Research LettersAdult cardiovascular risk factors in premature babies
Summary
Among babies born at term, low birthweight predicts cardiovascular risk factors and disease in adulthood. This study shows that babies born prematurely, whether or not they have intrauterine growth retardation, are predisposed to similar risks as adults.
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Cited by (236)
Prevention of preeclampsia with aspirin
2022, American Journal of Obstetrics and GynecologyPreeclampsia is defined as hypertension arising after 20 weeks of gestational age with proteinuria or other signs of end-organ damage and is an important cause of maternal and perinatal morbidity and mortality, particularly when of early onset. Although a significant amount of research has been dedicated in identifying preventive measures for preeclampsia, the incidence of the condition has been relatively unchanged in the last decades. This could be attributed to the fact that the underlying pathophysiology of preeclampsia is not entirely understood. There is increasing evidence suggesting that suboptimal trophoblastic invasion leads to an imbalance of angiogenic and antiangiogenic proteins, ultimately causing widespread inflammation and endothelial damage, increased platelet aggregation, and thrombotic events with placental infarcts. Aspirin at doses below 300 mg selectively and irreversibly inactivates the cyclooxygenase-1 enzyme, suppressing the production of prostaglandins and thromboxane and inhibiting inflammation and platelet aggregation. Such an effect has led to the hypothesis that aspirin could be useful for preventing preeclampsia. The first possible link between the use of aspirin and the prevention of preeclampsia was suggested by a case report published in 1978, followed by the first randomized controlled trial published in 1985. Since then, numerous randomized trials have been published, reporting the safety of the use of aspirin in pregnancy and the inconsistent effects of aspirin on the rates of preeclampsia. These inconsistencies, however, can be largely explained by a high degree of heterogeneity regarding the selection of trial participants, baseline risk of the included women, dosage of aspirin, gestational age of prophylaxis initiation, and preeclampsia definition. An individual patient data meta-analysis has indicated a modest 10% reduction in preeclampsia rates with the use of aspirin, but later meta-analyses of aggregate data have revealed a dose-response effect of aspirin on preeclampsia rates, which is maximized when the medication is initiated before 16 weeks of gestational age. Recently, the Aspirin for Evidence-Based Preeclampsia Prevention trial has revealed that aspirin at a daily dosage of 150 mg, initiated before 16 weeks of gestational age, and given at night to a high-risk population, identified by a combined first trimester screening test, reduces the incidence of preterm preeclampsia by 62%. A secondary analysis of the Aspirin for Evidence-Based Preeclampsia Prevention trial data also indicated a reduction in the length of stay in the neonatal intensive care unit by 68% compared with placebo, mainly because of a reduction in births before 32 weeks of gestational age with preeclampsia. The beneficial effect of aspirin has been found to be similar in subgroups according to different maternal characteristics, except for the presence of chronic hypertension, where no beneficial effect is evident. In addition, the effect size of aspirin has been found to be more pronounced in women with good compliance to treatment. In general, randomized trials are underpowered to investigate the treatment effect of aspirin on the rates of other placental-associated adverse outcomes such as fetal growth restriction and stillbirth. This article summarizes the evidence around aspirin for the prevention of preeclampsia and its complications.
The 9-Month Stress Test: Pregnancy and Exercise—Similarities and Interactions
2021, Canadian Journal of CardiologyOf all physiological systems, the cardiovascular system takes on the most profound adaptation in pregnancy to support fetal growth and development. The adaptations that arise are systemic and involve structural and functional changes that can be observed at the cerebral, central, peripheral, and microvascular beds. This includes, although is not limited to, increased heart rate, stroke volume, and cardiac output with negligible change to blood pressure, reductions in vascular resistance, and cerebral blood flow velocity, systemic artery enlargement, and enhanced endothelial function. All of this takes place to accommodate blood volume expansion and ensure adequate fetal and maternal oxygen delivery. In some instances, the demand placed on the vasculature can manifest as cardiovascular maladaptation and thus, cardiovascular complications can arise. Exercise is recommended in pregnancy because of its powerful ability to reduce the incidence and severity of cardiovascular complications in pregnancy. However, the mechanism by which it acts is poorly understood. The first of our aims in this review was to describe the systemic adaptations that take place in pregnancy. Our second aim was to describe the influence of exercise on these systemic adaptations. It is anticipated that this review can comprehensively capture the extent of knowledge in this area while identifying areas that warrant further investigation.
De tous les systèmes physiologiques, le système cardiovasculaire est celui qui subit durant la grossesse les plus profondes adaptations pour soutenir la croissance et le développement du fœtus. Les adaptations sont de nature systémique et impliquent des changements structurels et fonctionnels qui peuvent être observés au niveau des lits cérébraux, centraux, périphériques et microvasculaires. Elles se traduisent, entre autres, par une augmentation de la fréquence cardiaque, du volume d’éjection et du débit cardiaque sans modifications de la pression artérielle notable, une diminution de la résistance vasculaire et du débit sanguin cérébral, une dilatation artérielle systémique et un accroissement de la fonction endothéliale. Tout ce processus adaptatif survient en réponse à l’expansion du volume sanguin et vise à assurer un apport suffisant d’oxygène au fœtus et à la mère. Dans certains cas, l’accroissement de la charge vasculaire peut occasionner une inadaptation cardiovasculaire, et des complications cardiovasculaires risquent alors de survenir. L’exercice physique est recommandé chez la femme enceinte puisqu’il peut grandement réduire la fréquence et la gravité des complications cardiovasculaires pendant la grossesse. Toutefois, le mécanisme par lequel cet effet s’opère nous échappe en grande partie. En rédigeant le présent article de synthèse, notre premier objectif était de décrire les adaptations systémiques qui surviennent pendant la grossesse. Notre second objectif était de décrire l’influence de l’exercice physique sur ces adaptations systémiques. L’information présentée vise à faire état des connaissances actuelles en la matière et à cerner certains points qui méritent d’être étudiés de façon plus approfondie.
Exercise-induced irregular right heart flow dynamics in adolescents and young adults born preterm
2021, Journal of Cardiovascular Magnetic ResonancePreterm birth has been linked to an elevated risk of heart failure and cardiopulmonary disease later in life. With improved neonatal care and survival, most infants born preterm are now reaching adulthood. In this study, we used 4D flow cardiovascular magnetic resonance (CMR) coupled with an exercise challenge to assess the impact of preterm birth on right heart flow dynamics in otherwise healthy adolescents and young adults who were born preterm.
Eleven young adults and 17 adolescents born preterm (< 32 weeks of gestation and < 1500 g birth weight) were compared to 11 young adult and 18 adolescent age-matched controls born at term. Stroke volume, cardiac output, and flow in the main pulmonary artery were quantified with 4D flow CMR. Kinetic energy and vorticity were measured in the right ventricle. All parameters were measured at rest and during exercise at a power corresponding to 70% VO2max for each subject. Multivariate linear regression was used to perform age-adjusted term-preterm comparisons.
With exercise, stroke volume increased 10 ± 21% in term controls and decreased 4 ± 18% in preterm born subjects (p = 0.007). This resulted in significantly reduced capacity to increase cardiac output in response to exercise stress for the preterm group (58 ± 26% increase in controls, 36 ± 27% increase in preterm, p = 0.004). Elevated kinetic energy (KEterm = 71 ± 22 nJ, KEpreterm = 87 ± 38 nJ, p = 0.03) and vorticity (ωterm = 79 ± 16 s−1, ωpreterm = 94 ± 32 s−1, p = 0.01) during diastole in the right ventricle (RV) suggested altered RV flow dynamics in the preterm subjects. Streamline visualizations showed altered structure to the diastolic filling vortices in those born preterm.
For the participants examined here, preterm birth appeared to result in altered right-heart flow dynamics as early as adolescence, especially during diastole. Future studies should evaluate whether the altered dynamics identified here evolves into cardiopulmonary disease later in life.
Trial registration None
Preterm Birth as a Risk Factor for Metabolic Syndrome and Cardiovascular Disease in Adult Life: A Systematic Review and Meta-Analysis
2019, Journal of PediatricsTo determine if preterm birth is associated with components of the metabolic syndrome in adult life.
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.
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.
Preterm birth is strongly associated with a number of components of the metabolic syndrome and cardiovascular disease in adult life.
Female fertility under the impact of COVID-19 pandemic: A narrative review
2021, Expert Reviews in Molecular MedicineCardiovascular risk factors in those born preterm - Systematic review and meta-analysis
2021, Journal of Developmental Origins of Health and Disease