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Preterm Birth and Cardiometabolic Health Trajectories From Birth to Adulthood: The Avon Longitudinal Study of Parents
Gemma L Clayton1,2, Laura D Howe1,2, Linda M O'Keeffe1,2,3
1Medical Research Council Integrative Epidemiology Unit at the University of Bristol Bristol UK.
Insights
Individuals born prematurely showed few, modest cardiometabolic health differences compared to those born at term. Most differences resolved by age 25, except for a slight increase in systolic blood pressure, indicating a need for longer follow-up.
Area of Science:
- Cardiovascular health
- Developmental origins of health and disease
- Pediatric and adolescent health
Background:
- Adults born prematurely (<37 weeks' gestation) face increased cardiovascular disease risk.
- The emergence of this risk throughout the life course remains unclear.
- This study investigates cardiometabolic risk factor trajectories from childhood to early adulthood in preterm-born individuals.
Purpose of the Study:
- To compare the developmental trajectories of multiple cardiometabolic risk factors.
- To assess differences between individuals born preterm and those born at term.
- To determine the timing of divergence in cardiometabolic health between these groups.
Main Methods:
- Utilized multilevel models to analyze data from a UK birth cohort study.
- Tracked body mass index, body composition, blood pressure, lipids, glucose, and insulin from early childhood to age 25.
- Compared individuals born preterm (25-36 weeks' gestation) with those born at term.
Main Results:
- Preterm-born children had higher systolic and diastolic blood pressure at age 7.
- Systolic blood pressure differences persisted to age 18 but attenuated by age 25.
- Body mass index and lipid profiles showed no significant differences by age 25.
Conclusions:
- Modest differences in cardiometabolic health were observed between preterm and term-born individuals.
- Most observed differences resolved by early adulthood (age 25).
- Longer-term follow-up is necessary to fully understand the divergence in cardiometabolic health trajectories.
Background:
Adults who were born prematurely (<37 weeks' gestation) are at increased cardiovascular disease risk, but it is unclear when in the life course this risk emerges. Our aim was to compare trajectories of multiple cardiometabolic risk factors from childhood to early adulthood between those who had and had not been born preterm.
Methods And Results:
Multilevel models were used to compare trajectories from early childhood (<9 years) to age 25 years of body mass index, fat and lean mass, systolic and diastolic blood pressure, lipids, glucose, and insulin, between individuals born preterm (N=311-676; range, 25-36 weeks' gestation) and term (N=4973-10 534) in a UK birth cohort study. We also investigated gestational age as a continuum. In children born preterm (versus term), systolic and diastolic blood pressures were higher at age 7 years (mean predicted differences, 0.7 [95% CI, -0.2 to 1.6] mm Hg and 0.6 [95% CI, -0.04 to 1.3] mm Hg, respectively). By age 18 years, the difference in systolic blood pressure persisted (1.9 [95% CI, 0.8-3.1] mm Hg) and in diastolic blood pressure (0.1 [95% CI, -0.7 to 1.0 mm Hg]) disappeared. By age 25 years, this difference in systolic blood pressure began to attenuate towards the null (0.9 [95% CI, -0.5 to 2.3] mm Hg). Participants born preterm (versus term) had lower body mass index between ages 7 and 18 years, but by age 25 years, there was no difference. Fat and lean mass trajectories were consistent with body mass index. High-density lipoprotein cholesterol was higher and triglycerides lower at birth, in those born preterm, but this difference also disappeared by age 25 years. There was no evidence of differences in glucose and insulin.
Conclusions:
Few, modest differences in cardiometabolic health were found in those born preterm versus term. All disappeared by age 25 years, except the small difference in systolic blood pressure. Longer follow-up is needed to establish if and when cardiometabolic health trajectories diverge between these 2 groups.
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