Preterm Birth as a Risk Factor for Metabolic Syndrome and Cardiovascular Disease in Adult Life: A Systematic Review and Meta-Analysis

Panagiota Markopoulou; Eleni Papanikolaou; Antonis Analytis; Emmanouil Zoumakis; Tania Siahanidou

doi:10.1016/j.jpeds.2019.02.041

Preterm Birth as a Risk Factor for Metabolic Syndrome and Cardiovascular Disease in Adult Life: A Systematic Review and Meta-Analysis

J Pediatr. 2019 Jul:210:69-80.e5. doi: 10.1016/j.jpeds.2019.02.041. Epub 2019 Apr 13.

Authors

Panagiota Markopoulou¹, Eleni Papanikolaou², Antonis Analytis³, Emmanouil Zoumakis¹, Tania Siahanidou⁴

Affiliations

¹ First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece.
² Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
³ Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
⁴ First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: siahan@med.uoa.gr.

PMID: 30992219
DOI: 10.1016/j.jpeds.2019.02.041

Abstract

Objective: To determine if preterm birth is associated with components of the metabolic syndrome in adult life.

Study design: A structured literature search was performed using PubMed. All comparative studies reported metabolic and cardiovascular outcomes in adults (≥18 years of age) born preterm (<37 weeks of gestation) compared with adults born at term (37-42 weeks of gestation) and published through March 2018 were included. The major outcomes assessed were body mass index, waist circumference, waist-to-hip ratio, fat mass, systolic blood pressure (SBP), diastolic blood pressure (DBP), 24-hour SBP, 24-hour DBP, endothelium-dependent brachial artery flow-mediated dilation, carotid intima-media thickness, pulse wave velocity, fasting glucose and insulin, Homeostasis Model Assessment-Estimated Insulin Resistance Index, and lipid profiles. Quality appraisal was performed using a modified version of the Newcastle-Ottawa scale. A meta-analysis was performed for comparable studies which reported sufficient data.

Results: Forty-three studies were included, including a combined total of 18 295 preterm and 294 063 term-born adults. Prematurity was associated with significantly higher fat mass (P = .03), SBP (P < .0001), DBP (P < .0001), 24-hour SBP (P < .001), and 24-hour DBP (P < .001). Furthermore, preterm-born adults presented higher values of fasting glucose (P = .01), insulin (P = .002), Homeostasis Model Assessment-Estimated Insulin Resistance Index (P = .05), and total cholesterol levels (P = .05) in comparison with adults born at term, in random effect models. No statistically significant difference was found between preterm and term-born adults for the other outcomes studied.

Conclusions: Preterm birth is strongly associated with a number of components of the metabolic syndrome and cardiovascular disease in adult life.

Keywords: cardiovascular risk; components of the metabolic syndrome; insulin resistance; neonates; prematurity; preterm infants.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Cardiovascular Diseases / epidemiology*
Humans
Metabolic Syndrome / epidemiology*
Premature Birth*
Risk Factors