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Lopez-Sublet M, Merkling T, Girerd N, Xhaard C, Flahault A, Bozec E, Leroy C, Fujikawa T, Vaag AA, Mebazaa A, Kistorp CM, Heude B, Boivin JM, Zannad F, Wagner S, Rossignol P. Birth weight and subclinical cardiovascular and renal damage in a population-based study (the STANISLAS cohort study). J Hypertens 2023; 41:1040-1050. [PMID: 37071444 DOI: 10.1097/hjh.0000000000003438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Although preterm-born and low-birth-weight individuals have an increased risk of cardiovascular diseases in adulthood, little is known regarding early cardiovascular and renal damage (CVRD) or hypertension in adulthood. Our study investigated the association of birth weight with early CVRD markers as well as the heritability of birth weight in an initially healthy family-based cohort. METHODS This study was based on 1028 individuals from the familial longitudinal STANISLAS cohort (399 parents/629 children) initiated in 1993-1995, with a fourth examination conducted in 2011-2016. Analyses performed at the fourth visit included pulse-wave velocity, central pressure, ambulatory blood pressure, hypertension status, diastolic dysfunction/distensibility, left ventricular mass indexed (LVMI), carotid intima-media thickness and kidney damage. The family structure of the cohort allowed birth weight heritability estimation. RESULTS Mean (±SD) birth weight was 3.3 ± 0.6 kg. Heritability was moderate (42-44%). At the fourth visit, individuals were 37 years old (32.0-57.0), 56% were women and 13% had antihypertensive treatment. Birth weight was strongly and negatively associated with hypertension [odds ratio (OR) 95% confidence interval (CI) 0.61 (0.45-0.84)]. A nonlinear association was found with LVMI, participants with a birth weight greater than 3 kg having a higher LVMI. A positive association ( β 95% CI 5.09 (1.8-8.38)] was also observed between birth weight and distensibility for adults with normal BMI. No associations were found with other CVRD. CONCLUSION In this middle-aged population, birth weight was strongly and negatively associated with hypertension, and positively associated with distensibility in adults with normal BMI and with LVMI for higher birth weights. No associations were found with other CVRD markers.
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Affiliation(s)
- Marilucy Lopez-Sublet
- AP-HP, Hôpital Avicenne, Centre d'Excellence Européen en Hypertension Artérielle, Service de Médecine Interne
- INSERM UMR 942 MASCOT, Paris 13-Université Paris Nord, Bobigny
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
| | - Thomas Merkling
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy
| | - Nicolas Girerd
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy
| | - Constance Xhaard
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy
| | - Adrien Flahault
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Erwan Bozec
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy
| | - Celine Leroy
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy
| | - Tomona Fujikawa
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy
| | - Allan Arthur Vaag
- Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Alexandre Mebazaa
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
- UMR-S 942 INSERM, Lariboisière Hospital, Paris
- Paris Diderot University, Sorbonne Paris Cité
- Department of Anaesthesiology and Critical Care, Laribosière Hospital, AP-HP, Paris
| | - Caroline Michaela Kistorp
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Barbara Heude
- Université de Paris, Research Center in Epidemiology and Biostatistics (CRESS), INSERM, INRAE, Paris, France
| | - Jean Marc Boivin
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy
| | - Faiez Zannad
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy
| | - Sandra Wagner
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy
| | - Patrick Rossignol
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy
- Medicine and Nephrology-Hemodialysis departments, Princess Grace Hospital, and Monaco Private Hemodialysis Centre, Monaco, Monaco
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González J, Vilella M, Ruiz S, Iglesia I, Clavero-Adell M, Ayerza-Casas A, Matute-Llorente A, Oros D, Casajús JA, Pueyo V, Rodriguez G, Paules C. Impact of Suspected Preterm Labor during Pregnancy on Cardiometabolic Profile and Neurodevelopment during Childhood: A Prospective Cohort Study Protocol. Diagnostics (Basel) 2023; 13:diagnostics13061101. [PMID: 36980410 PMCID: PMC10047113 DOI: 10.3390/diagnostics13061101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: Suspected preterm labor (SPL), defined as the presence of regular and painful uterine contractions and cervical shortening, represents a prenatal insult with potential long-term consequences. However, despite recent evidence demonstrating suboptimal neurodevelopment at 2 years in this population, it remains underestimated as a significant risk factor for neurodevelopmental disorders or other chronic diseases. The aim of this study is to assess the impact of suspected preterm labor during pregnancy on cardiometabolic profile and neurodevelopment during childhood (6–8 years). Methods and analysis: Prospective cohort study including children whose mothers suffered suspected preterm labour during pregnancy and paired controls. Neurodevelopmental, cardiovascular, and metabolic assessments will be performed at 6–8 years of age. A trained psychologist will carry out the neurodevelopment assessment including intelligence, visual perception, and behavioral assessment. Body composition and physical fitness assessment will be performed by one trained pediatrician and nurse. Finally, cardiovascular evaluation, including echocardiography and blood pressure, will be performed by two pediatric cardiologists. Data regarding perinatal and postnatal characteristics, diet, lifestyle, and weekly screen time of the child will be obtained from medical history and direct interviews with families. Primary outcome measures will include body mass index and adiposity, percentage of fat mass and total and regional lean mass, bone mineral content and density, cardiorespiratory resistance, isometric muscle strength, dynamic lower body strength, systolic and diastolic blood pressure, left ventricle (LV) systolic and diastolic function, general intelligence index, visuospatial working memory span, oculomotor control test, index of emotional, and behavioral problems.
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Affiliation(s)
- Jesús González
- Pediatrics Department, Quirónsalud Hospital Zaragoza, 50006 Zaragoza, Spain
| | - Marina Vilella
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
| | - Sonia Ruiz
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
| | - Iris Iglesia
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragon IA2 Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Marcos Clavero-Adell
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Paediatric Cardiology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ariadna Ayerza-Casas
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Paediatric Cardiology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Angel Matute-Llorente
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragon IA2 Universidad de Zaragoza, 50009 Zaragoza, Spain
- Department of Physiatry and Nursing, Faculty of Health and Sport Sciences (FCSD), University of Zaragoza, 22001 Huesca, Spain
- Physiopathology of Obesity and Nutrition Networking Biomedical Research Center (CIBERObn), 28029 Madrid, Spain
| | - Daniel Oros
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, University of Zaragoza, 50009 Zaragoza, Spain
| | - Jose Antonio Casajús
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragon IA2 Universidad de Zaragoza, 50009 Zaragoza, Spain
- Physiopathology of Obesity and Nutrition Networking Biomedical Research Center (CIBERObn), 28029 Madrid, Spain
| | - Victoria Pueyo
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Ophthalmology Department, Miguel Servet University Hospital, University of Zaragoza, 50009 Zaragoza, Spain
| | - Gerardo Rodriguez
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragon IA2 Universidad de Zaragoza, 50009 Zaragoza, Spain
- Pediatrics Department, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, 50009 Zaragoza, Spain
| | - Cristina Paules
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, University of Zaragoza, 50009 Zaragoza, Spain
- Correspondence: or ; Tel.: +34-976765700 (ext. 4908)
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3
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Fenton TR, Elmrayed S, Scime NV, Tough SC, Pinto J, Sabet F, Wollny K, Lee Y, Harrison TG, Alladin-Karan B, Kramer MS, Ospina MB, Lorenzetti DL, Madubueze A, Leung AA, Kumar M. Small for date preterm infants and risk of higher blood pressure in later life: A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2023. [PMID: 36688258 DOI: 10.1111/ppe.12955] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Historical reports suggest that infants born small for gestational age (SGA) are at increased risk for high blood pressure (BP) at older ages after adjustment for later age body size. Such adjustment may be inappropriate since adiposity is a known cause of cardiovascular and metabolic disease. OBJECTIVES To assess the association between SGA births and later BP among preterm births, considering potential background confounders and over-adjustment for later body size. METHODS A database search of studies up to October 2022 included MEDLINE, EMBASE and CINAHL. Studies were included if they reported BP (systolic [SBP] or diastolic [DBP]) (outcomes) for participants born preterm with SGA (exposure) or non-SGA births. All screening, extraction steps, and risk of bias (using the Risk of Bias In Non-randomised Studies of Interventions [ROBINS-I] tool) were conducted in duplicate by two reviewers. Data were pooled in meta-analysis using random-effects models. We explored potential sources of heterogeneity. RESULTS We found no meaningful difference in later BP between preterm infants with and without SGA status at birth. Meta-analysis of 25 studies showed that preterm SGA, compared to preterm non-SGA, was not associated with higher BP at age 2 and older with mean differences for SBP 0.01 mmHg (95% CI -0.10, 0.12, I2 = 59.8%, n = 20,462) and DBP 0.01 mm Hg (95% CI -0.10, 0.12), 22 studies, (I2 = 53.0%, n = 20,182). Adjustment for current weight did not alter the results, which could be due to the lack of differences in later weight status in most of the included studies. The included studies were rated to be at risk of bias due to potential residual confounding, with a low risk of bias in other domains. CONCLUSIONS Evidence indicates that preterm infants born SGA are not at increased risk of developing higher BP as children or as adults as compared to non-SGA preterm infants.
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Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Seham Elmrayed
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Global Health and Human Ecology Institute, American University in Cairo, Cairo, Egypt
| | - Natalie V Scime
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jahaira Pinto
- Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Fatemeh Sabet
- Interior Health Authority, Kelowna, British Columbia, Canada
| | - Krista Wollny
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Yoonshin Lee
- Senior Persons Living Connected, Hong Fook Mental Health Association, Toronto, Ontario, Canada
| | - Tyrone G Harrison
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bibi Alladin-Karan
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Maria B Ospina
- Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Diane L Lorenzetti
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Health Sciences Library and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ada Madubueze
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A Leung
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Manoj Kumar
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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4
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Course CW, Kotecha SJ, Cousins M, Hart K, Lowe J, Watkins WJ, Kotecha S. Association of Gestation and Fetal Growth Restriction on Cardiovascular Health in Preterm-Born Children. J Pediatr 2022; 255:42-49.e4. [PMID: 36241052 PMCID: PMC7614853 DOI: 10.1016/j.jpeds.2022.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To prospectively evaluate the associations of early and current life factors, including gestational age and fetal growth restriction in preterm-born subjects, on cardiovascular health including measures of central and peripheral blood pressure and arterial stiffness and assess cardiovascular changes before and after acute exercise in preterm- and term-born school-aged children. STUDY DESIGN From 240 children, aged 7-12 years, 204 (141 preterm-born and 63 term-born) had satisfactory data. An oscillometric device recorded cardiovascular measures before and after cycle ergometer exercise testing. Data were analyzed with multivariable linear regression and mediation. RESULTS Central systolic blood pressure (SBP) was 6.4 mmHg (95% CI, 1.2, 11.6) higher in preterm-born children with fetal growth restriction and 3.4 mmHg (0.02, 6.8) higher in those without fetal growth restriction when compared with term controls. Augmentation index was 4.1% (0.7, 7.4) higher in the preterm fetal growth restriction group when compared with those without fetal growth restriction but was similar between the latter group and term controls. Regression modelling showed gestational age, female sex, and antenatal smoking, but not fetal growth restriction, were significantly associated with SBP. In contrast, fetal growth restriction and fat mass index, but not gestation, were significantly associated with augmentation index. Cardiovascular exercise responses were similar between all 3 groups studied. CONCLUSIONS Our data show the differential associations of prematurity and fetal growth restriction on central SBP and augmentation index. Cardiovascular responses to exercise were similar in all 3 groups. Preterm-born children with and without fetal growth restriction are at an increased risk of cardiovascular disease in adult life. TRIAL REGISTRATION URL: https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-003712-20/GB: RHiNO, EudraCT: 2015-003712-20.
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Affiliation(s)
- Christopher W Course
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sarah J Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Michael Cousins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom; Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Kylie Hart
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - John Lowe
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - W John Watkins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom.
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5
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Chainoglou A, Sarafidis K, Chrysaidou K, Farmaki E, Kollios K, Economou M, Kotsis V, Stabouli S. Arterial stiffness and nocturnal hypertension in preterm children and adolescents. J Hypertens 2022; 40:1751-1757. [PMID: 35881434 DOI: 10.1097/hjh.0000000000003209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Preterm birth has been associated with increased risk for developing hypertension and other chronic diseases during childhood and adulthood. The aim of the current prospective case-control study was to investigate the associations of preterm birth with ambulatory blood pressure (BP) levels and arterial stiffness during childhood and adolescence. METHODS The study population included 52 children and adolescents born preterm and 26 healthy children born full term with similar age. The participants underwent ambulatory BP monitoring (ABPM) and assessment of carotid-femoral pulse wave velocity (PWV). RESULTS Preterm children presented higher night SBP z score values compared to controls, but did not differ in other ABPM parameters, office peripheral and central SBPs. Nocturnal hypertension was found in 78% (7/9) of ex-preterm children with ambulatory BP hypertension. Preterm birth was an independent predictor of PWV z score adjusted for heart rate. Estimated marginal means for PWV z score adjusted for age, sex, presence of kidney disease at birth, office BPs, night BPs, central SBP, and BMI z scores were significantly higher in preterm individuals compared to controls (0.703, 95% confidence interval [CI] 0.431-0.975 versus -0.19, 95% CI -0.574-0.536, respectively, P = 0.027). Preterm children who were overweight presented the highest values of night SBP and PWV z score. CONCLUSION Preterm birth is associated with higher nocturnal BP and increased arterial stiffness in childhood and adolescence. Increased awareness for detection of hypertension and prevention of obesity in childhood could prevent future adverse cardiovascular outcomes in preterm individuals.
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Affiliation(s)
- Athanasia Chainoglou
- 1st Department of Pediatrics, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | | | - Katerina Chrysaidou
- 1st Department of Pediatrics, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Evangelia Farmaki
- 1st Department of Pediatrics, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Konstantinos Kollios
- 3rd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokratio Hospital
| | - Marina Economou
- 1st Department of Pediatrics, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Vasilios Kotsis
- 3rd Department of Medicine, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Stella Stabouli
- 1st Department of Pediatrics, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
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6
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Markopoulou P, Papanikolaou E, Loukopoulou S, Galina P, Papassotiriou I, Siahanidou T. Elevated circulating endothelial microparticles (EMPs) in prepubertal children born preterm. Pediatr Res 2022; 91:1754-1761. [PMID: 34285352 DOI: 10.1038/s41390-021-01655-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/14/2021] [Accepted: 06/11/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Endothelial microparticles (EMPs) act as early biomarkers of endothelial activation and damage. No studies have investigated EMPs in preterm-born individuals. METHODS Sixty-three preterm-born children and 52 children born full-term (controls) were studied. Circulating CD62E(+), CD144(+), and CD31(+)/CD42b(-) EMPs were measured in preterm-born children compared to controls; possible associations with cardiovascular risk factors and endothelial function parameters were also assessed. RESULTS Circulating CD62E(+), CD144(+), and CD31(+)/CD42b(-) EMPs were significantly higher in preterm-born children compared to controls (p = 0.003, p < 0.001, and p < 0.001, respectively). Preterm birth was recognized as an independent predictor of each EMP subpopulation studied; moreover, the mean pressure and velocity of pulmonary artery were independently correlated with CD62E(+) (β = 0.20, p = 0.04) and CD144(+) EMPs (β = 0.22, p = 0.02), respectively, whereas age (β = 0.21, p = 0.03) and being born SGA (β = 0.26, p = 0.01) correlated independently with CD31(+)/CD42b(-) EMPs in the study population. Furthermore, diastolic blood pressure (β = 0.24, p = 0.04), being born SGA (β = 0.24, p = 0.04) and the hyperemic peak velocity of the brachial artery (β = -0.65, p = 0.02) were independently associated with CD31(+)/CD42b(-) EMPs in the preterm-born group. CONCLUSION Circulating EMPs were higher in preterm-born children compared to children born full-term. Whether EMPs could act, in clinical practice, as a complementary tool for non-invasive evaluation of endothelium in preterm-born children, remains under investigation. IMPACT Circulating endothelial microparticles (EMPs) are small membrane vesicles released from endothelial cells and they act as novel biomarkers of endothelial activation and damage. No studies have investigated circulating EMPs in preterm-born individuals. Circulating EMPs were significantly higher in prepubertal preterm-born children compared to children born at term. In the preterm-born group, the hyperemic peak velocity of the brachial artery was independently associated with CD31(+)/CD42b(-) EMPs. Whether assessment of circulating EMPs could act, in clinical practice, as a complementary tool for non-invasive evaluation of endothelium in preterm-born children, remains to be defined in future investigations.
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Affiliation(s)
- Panagiota Markopoulou
- Neonatal Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Papanikolaou
- Laboratory of Biology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sofia Loukopoulou
- Department of Cardiology, "Aghia Sofia" Children's Hospital, Athens, Greece
| | - Paraskevi Galina
- Radiology Department, "Aghia Sofia" Children's Hospital, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, "Aghia Sofia" Children's Hospital, Athens, Greece
| | - Tania Siahanidou
- Neonatal Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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7
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Sutherland MR, Malik W, Nguyen VB, Tran V, Polglase GR, Black MJ. Renal morphology and glomerular capillarisation in young adult sheep born moderately preterm. J Dev Orig Health Dis 2021; 12:975-981. [PMID: 33300490 DOI: 10.1017/s2040174420001208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Preterm birth (delivery <37 weeks of gestation) is associated with impaired glomerular capillary growth in neonates; if this persists, it may be a contributing factor in the increased risk of hypertension and chronic kidney disease in people born preterm. Therefore, in this study, we aimed to determine the long-term impact of preterm birth on renal morphology, in adult sheep. Singleton male sheep were delivered moderately preterm at 132 days (~0.9) of gestation (n = 6) or at term (147 days gestation; n = 6) and euthanised at 14.5 months of age (early adulthood). Stereological methods were used to determine mean renal corpuscle and glomerular volumes, and glomerular capillary length and surface area, in the outer, mid and inner regions of the renal cortex. Glomerulosclerosis and interstitial collagen levels were assessed histologically. By 14.5 months of age, there was no difference between the term and preterm sheep in body or kidney weight. Renal corpuscle volume was significantly larger in the preterm sheep than the term sheep, with the preterm sheep exhibiting enlarged Bowman's spaces; however, there was no difference in glomerular volume between groups, with no impact of preterm birth on capillary length or surface area per glomerulus. There was also no difference in interstitial collagen levels or glomerulosclerosis index between groups. Findings suggest that moderate preterm birth does not adversely affect glomerular structure in early adulthood. The enlarged Bowman's space in the renal corpuscles of the preterm sheep kidneys, however, is of concern and merits further research into its cause and functional consequences.
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Affiliation(s)
- Megan R Sutherland
- Department of Anatomy and Developmental Biology and the Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Waleed Malik
- Department of Anatomy and Developmental Biology and the Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Vivian B Nguyen
- Department of Anatomy and Developmental Biology and the Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Vivian Tran
- Department of Anatomy and Developmental Biology and the Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University and the Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Mary Jane Black
- Department of Anatomy and Developmental Biology and the Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
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8
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NF-κB regulation in maternal immunity during normal and IUGR pregnancies. Sci Rep 2021; 11:20971. [PMID: 34697371 PMCID: PMC8545974 DOI: 10.1038/s41598-021-00430-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/06/2021] [Indexed: 12/27/2022] Open
Abstract
Intrauterine Growth Restriction (IUGR) is a leading cause of perinatal death with no effective cure, affecting 5-10% pregnancies globally. Suppressed pro-inflammatory Th1/Th17 immunity is necessary for pregnancy success. However, in IUGR, the inflammatory response is enhanced and there is a limited understanding of the mechanisms that lead to this abnormality. Regulation of maternal T-cells during pregnancy is driven by Nuclear Factor Kappa B p65 (NF-κB p65), and we have previously shown that p65 degradation in maternal T-cells is induced by Fas activation. Placental exosomes expressing Fas ligand (FasL) have an immunomodulatory function during pregnancy. The aim of this study is to investigate the mechanism and source of NF-κB regulation required for successful pregnancy, and whether this is abrogated in IUGR. Using flow cytometry, we demonstrate that p65+ Th1/Th17 cells are reduced during normal pregnancy, but not during IUGR, and this phenotype is enforced when non-pregnant T-cells are cultured with normal maternal plasma. We also show that isolated exosomes from IUGR plasma have decreased FasL expression and are reduced in number compared to exosomes from normal pregnancies. In this study, we highlight a potential role for FasL+ exosomes to regulate NF-κB p65 in T-cells during pregnancy, and provide the first evidence that decreased exosome production may contribute to the dysregulation of p65 and inflammation underlying IUGR pathogenesis.
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9
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Barnard CR, Peters M, Sindler AL, Farrell ET, Baker KR, Palta M, Stauss HM, Dagle JM, Segar J, Pierce GL, Eldridge MW, Bates ML. Increased aortic stiffness and elevated blood pressure in response to exercise in adult survivors of prematurity. Physiol Rep 2021; 8:e14462. [PMID: 32562387 PMCID: PMC7305240 DOI: 10.14814/phy2.14462] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/12/2020] [Accepted: 04/26/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives Adults born prematurely have an increased risk of early heart failure. The impact of prematurity on left and right ventricular function has been well documented, but little is known about the impact on the systemic vasculature. The goals of this study were to measure aortic stiffness and the blood pressure response to physiological stressors; in particular, normoxic and hypoxic exercise. Methods Preterm participants (n = 10) were recruited from the Newborn Lung Project Cohort and matched with term‐born, age‐matched subjects (n = 12). Aortic pulse wave velocity was derived from the brachial arterial waveform and the heart rate and blood pressure responses to incremental exercise in normoxia (21% O2) or hypoxia (12% O2) were evaluated. Results Aortic pulse wave velocity was higher in the preterm groups. Additionally, heart rate, systolic blood pressure, and pulse pressure were higher throughout the normoxic exercise bout, consistent with higher conduit artery stiffness. Hypoxic exercise caused a decline in diastolic pressure in this group, but not in term‐born controls. Conclusions In this first report of the blood pressure response to exercise in adults born prematurely, we found exercise‐induced hypertension relative to a term‐born control group that is associated with increased large artery stiffness. These experiments performed in hypoxia reveal abnormalities in vascular function in adult survivors of prematurity that may further deteriorate as this population ages.
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Affiliation(s)
| | - Matthew Peters
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Amy L Sindler
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Emily T Farrell
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | - Kim R Baker
- Department of Cardiology, University of Wisconsin, Madison, WI, USA
| | - Mari Palta
- Department of Population Health, University of Wisconsin, Madison, WI, USA
| | - Harald M Stauss
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.,Department of Biomedical Sciences, Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - John M Dagle
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Jeffrey Segar
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Gary L Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Marlowe W Eldridge
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA.,The John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin, Madison, WI, USA.,Department of Kinesiology, University of Wisconsin, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Melissa L Bates
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.,Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
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10
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Markopoulou P, Papanikolaou E, Loukopoulou S, Galina P, Mantzou A, Siahanidou T. Increased circulating endothelial progenitor cells (EPCs) in prepubertal children born prematurely: a possible link between prematurity and cardiovascular risk. Pediatr Res 2021; 90:156-165. [PMID: 33038874 DOI: 10.1038/s41390-020-01190-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/17/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endothelial progenitor cells (EPCs) ensure vascular integrity and neovascularization. No studies have investigated EPCs in preterm-born children beyond infancy. METHODS One hundred and thirty-six prepubertal children were enrolled: 63 preterm and 73 born at term (controls). Circulating CD34(+)/VEGFR-2(+)/CD45(-) and CD34(+)/VEGFR-2(+)/CD45dim EPCs were measured in preterm-born children compared to controls. Body mass index (BMI), waist-to-hip ratio (WHR), neck circumference, systolic and diastolic blood pressure (SBP and DBP, respectively), fasting glucose, insulin, lipid profile, common carotid and abdominal aortic intima-media thickness (cIMT and aIMT, respectively), endothelium-dependent brachial artery flow-mediated dilation (FMD), and echocardiographic parameters were also assessed. RESULTS Circulating CD34(+)/VEGFR-2(+)/CD45(-) and CD34(+)/VEGFR-2(+)/CD45dim EPCs were significantly higher in preterm-born children compared to controls (p < 0.001 and p < 0.001, respectively). In total study population and in the preterm-born group, EPCs were significantly lower in children born to mothers with gestational diabetes compared to non-diabetic mothers. Prematurity was associated with higher WHR, neck circumference, SBP, DBP, cIMT, aIMT, mean pressure, and velocity of pulmonary artery; the peak velocity of the brachial artery was significantly lower in children born prematurely. In multiple regression analysis, preterm birth and maternal gestational diabetes were recognized as independent predictors of EPCs. CONCLUSIONS Circulating EPCs were increased in prepubertal preterm-born children in comparison with peers born full-term. Maternal gestational diabetes was associated with a decrease in EPCs. IMPACT Mounting evidence supports the adverse effect of prematurity on cardiovascular health. However, the underlying mechanisms that could lead to endothelial dysfunction in preterm-born individuals are not fully understood. Endothelial progenitor cells (EPCs) ensure vascular integrity, normal endothelial function and neovascularization. No studies have investigated the EPCs counts in peripheral blood beyond infancy in children born prematurely. Circulating EPCs were significantly higher in preterm-born prepubertal children compared to controls, thus indicating that prematurity is possibly associated with endothelial damage. In total study population and in the preterm-born group, maternal gestational diabetes was associated with decreased EPCs concentrations.
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Affiliation(s)
- Panagiota Markopoulou
- Neonatal Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Papanikolaou
- Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Loukopoulou
- Department of Cardiology, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Paraskevi Galina
- Radiology Department, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Aimilia Mantzou
- Unit of Clinical and Translational Research in Endocrinology, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Tania Siahanidou
- Neonatal Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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11
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Postnatal Expression Profile of MicroRNAs Associated with Cardiovascular Diseases in 3- to 11-Year-Old Preterm-Born Children. Biomedicines 2021; 9:biomedicines9070727. [PMID: 34202871 PMCID: PMC8301298 DOI: 10.3390/biomedicines9070727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/11/2021] [Accepted: 06/22/2021] [Indexed: 01/07/2023] Open
Abstract
(1) Background: Preterm-born children have an increased cardiovascular risk with the first clinical manifestation during childhood and/or adolescence. (2) Methods: The occurrence of overweight/obesity, prehypertension/hypertension, valve problems or heart defects, and postnatal microRNA expression profiles were examined in preterm-born children at the age of 3 to 11 years descending from preterm prelabor rupture of membranes (PPROM) and spontaneous preterm birth (PTB) pregnancies. The whole peripheral blood gene expression of 29 selected microRNAs associated with cardiovascular diseases was the subject of our interest. (3) Results: Nearly one-third of preterm-born children (32.43%) had valve problems and/or heart defects. The occurrence of systolic and diastolic prehypertension/hypertension was also inconsiderable in a group of preterm-born children (27.03% and 18.92%). The vast majority of children descending from either PPROM (85.45%) or PTB pregnancies (85.71%) had also significantly altered microRNA expression profiles at 90.0% specificity. (4) Conclusions: Postnatal microRNA expression profiles were significantly influenced by antenatal and early postnatal factors (gestational age at delivery, birth weight of newborns, and condition of newborns at the moment of birth). These findings may contribute to the explanation of increased cardiovascular risk in preterm-born children. These findings strongly support the belief that preterm-born children should be dispensarized for a long time to have access to specialized medical care.
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12
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Cardiovascular risk factors in those born preterm - systematic review and meta-analysis. J Dev Orig Health Dis 2020; 12:539-554. [PMID: 33028453 DOI: 10.1017/s2040174420000914] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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.
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13
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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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14
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Haseler E, Melhem N, Sinha MD. Renal disease in pregnancy: Fetal, neonatal and long-term outcomes. Best Pract Res Clin Obstet Gynaecol 2019; 57:60-76. [PMID: 30930143 DOI: 10.1016/j.bpobgyn.2019.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/19/2018] [Accepted: 01/21/2019] [Indexed: 12/17/2022]
Abstract
Renal disease in women of childbearing age is estimated to be approximately 3%; consequently, renal disease is not an uncommon comorbidity in pregnancy. There has been considerable evidence published over the last 20 years to suggest that renal disease in pregnancy is associated with higher maternal, fetal, and offspring morbidity. Studies published are largely heterogeneous; include unmatched cohort studies; and focus on early neonatal outcomes such as prematurity, small for gestational age, and neonatal unit admission. There appears to be an inverse relationship between maternal renal function and likelihood of neonatal morbidity using these outcome measures. Overall though, data regarding medium-to long-term outcomes for children born to mothers with renal disease are scarce. However, in view of emerging epidemiological evidence regarding cardiovascular programming in intrauterine life in those born premature or small for gestational age, it is likely that this population of children remain at high risk of cardiovascular disease as adults. The scope of this review is to amalgamate and summarize existing evidence regarding the outcomes of infants born to mothers with renal disease. Focus will be given to pregnancy-related acute kidney injury, chronic kidney disease, dialysis, and transplantation.
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Affiliation(s)
- Emily Haseler
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Nabil Melhem
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK; Kings College London, UK.
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15
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Yiallourou SR, Wallace EM, Whatley C, Odoi A, Hollis S, Weichard AJ, Muthusamy JS, Varma S, Cameron J, Narayan O, Horne RSC. Sleep: A Window Into Autonomic Control in Children Born Preterm and Growth Restricted. Sleep 2017; 40:3737644. [PMID: 28419371 DOI: 10.1093/sleep/zsx048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2017] [Indexed: 11/14/2022] Open
Abstract
Study Objectives Preterm birth and fetal growth restriction (FGR) are both associated with risk of hypertension in adulthood. Mechanisms leading to this pathology are unclear. In children aged 5-12 years, who were born preterm and FGR, we used sleep as a tool to assess autonomic control with assessment of cardiovascular structure and function. Methods Eighteen children born preterm and FGR, 15 children born preterm with appropriate birth weights for gestational age (AGA), and 20 AGA term-born children were studied. Children underwent overnight polysomnography with the addition of continuous noninvasive blood pressure (Finometer™). Spectral measures of heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity were assessed and overnight urinary catecholamine levels measured. Echocardiographic studies (Vivid7, GE Healthcare) were performed and vascular compliance assessed (Miller Instruments™). Statistical comparisons were adjusted for age and body size. Results Compared to term children, preterm AGA children had increased high frequency HRV (p < .05) and BPV (p < .05) during sleep, reflecting increased parasympathetic activation and blood pressure changes related to respiration. Preterm FGR children had smaller left ventricular lengths, ascending aorta, and left ventricular outflow tract diameter (p < .05 for all) and vascular compliance was positively correlated with gestational age (r2 = 0.93, p < .05). Conclusions FGR combined with preterm birth did not alter autonomic control but altered heart structure in children. In contrast, preterm birth alone altered autonomic control but had no change in heart structure. These changes in children born preterm and FGR may contribute, in part, to increased risk of cardiovascular disease later in life but by different mechanisms.
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Affiliation(s)
- Stephanie R Yiallourou
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Euan M Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Christie Whatley
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Melbourne, Australia
| | - Alexsandria Odoi
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | - Samantha Hollis
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | - Aidan J Weichard
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | | | - Suraj Varma
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Melbourne, Australia
| | - James Cameron
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Melbourne, Australia
| | - Om Narayan
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
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16
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Edstedt Bonamy AK, Mohlkert LA, Hallberg J, Liuba P, Fellman V, Domellöf M, Norman M. Blood Pressure in 6-Year-Old Children Born Extremely Preterm. J Am Heart Assoc 2017; 6:JAHA.117.005858. [PMID: 28765277 PMCID: PMC5586434 DOI: 10.1161/jaha.117.005858] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Advances in perinatal medicine have increased infant survival after very preterm birth. Although this progress is welcome, there is increasing concern that preterm birth is an emerging risk factor for hypertension at young age, with implications for the lifetime risk of cardiovascular disease. Methods and Results We measured casual blood pressures (BPs) in a population‐based cohort of 6‐year‐old survivors of extremely preterm birth (<27 gestational weeks; n=171) and in age‐ and sex‐matched controls born at term (n=172). Measured BP did not differ, but sex, age‐, and height‐adjusted median z scores were 0.14 SD higher (P=0.02) for systolic BP and 0.10 SD higher (P=0.01) for diastolic BP in children born extremely preterm than in controls. Among children born extremely preterm, shorter gestation, higher body mass index, and higher heart rate at follow‐up were all independently associated with higher BP at 6 years of age, whereas preeclampsia, smoking in pregnancy, neonatal morbidity, and perinatal corticosteroid therapy were not. In multivariate regression analyses, systolic BP decreased by 0.10 SD (P=0.08) and diastolic BP by 0.09 SD (P=0.02) for each week‐longer gestation. Conclusions Six‐year‐old children born extremely preterm have normal but slightly higher BP than their peers born at term. Although this finding is reassuring for children born preterm and their families, follow‐up at older age is warranted.
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Affiliation(s)
- Anna-Karin Edstedt Bonamy
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden .,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children's and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Lilly-Ann Mohlkert
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children's and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Jenny Hallberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children's and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Petru Liuba
- Department of Pediatric Cardiology, Lund University, Lund, Sweden.,Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
| | - Vineta Fellman
- Department of Pediatrics & Clinical Science, Skåne University Hospital and Lund University, Lund, Sweden.,Children's Hospital, Clinicum, Helsinki University Hospital and University of 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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17
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Cabral E, Soares H, Guimarães H, Vitorino R, Ferreira R, Henriques-Coelho T. Prediction of cardiovascular risk in preterm neonates through urinary proteomics: An exploratory study. Porto Biomed J 2017; 2:287-292. [PMID: 32258784 DOI: 10.1016/j.pbj.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/10/2017] [Indexed: 01/28/2023] Open
Abstract
Highlights Urine proteomics allows the identification of the pathways modulated in neonates.Up-regulated pathways in preterm include immunity, metabolism and oxidative stress.Some of these pathways seem to be modulated by the nutritional support.AGT and RBP4 might be related to the development of cardiovascular diseases. Abstract Preterm birth has been associated with an increased risk of cardiovascular diseases (CVD) in adulthood. The goal of our study was to give new molecular insights on the relationship between prematurity and CVD risk and to identify putative biomarkers that would facilitate the development of effective screening and therapeutic strategies. In this sense, mass spectrometry (MS)-based proteomics was applied to the characterization of urine protein profile.GeLC-MS/MS analysis of urine (desalted and concentrated with a 10-kDa filter) followed by bioinformatics was applied for the characterization of preterm and full-term neonates. Urine proteome profiling retrieved 434 unique proteins, from which 126 were common to both groups, 37 were unique to preterm and 58 to full-term neonates. Protein-protein interaction analysis for unique proteins and common ones present in significant distinct levels retrieved immune system, metabolism, defense systems and tissue remodeling as the most representative clusters in preterm neonates.Metabolic adaptation along with the up-regulation of heart growth (identified by angiotensinogen and retinol-binding protein 4) may account for an increased CVD risk in preterm neonates. These proteins may have predictive value of CVD in adulthood of this specific group of neonates. The follow-up of urinary proteome dynamics of preterm and full-term neonates will be crucial for the validation of this hypothesis.
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Affiliation(s)
- Estela Cabral
- School of Health Sciences, University of Minho, Braga, Portugal
| | - Henrique Soares
- Departmento de Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Hercília Guimarães
- Departmento de Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rui Vitorino
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,iBiMED, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Rita Ferreira
- QOPNA, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Tiago Henriques-Coelho
- Departmento de Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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18
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Luu TM, Rehman Mian MO, Nuyt AM. Long-Term Impact of Preterm Birth: Neurodevelopmental and Physical Health Outcomes. Clin Perinatol 2017; 44:305-314. [PMID: 28477662 DOI: 10.1016/j.clp.2017.01.003] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Preterm birth severely disrupts the normal developmental maturation of organ systems, resulting in lasting adverse effects. High blood pressure, cardiac dysfunction, obstructive lung disease, elevated blood glucose, and mental health problems occur earlier and at higher rates in the preterm-born than in the term populations. Disadvantageous health conditions may have a significant impact on the well-being of preterm-born individuals from childhood through adulthood. This review summarizes the impact of preterm birth on neurodevelopment and on cardiovascular, renal, metabolic, and pulmonary health.
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Affiliation(s)
- Thuy Mai Luu
- Department of Pediatrics, Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.
| | - Muhammad Oneeb Rehman Mian
- Department of Biomedical Sciences, Fetomaternal and Neonatal Pathologies Axis, Research Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, 3175 Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Anne Monique Nuyt
- Department of Pediatrics, Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
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Odri Komazec I, Posod A, Schwienbacher M, Resch M, Pupp Peglow U, Kiechl S, Baumgartner D, Kiechl-Kohlendorfer U. Aortic Elastic Properties in Preschool Children Born Preterm. Arterioscler Thromb Vasc Biol 2016; 36:2268-2274. [PMID: 27659099 DOI: 10.1161/atvbaha.116.308144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/09/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Preterm birth predisposes children to the development of cardiovascular diseases in adulthood. The aim of this study was to characterize elastic properties of the aorta at preschool age and test the hypothesis that prematurity is associated with decreased aortic distensibility and increased stiffness, both of which are predictors of increased cardiovascular risk. APPROACH AND RESULTS In an observational study of 76 five- to seven-year-old children born at a gestational age <32 weeks and 79 term-born controls, elastic parameters of the ascending and descending abdominal aorta were determined noninvasively by means of M mode echocardiographic tracings and calculated using computerized wall contour analysis. Compared with children born at term, the preterm group showed significantly reduced distensibility and increased stiffness of the descending abdominal aorta. These results remained significant under multivariable adjustment for birth weight z score, maternal smoking in pregnancy, maternal education, family history of cardiovascular disease, breastfeeding, childhood nutrition, and current body mass index z score (multivariable odds ratios and 95% confidence intervals 5.1, 1.7-15.9; P=0.005 and 2.8, 1.0-7.9; P=0.046, respectively). Further adjustment for intravenous lipid therapy attenuated the strength of association. Elastic properties of the ascending aorta did not differ between the 2 study groups. CONCLUSIONS Children born preterm are characterized by decreased elastic properties of the descending abdominal aorta potentially attributable to impaired viscoelastic properties of and lipid damage to the aorta. Clinical follow-up of preterm infants with a focus on aortic elastic properties may be useful for tailoring early prevention programs and counteracting cardiovascular risk in adulthood.
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Affiliation(s)
- Irena Odri Komazec
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Anna Posod
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Martin Schwienbacher
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Maria Resch
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Ulrike Pupp Peglow
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Stefan Kiechl
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Daniela Baumgartner
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Ursula Kiechl-Kohlendorfer
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.).
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Luu TM, Katz SL, Leeson P, Thébaud B, Nuyt AM. Preterm birth: risk factor for early-onset chronic diseases. CMAJ 2015; 188:736-746. [PMID: 26644500 DOI: 10.1503/cmaj.150450] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Thuy Mai Luu
- Department of Pediatrics (Luu, Nuyt), Centre hospitalier universitaire Sainte-Justine Research Center, Montréal, Que.; Department of Pediatrics (Katz), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Cardiovascular Medicine (Leeson), University of Oxford, Oxford, United Kingdom; Department of Pediatrics (Thébaud), Ottawa Hospital Research Institute, Ottawa, Ont.
| | - Sherri L Katz
- Department of Pediatrics (Luu, Nuyt), Centre hospitalier universitaire Sainte-Justine Research Center, Montréal, Que.; Department of Pediatrics (Katz), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Cardiovascular Medicine (Leeson), University of Oxford, Oxford, United Kingdom; Department of Pediatrics (Thébaud), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Paul Leeson
- Department of Pediatrics (Luu, Nuyt), Centre hospitalier universitaire Sainte-Justine Research Center, Montréal, Que.; Department of Pediatrics (Katz), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Cardiovascular Medicine (Leeson), University of Oxford, Oxford, United Kingdom; Department of Pediatrics (Thébaud), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Bernard Thébaud
- Department of Pediatrics (Luu, Nuyt), Centre hospitalier universitaire Sainte-Justine Research Center, Montréal, Que.; Department of Pediatrics (Katz), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Cardiovascular Medicine (Leeson), University of Oxford, Oxford, United Kingdom; Department of Pediatrics (Thébaud), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Anne-Monique Nuyt
- Department of Pediatrics (Luu, Nuyt), Centre hospitalier universitaire Sainte-Justine Research Center, Montréal, Que.; Department of Pediatrics (Katz), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Cardiovascular Medicine (Leeson), University of Oxford, Oxford, United Kingdom; Department of Pediatrics (Thébaud), Ottawa Hospital Research Institute, Ottawa, Ont
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Comprehensive multi-modality assessment of regional and global arterial structure and function in adults born preterm. Hypertens Res 2015; 39:39-45. [PMID: 26399455 PMCID: PMC4709461 DOI: 10.1038/hr.2015.102] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 06/08/2015] [Accepted: 07/08/2015] [Indexed: 02/03/2023]
Abstract
Preterm birth is associated with higher blood pressure, which could be because preterm birth alters early aortic elastin and collagen development to cause increased arterial stiffness. We measured central and conduit artery size and multiple indices of arterial stiffness to define the extent and severity of macrovascular changes in individuals born preterm. A total of 102 young adults born preterm and 102 controls who were born after an uncomplicated pregnancy underwent cardiovascular magnetic resonance on a Siemens 1.5 T scanner to measure the aortic cross-sectional area in multiple locations. Ultrasound imaging with a Philips CX50 and linear array probe was used to measure carotid and brachial artery diameters. Carotid-femoral pulse wave velocity and the augmentation index were measured by SphygmoCor, brachial-femoral pulse wave velocity by Vicorder and aortic pulse wave velocity by cardiovascular magnetic resonance. The cardio-ankle vascular index (CAVI) was used as a measurement of global stiffness, and ultrasound was used to assess peripheral vessel distensibility. Adults born preterm had 20% smaller thoracic and abdominal aortic lumens (2.19 ± 0.44 vs. 2.69 ± 0.60 cm(2), P<0.001; 1.25 ± 0.36 vs. 1.94 ± 0.45 cm(2), P<0.001, respectively) but similar carotid and brachial diameters to adults born at term. Pulse wave velocity was increased (5.82 ± 0.80 vs. 5.47 ± 0.59 m s(-1), P<0.01, 9.06 ± 1.25 vs. 8.33 ± 1.28 m s(-1), P=0.01, 5.23 ± 1.19 vs. 4.75 ± 0.91 m s(-1), P<0.01) and carotid distensibility was decreased (4.75 ± 1.31 vs. 5.60 ± 1.48 mm Hg(-1)10(3), P<0.001) in this group compared with the group born at term. However, the global and peripheral arterial stiffness measured by CAVI and brachial ultrasound did not differ (5.95 ± 0.72 vs. 5.98 ± 0.60, P=0.80 and 1.07 ± 0.48 vs. 1.19 ± 0.54 mm Hg(-1)10(3), P=0.12, respectively). Adults who are born preterm have significant differences in their aortic structure from adults born at term, but they have relatively small differences in central arterial stiffness that may be partially explained by blood pressure variations.
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