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Abstract and Introduction
Abstract
Adults who were born preterm with a very low birth weight have higher blood pressure and impaired glucose regulation later in life compared with those born at term. We investigated cardiometabolic risk factors in young adults who were born at any degree of prematurity in the Preterm Birth and Early Life Programming of Adult Health and Disease (ESTER) Study, a population-based cohort study of individuals born in 1985–1989 in Northern Finland. In 2009–2011, 3 groups underwent clinical examination: 134 participants born at less than 34 gestational weeks (early preterm), 242 born at 34–36 weeks (late preterm), and 344 born at 37 weeks or later (controls). Compared with controls, adults who were born preterm had higher body fat percentages (after adjustment for sex, age, and cohort (1985–1986 or 1987–1989), for those born early preterm, difference = 6.2%, 95% confidence interval (CI): 0.4, 13.2; for those born late preterm, difference = 8.0%, 95% CI: 2.4, 13.8), waist circumferences, blood pressure (for those born early preterm, difference = 3.0 mm Hg, 95% CI: 0.9, 5.1; for those born late preterm, difference = 1.7, 95% CI: −0.1, 3.4), plasma uric acid levels (for those born early preterm, difference = 20.1%, 95% CI: 7.9, 32.3; for those born late preterm, difference = 20.2%, 95% CI: 10.7, 30.5), alanine aminotransferase levels, and aspartate transaminase levels. They were also more likely to have metabolic syndrome (for those born early preterm, odds ratio = 3.7, 95% CI: 1.6, 8.2; for those born late preterm, odds ratio = 2.5, 95% CI: 1.2, 5.3). Elevated levels of conventional and emerging risk factors suggest a higher risk of cardiometabolic disease later in life. These risk factors are also present in the large group of adults born late preterm.
Introduction
Each year, 14.9 million infants worldwide, approximately 1 of every 9 who are liveborn, are born before 37 weeks of gestation. There is increasing evidence that the smallest and most immature of them, such as those born with very low birth weight (<1,500 g) or born very preterm (<32 weeks), have higher levels of cardiometabolic risk factors as adults, including elevated blood pressure, impaired glucose regulation, and atherogenic lipid profiles. However, most of this evidence is limited to these conventional cardiometabolic risk factors in the extreme groups of adults born at very low birth weight or very preterm.
Of all preterm infants in the United States, 70% are born late preterm, that is, between 34 and 36 weeks of gestation; in the European Union, more than 80% of preterm infants are born moderately preterm, that is, between 32 and 36 weeks of gestation. Yet, only few studies investigating adult cardiometabolic risks have included the whole range of preterm births. Results from these studies have suggested that a linear relationship exists between a shorter gestation period and higher blood pressure in adult life. Should a similar "dose-response" relationship exist for other cardiometabolic risk factors, even moderately higher risks in the much larger group of people born late or moderately preterm could potentially cause a larger public health burden.
We hypothesized that preterm birth at all levels is associated with cardiometabolic risk factors in adult life. We tested this hypothesis in a cohort of young adults by using both conventional risk factors, such as body size and the established components and criteria of the metabolic syndrome, and emerging risk factors that may reflect specific pathophysiological pathways, such as body composition, plasma apolipoproteins, uric acid, and markers of inflammation and fatty liver disease.
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