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Metabolic-endocrine disruption due to preterm birth impacts growth, body composition, and neonatal outcome

Lea Sophie Möllers1, Efrah I Yousuf2, Constanze Hamatschek1

  • 1Department of Pediatrics, Paracelsus Medical University, Nuremberg, Germany.

Pediatric Research
|May 27, 2021
PubMed

Insights

Preterm birth disrupts fetal endocrine function, leading to poor growth and excess fat in infants. Early insulin-like growth factor (IGF) therapy shows promise in improving outcomes for these vulnerable newborns.

Area of Science:

  • Endocrinology
  • Neonatology
  • Developmental Biology

Background:

  • Preterm infants exhibit suboptimal growth and increased fat accretion despite nutritional support.
  • The premature separation of the maternal-placental-fetal unit is hypothesized to disrupt fetal endocrine function.
  • This disruption has significant implications for postnatal development and infant body composition.

Purpose of the Study:

  • To review endocrine interactions within the maternal-placental-fetal unit during the perinatal period.
  • To examine the impact of hormonal levels and nutrition on preterm infant body composition.
  • To explore the consequences of premature maternal-placental unit dissociation on fetal endocrine function and postnatal outcomes.

Main Methods:

  • Review of hormonal levels (thyroid, adrenal, pituitary, placental, pancreatic, tissue hormones) in preterm and term infants.
  • Analysis of nutritional supply and its correlation with infant body composition.
  • Examination of interventional studies using insulin-like growth factor (IGF) therapy in preterm infants.

Main Results:

  • Premature dissociation of the maternal-placental-fetal unit mimics panhypopituitarism in preterm infants.
  • Neonatal morbidities and perinatal stress contribute to altered growth hormone levels, particularly insulin-like growth factors (IGFs).
  • Early IGF therapy in preterm infants improved neonatal morbidity and growth, suggesting a role in compensating for endocrine disruption.

Conclusions:

  • Preterm birth causes metabolic-endocrine disruption, leading to symptoms similar to anterior pituitary failure, low IGF-1, excessive fat, and failure to thrive.
  • Gestational age-adapted nutrition alone is insufficient for optimal preterm infant growth.
  • Early IGF-1 supplementation offers a promising therapeutic strategy for improving postnatal development and neonatal outcomes in preterm infants.

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