Cardiology (Heart and vessels)

Impacts of Preterm Birth on Cardiovascular Health

Researchers from Oxford, UK have helped identify key changes to the heart of adults born prematurely, causing more significant problems for those born at the earliest gestations. They highlight that premature birth increases the risk of heart disease in later life and also reduce the ability of the heart to cope with stressors such as exercise.

You can read more in this link to The Conversation article or watch the video below where the lead researcher, Adam Lewandowski, explains what the research has identified and what can be done to reduce the risks.

Increased risk of pulmonary hypertension following premature birth

This study has found that premature birth significantly increases an individuals risk on pulmonary hypertension. They feel there are a few factors that have an impact upon this risk, and that is it still unclear what the underlying cause is. Click to read the full article.

Naumburg, E., Soderstorm, L. (2019) Increased risk of pulmonary hypertension following premature birth. BMC Pediatrics, 19(288)

Blood Pressure in Young Adults Born at Very Low Birth Weight

This study supported by the APIC collaboration has found that adults born preterm at very low birth weight (<1500 g) have higher blood pressure than those born at term, with being female and exposure to maternal preeclampsia as additional risk factors. Click to read the full article.

Hovi, P., et al, 2016. Blood Pressure in Young Adults Born at Very Low Birth Weight, Hypertension, 68(880–887).

Cardiovascular Morbidities in Adults Born Preterm: Getting to the Heart of the Matter!

This review paper covers;

Heart Structure and Function in adults born Preterm

Risk of Heart Disease

Adult on-set High Blood Pressure

Preterm Birth and Ischemic Heart Disease

Preterm Birth and Reduced Exercise Capacity

Heart Failure in Adults Born Preterm

Assessing Cardiovascular Health in Adults Born Preterm

Key Points

All physicians should ask about birth history including the degree of prematurity, birth weight, mechanical ventilation, and significant or minor comorbidities.

Physicians should be proactive in regular assessment, monitoring and management of adults born preterm to reduce cardiometabolic risks. This may include regular monitoring of blood pressure, assessment of cardiometabolic risk profile, evaluation of cardiac performance and cardiovascular fitness by echocardiography and cardiopulmonary exercise testing.

Adults born preterm may have a combination of abnormalities that could impact lung and cardiac structure and function, which may be challenging to diagnose clinically.

The risk for multiple complications and cardio-respiratory issues, including endocrine, neurological, and mental health problems, could burden the adults born preterm.

The paper recommends the development of academic programs specifically addressing the problems of adults born preterm and commitment of resources by all stakeholders to improve the health of preterm-born adults.

The development of databases with essential pieces of information would help develop intervention strategies to improve the quality of life of adults born preterm.

Addressing the development of cardiovascular risk factors and their interactions with other organ systems will contribute to the overall wellness of the adults born preterm.

Click here to read the paper.

Kumar V.H.S. (2022) Cardiovascular Morbidities in Adults Born Preterm: Getting to the Heart of the Matter! Children. 9 (12): 1843.

Lower birth weight is linked to poorer cardiovascular health in middle-aged population-based adult

Previous studies have linked prematurity and small-for-gestational age (SGA) with increased lifetime cardiovascular (heart and blood vessels) risk. 

Association of lower birth weight > higher risk of myocardial infarction (heart attack) & harmful left ventricular remodelling. The left ventricle is the heart’s main pumping chamber.

The study looked at 258 787 middle-aged adults > singleton births > birth weights between 1 and 5 kg.

Lower birth weight of less than 3.2 kgs > significantly increased risk of incident of a heart attack.

Poor blood sugar control > cholesterol > high blood pressure > whole body inflammation = important independent influences of this link.

The above factors showed an effect in less than one-third of the birth weight effect > suggests important influence of other biological pathways.

Lower birth weight > linked to an unhealthy pattern of heart & blood vessel remodelling / changes > indicate greater thickening of the heart wall & poorer left ventricular function.

Further research is required to see if;

1. Inclusion of birth weight may improve existing risk tools

2. Preventative strategies targeted at individuals with lower birth weight > improving clinical outcomes.

Click here to see the paper.

Raisi-Estabragh Z, Cooper J, Bethell MS, et al. (2022) Lower birth weight is linked to poorer cardiovascular health in middle-aged population-based adults. Heart. Published Online: 16 November 2022. 

Cardiac and vascular health in late preterm infants

Infants born late preterm show selective differences in markers of cardiovascular risk, with potentially positive / good differences in aortic wall thickness and potentially bad / negative differences in autonomic control (regulation of involuntary physiologic processes), when compared with term-born control infants.

This provides evidence to support an increased risk of hypertension (high blood pressure) and sudden cardiac (heart) death in individuals born late preterm.

Click here to view the abstract.

Dissanayake, H., McMullan, R., Kong, Y., Caterson, I., Celermajer, D., Phang, M., Skilton, M. (2022). Cardiac and vascular health in late preterm infants. Journal of Developmental Origins of Health and Disease, 13(1), 128-134.

Long-lasting effects of very preterm birth on brain structure in adulthood: A systematic review and meta-analysis.

This paper conducted a systematic review and concluded that early life experiences, such as very preterm (VP) birth, can affect brain and cognitive development. They highlight that very preterm and very low birth weight adults exhibited volume, structure and microstructural alterations in the brain. This study suggests there is a persisting neurological impact of VP birth, which may provide developmental neurobiological insights for adult cognition in high-risk populations. Click here to read the full paper.

Kelly, C., Shaul, M., Thompson, D., Mainzer, R., Yang, J., Dhollander, T., Cheong, J., Inder, T., Doyle, L., and Anderson, P., 2023. Long-lasting effects of very preterm birth on brain structure in adulthood: A systematic review and meta-analysis. Neuroscience and biobehavioral reviews, (147), pg 105082