Supervisors info:
Σουλτάνα Σιαχανίδου, Αναπληρώτρια Καθηγήτρια, Ιατρική, ΕΚΠΑ
Ευρυδίκη Δρογκάρη, Επίκουρη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Χρυσάνθη Τζουμάκα-Μπακούλα, Ομότιμη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Summary:
Introduction: Approximately, 11% of live born neonates, worldwide, has been born prematurely (<37 weeks of gestational age). It still remains a controversial subject if prematurity consists an independent risk factor for the subsequent onset of cardiovascular disease and metabolic syndrome; disorders that impose main causes of morbidity and mortality in developed countries.
Methods: A structured literature search in PubMed and Scopus databases was performed. Studies reporting metabolic syndrome components and cardiovascular risk factors, comparing adults (≥18 years of age) born preterm (<37 weeks of gestational age) and at term (37-42 weeks of gestational age) were included. Outcomes assessed were body mass index (BMI), waist-to-hip ratio (WHR), percentage of fat mass (FM), systolic (SBP) and diastolic (DBP) blood pressure, 24-hour ambulatory systolic (24-hour SBP) and diastolic (24-hour DBP) blood pressure, endothelium-dependent brachial artery flow mediated dilation (FMD), carotid intima-media thickness (cIMT), pulse wave velocity (PWV), fasting glucose and insulin, as well as lipid profiles. The quantitative composition of each of the outcomes was performed in Revman 5.3, the heterogeneity of the studies was assessed by calculating I2, and publication bias was investigated by funnel plots and Egger’s test in STATA 13.
Results: Thirty-nine studies were included, comprising a combined total of 18116 preterm and 294063 term born adults. In adult life, prematurity was associated with statistically significant higher levels of SBP [mean difference 4.29mmHg, 95% confidence interval (CI) 3.02 to 5.56, p<0.0001], DBP (mean difference 2.3mmHg, 95% CI 1.24 to 3.36, p<0.0001), 24-hour SBP (mean difference 4.61mmHg, 95% CI 1.39 to 7.84, p<0.0001), and 24-hour DBP (mean difference 1.79mmHg, 95% CI 0.91 to 2.67, p<0.0001). Furthermore, preterm-born adults presented higher values of fasting insulin (standardized mean difference 0.85mU/l, 95% CI 0.14 to 1.56, p=0.02), and high-density lipoprotein (HDL) (standardized mean difference 0.11mmol/l, 95% CI 0.01 to 0.21, p=0.03). The preterm-term differences were greater in women by 3.68mmHg for SBP (95% CI 2.31 to 5.06, p<0.0001), by 2.26mmHg for DBP (95% CI 1.21 to 3.31, p<0.0001), and by 3.06mmHg for 24-hour SBP (95% CI 0.41 to 5.71, p=0.02), compared with men. No statistically significant difference was found between preterm and term-born adults, for the other outcomes associated with features of metabolic syndrome and risk factors for cardiovascular disease.
Conclusions: Preterm birth is strongly associated with higher levels of arterial blood pressure in adult life, especially in women. Taking into account the standardized mean difference, prematurity is associated with increased levels of fasting insulin in adult life, representing a greater risk of insulin resistance in that group of adults.
Keywords:
Preterm, Metabolic syndrome, Cardiovascular risk, Arterial pressure, Meta-analysis, Adult
