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Published on: January 12, 2018
Preterm Birth: Long Term Cardiovascular and Renal Consequences
Hassib Chehade1, Umberto Simeoni1, Jean-Pierre Guignard2
1Division of Pediatrics and DOHaD Lab, CHUV-UNIL, Lausanne, CH, Switzerland.
Insights
Preterm birth increases the risk of cardiovascular and chronic kidney diseases in adulthood due to altered developmental programming. Antenatal steroids, while beneficial, require cautious use due to potential long-term effects.
Area of Science:
- Developmental biology
- Neonatal medicine
- Cardiovascular and renal medicine
Background:
- Cardiovascular and chronic kidney diseases are leading causes of global premature death.
- Adverse developmental conditions, like preterm birth, contribute to early origins of these noncommunicable diseases.
- Improved neonatal care leads to more preterm infants surviving to adulthood, necessitating study of long-term health outcomes.
Purpose of the Study:
- To review evidence linking preterm birth to cardiovascular and renal diseases in adulthood.
- To analyze the role of perinatal/neonatal factors, including antenatal steroids.
- To explore pathogenic mechanisms like developmental programming and epigenetic alterations.
Main Methods:
- Review of clinical and experimental evidence.
- Analysis of perinatal and neonatal factors.
- Investigation of pathogenic mechanisms including developmental programming and epigenetics.
Main Results:
- Preterm birth is associated with impaired organ development, increasing vulnerability to adult cardiovascular and renal diseases.
- Antenatal steroid therapy improves preterm birth outcomes but may induce long-term cardiovascular and metabolic alterations.
- Potential involvement of antenatal steroids in accelerated cellular senescence in preterm individuals.
Conclusions:
- Preterm-born individuals face a significantly elevated risk of altered cardiovascular and renal function in young adulthood.
- Specific follow-up strategies for preterm survivors require further determination.
- Cautious consideration of repeated antenatal steroid therapy is advised due to potential adverse long-term effects.
Background:
Cardiovascular and chronic kidney diseases are a part of noncommunicable chronic diseases, the leading causes of premature death worldwide. They are recognized as having early origins through altered developmental programming, due to adverse environmental conditions during development. Preterm birth is such an adverse factor. Rates of preterm birth increased in the last decades, however, with the improvement in perinatal and neonatal care, a growing number of preterm born subjects has now entered adulthood. Clinical and experimental evidence suggests that preterm birth is associated with impaired or arrested structural or functional development of key organs/systems making preterm infants vulnerable to cardiovascular and chronic renal diseases at adulthood. This review analyzes the evidence of such cardiovascular and renal changes, the role of perinatal and neonatal factors such as antenatal steroids and potential pathogenic mechanisms, including developmental programming and epigenetic alterations.
Conclusion:
Preterm born subjects are exposed to a significantly increased risk for altered cardiovascular and renal functions at young adulthood. Adequate, specific follow-up measures remain to be determined. While antenatal steroids have considerably improved preterm birth outcomes, repeated therapy should be considered with caution, as antenatal steroids induce long-term cardiovascular and metabolic alterations in animals' models and their involvement in the accelerated cellular senescence observed in human studies cannot be excluded.
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