 young men born in Sweden 1973-1983. Data on birth characteristics was obtained from the Medical Birth Register and linked to exercise capacity assessed by ergometer cycling and cognitive tests performed at conscription for military service in 1993-2001. Cognitive performance was assessed using stanine (STAndard NINE) scores. The results were adjusted for socioeconomic factors. RESULTS Exercise capacity was positively associated with cognitive performance across all gestational ages. The sub-group of men who were born extremely preterm (gestational age <28 weeks) and had low exercise capacity exhibited the lowest odds ratio (OR = 0.26, 95%CI:0.09-0.82) of having a cognitive function above the mean stanine score (2.9) for men born at term with normal birth weight. Men born extremely preterm with a high exercise capacity had similar or even higher ORs for cognitive function (OR = 0.59; 95% CI:0.35-0.99) than men born at term with low Wmax (OR = 0.57; 95% CI:0.55-0.59). CONCLUSIONS Physical fitness is associated with higher cognitive function at all gestational ages, also in young men born extremely preterm. Targeting early physical exercise may be a possible intervention to enhance cognitive performance and educational achievements in populations at risk, such as childhood and adult survivors of preterm birth.
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Affiliation(s)
- Jenny Svedenkrans
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
- * E-mail: (JS); (KB)
| | - Jan Kowalski
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Kajsa Bohlin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
- * E-mail: (JS); (KB)
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11
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Schubert U, Müller M, Abdul-Khaliq H, Norman M. Preterm Birth Is Associated with Altered Myocardial Function in Infancy. J Am Soc Echocardiogr 2016; 29:670-8. [PMID: 27156903 DOI: 10.1016/j.echo.2016.03.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preterm birth has been associated with myocardial remodeling and accelerated cardiovascular ageing in later life, but the underlying mechanisms are unknown. The investigators used echocardiography to undertake a sequential analysis of myocardial function in preterm infants. METHODS This study evaluated the cardiac performance of 25 very preterm infants (born at a gestational age of 26-30 weeks), at birth, 3 months (term-equivalent age), and 6 months later (3 months of corrected age). Speckle-tracking echocardiography was used to determine myocardial function, assessing the magnitude of myocardial deformation as longitudinal strain, deformation rate (strain rate), and velocity in both ventricles during systole and diastole. The results were compared with those in 30 infants born at term investigated at birth and at 3 months of age. RESULTS At term-equivalent age, the speckle-tracking estimates were similar in both groups. Three months later, very preterm infants exhibited significantly lower left ventricular mean free wall longitudinal strain (-20.0% vs -22.0%, P = .010) and lower left ventricular early diastolic (median, -7.37 vs -10.9 cm/sec, P = .003) and late diastolic (median, -5.11 vs -6.95 cm/sec, P = .009) myocardial velocities than infants born at term. There were no statistically significant group differences in right ventricular or interventricular septal measurements. Conventional echocardiographic variables did not differ significantly between the two groups at any age. CONCLUSIONS Very preterm infants develop altered left ventricular myocardial function 6 months after birth. Follow-up examinations are needed to determine the implications for cardiovascular health in the growing number of children surviving very preterm birth.
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Affiliation(s)
- Ulf Schubert
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Matthias Müller
- Department of Pediatric Cardiology, University Hospital Homburg (Saar), Homburg, Germany
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, University Hospital Homburg (Saar), Homburg, Germany
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Kowalski RR, Beare R, Doyle LW, Smolich JJ, Cheung MMH. Elevated Blood Pressure with Reduced Left Ventricular and Aortic Dimensions in Adolescents Born Extremely Preterm. J Pediatr 2016; 172:75-80.e2. [PMID: 26873655 DOI: 10.1016/j.jpeds.2016.01.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/15/2015] [Accepted: 01/06/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the long-term cardiovascular effects of extremely preterm birth in a cohort of adolescents followed prospectively, who were largely free from intrauterine growth restriction. STUDY DESIGN Central blood pressures, aortic and cardiac dimensions, left ventricle (LV) function, pulse wave velocity, augmentation index, and microvascular reactive hyperemia were measured in 18-year-old subjects born extremely preterm at <28 weeks' gestation (n = 109) and term-born controls (n = 81). RESULTS Compared with controls, preterm adolescents had higher systolic (124 ± 13 vs 118 ± 10 mm Hg, P = .002) and diastolic (72 ± 8 vs 67 ± 7 mm Hg, P < .001) blood pressures, but lower ascending aortic z-scores (0.13 ± 0.89 vs 0.42 ± 0.78, P = .02), LV diastolic (48.5 ± 4 vs 50.3 ± 4.5 mm, P = .007) and systolic (30.2 ± 3.5 vs 31.9 ± 4.0 mm, P = .003) diameters, and a reduced LV mass (130 ± 34 vs 145 ± 41 g, P = .01) and mass index (75 ± 14 vs 81 ± 16 g/m(2), P = .02). However, LV relative wall thickness, LV function, pulse wave velocity, augmentation index, and microvascular reactive hyperemia were similar. Within the ex-preterm group, there were no significant relationships between birthweight z-scores and any cardiovascular measures, once the latter were adjusted for current body size. CONCLUSIONS Extremely preterm birth had relatively minor cardiovascular effects in late-adolescence, with increased blood pressures, decreased LV, and aortic size, but preserved LV function, macrovascular properties, and microvascular function. In utero growth was not independently related to cardiovascular function within the ex-preterm cohort.
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Affiliation(s)
- Remi R Kowalski
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Cardiology, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.
| | - Richard Beare
- Developmental Imaging, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Lex W Doyle
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia; Research Office, Royal Women's Hospital, Parkville, Victoria, Australia; Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Victoria, Australia
| | - Joseph J Smolich
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Michael M H Cheung
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Cardiology, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
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Lewandowski AJ, Davis EF, Yu G, Digby JE, Boardman H, Whitworth P, Singhal A, Lucas A, McCormick K, Shore AC, Leeson P. Elevated blood pressure in preterm-born offspring associates with a distinct antiangiogenic state and microvascular abnormalities in adult life. Hypertension 2014; 65:607-14. [PMID: 25534704 DOI: 10.1161/hypertensionaha.114.04662] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Preterm-born individuals have elevated blood pressure. We tested the hypothesis that this associates with an enhanced antiangiogenic circulating profile and that this association is mediated by variations in capillary density. We studied 204 adults aged 25 years (range, 20-30 years), of which 102 had been followed up prospectively since very preterm birth (mean gestational age, 30.3±2.5 weeks) and 102 were born term to uncomplicated pregnancies. A panel of circulating biomarkers, including soluble endoglin and soluble fms-like tyrosine kinase-1, were compared between groups and related to perinatal history and adult cardiovascular risk. Associations with cardiovascular phenotype were studied in 90 individuals who had undergone detailed assessment of microvascular, macrovascular, and cardiac structure and function. Preterm-born individuals had elevations in soluble endoglin (5.64±1.03 versus 4.06±0.85 ng/mL; P<0.001) and soluble fms-like tyrosine kinase-1 (88.1±19.0 versus 73.0±15.3 pg/mL; P<0.001) compared with term-born individuals, proportional to elevations in resting and ambulatory blood pressure, as well as degree of prematurity (P<0.05). Maternal hypertensive pregnancy disorder was associated with additional increases in soluble fms-like tyrosine kinase-1 (P=0.002). Other circulating biomarkers, including those of inflammation and endothelial activation, were not related to blood pressure. There was a specific graded association between soluble endoglin and degree of functional and structural capillary rarefaction (P=0.002 and P<0.001), and in multivariable analysis, there were capillary density-mediated associations between soluble endoglin and blood pressure. Preterm-born individuals exhibit an enhanced antiangiogenic state in adult life that is specifically related to elevations in blood pressure. The association seems to be mediated through capillary rarefaction and is independent of other cardiovascular structural and functional differences in the offspring.
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Affiliation(s)
- Adam J Lewandowski
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Esther F Davis
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Grace Yu
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Janet E Digby
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Henry Boardman
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Polly Whitworth
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Atul Singhal
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Alan Lucas
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Kenny McCormick
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Angela C Shore
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Paul Leeson
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.).
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Premature guinea pigs: a new paradigm to investigate the late-effects of preterm birth. J Dev Orig Health Dis 2014; 6:143-8. [PMID: 25497136 DOI: 10.1017/s2040174414000592] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Preterm birth is common and the associated short-term morbidity well described. The adult-onset consequences of preterm birth are less clear, but cardiovascular and metabolic health may be adversely affected. Although large animal models of preterm birth addressing important short-term issues exist, long-term studies are hampered by significant logistical constraints. Current small animal models of prematurity require terminal caesarean section of the mother; both caesarean birth and early maternal care modify offspring adult cardio-metabolic function. We describe a novel method for inducing preterm labour in guinea pigs. With support comparable to that received by moderately preterm human infants, preterm pups are viable. Growth trajectories between preterm and term-born pups differ significantly; between term equivalent age and weaning ex-preterm animals demonstrate increased weight and ponderal index. We believe this novel paradigm will significantly improve our ability to investigate the cardio-metabolic sequelae of preterm birth throughout the life course and into the second generation.
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Sutherland MR, Bertagnolli M, Lukaszewski MA, Huyard F, Yzydorczyk C, Luu TM, Nuyt AM. Preterm Birth and Hypertension Risk. Hypertension 2014; 63:12-8. [DOI: 10.1161/hypertensionaha.113.01276] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Megan R. Sutherland
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Mariane Bertagnolli
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Marie-Amélie Lukaszewski
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Fanny Huyard
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Catherine Yzydorczyk
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Thuy Mai Luu
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Anne Monique Nuyt
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
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Svedenkrans J, Henckel E, Kowalski J, Norman M, Bohlin K. Long-term impact of preterm birth on exercise capacity in healthy young men: a national population-based cohort study. PLoS One 2013; 8:e80869. [PMID: 24324639 PMCID: PMC3855651 DOI: 10.1371/journal.pone.0080869] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/09/2013] [Indexed: 11/18/2022] Open
Abstract
Background Increasing numbers of survivors of preterm birth are growing into adulthood today. Long-term health-effects of prematurity are still poorly understood, but include increased risk for diabetes, obesity and cardiovascular diseases in adult life. To test if reduced physical fitness may be a link in the causal chain of preterm birth and diseases in later life, the association of preterm birth and adult exercise capacity was investigated. The hypothesis was that preterm birth contributes independently of other risk factors to lower physical fitness in adulthood. Methods and Findings Population-based national cohort study of all males conscripting for military service in 1993–2001 and born in Sweden 1973–1983, n = 218,820. Data were retrieved from the Swedish Conscript Register, the Medical Birth Register and the Population and Housing Census 1990. Primary outcome was the results from maximal exercise test (Wmax in Watt) performed at conscription. Association to perinatal and socioeconomic risk factors, other co-variates and confounders were analysed. General linear modelling showed that preterm birth predicted low Wmax in a dose-response related pattern, with 25 Watt reduction in Wmax for the lowest gestational ages, those born ≤27 weeks. Low birth weight for gestational age also independently predicted low Wmax compared to normal and high birth weight (32 Watt reduction for those with a birth weight Standard Deviation Score <2). Low parental education was significantly associated with reduced Wmax (range 17 Watt), as well as both low and high current BMI, with severe obesity resulting in a 16 Watt deficit compared to Wmax top performance. Conclusion Being born preterm as well as being born small for gestational age predicts low exercise capacity in otherwise healthy young men. The effect size of being born preterm equal or exceed that of other known risk factors for unfitness in adults, such as low parental education and overweight.
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Affiliation(s)
- Jenny Svedenkrans
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ewa Henckel
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jan Kowalski
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Kajsa Bohlin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital Huddinge, Stockholm, Sweden
- * E-mail:
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Schubert U, Müller M, Abdul-Khaliq H, Norman M, Bonamy AKE. Relative intima-media thickening after preterm birth. Acta Paediatr 2013; 102:965-9. [PMID: 23848508 DOI: 10.1111/apa.12355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/26/2013] [Accepted: 07/10/2013] [Indexed: 12/14/2022]
Abstract
AIM Preterm infants are at increased risk of early arterial growth arrest and cardiovascular mortality. We assessed intima-media thickness (IMT) - an early marker of accelerated vascular ageing - in very preterm infants. METHODS Longitudinal cohort study of 21 very preterm and 29 term infants, all with appropriate birthweights. Intima-media thickness was assessed by M-Mode ultrasound of the aorta and carotid arteries at three occasions during a 6-month period corresponding to the third trimester of pregnancy and ending 3 months after term equivalent age. RESULTS No differences in absolute aortic or carotid IMT were found. However, in relation to vessel lumen diameter, the IMT switched from being narrower in preterm infants, compared with foetuses at 28 weeks of gestation, to being significantly thicker in both the aorta and carotid artery in older infants born preterm, compared with term controls of equivalent postmenstrual age. Although the aortic and carotid artery diameters increased significantly with postnatal age, IMT did not. CONCLUSION In relation to vessel diameter, subjects born preterm show thicker intima-media in the great arteries than infants born at term. It remains to be established whether this relative intima-media thickening persists and may be a risk marker for future cardiovascular disease.
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Affiliation(s)
- Ulf Schubert
- Division of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm; Sweden
| | - Matthias Müller
- Department of Pediatric Cardiology; University Hospital Homburg Saar; Homburg Saar; Germany
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology; University Hospital Homburg Saar; Homburg Saar; Germany
| | - Mikael Norman
- Division of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm; Sweden
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