Children Born Late, Moderately Preterm Associated With Higher Cardiometabolic Risk

Laura N. Anderson, PhD

New findings suggest that children born late preterm (34-36 weeks’ gestation) and moderately preterm (<34 weeks’ gestation) have higher cardiometabolic risk in childhood.

Both late and moderately preterm birth were found to have associations with a higher overall risk score, higher systolic blood pressure (SBP), higher triglyceride levels, and lower high-density lipoprotein [HDL] cholesterol level.

“Because the [cardiometabolic risk] score tracks risk from childhood into adulthood, early preventive evaluation and CMR monitoring beginning early in childhood is warranted for preterm-born children,” wrote study author Laura N. Anderson, PhD, Department of Health Research Methods, Evidence, and Impact, McMaster University.

In this retrospective cohort study, Anderson and colleagues aimed to evaluate if late preterm birth, gestational age as a continuous measure, and size for gestational age, and size for gestational age were associated with cardiometabolic risk among children aged 3 to 12 years.

The cohort consisted of children who participated in the Applied Research Group for Kids (TARGet Kids!) primary care practice-based research network in Toronto Canada between April 2006 and September 2019. The data were additionally linked to the healthcare administrative database at ISES, according to investigators.

Exclusions for children included health conditions affecting growth, any acute or chronic conditions other than asthma or high-functioning autism, severe developmental delay, or families who did not speak English.

The primary study outcome was cardiometabolic risk score at ages 3 to 12 years, consisting of individual components, including waist circumference, log triglyceride level, glucose level, SBP, and HDL cholesterol level. Investigators performed multivariable linear regression analysis to separately evaluate the association of late preterm birth, continuous gestational age, and size for gestational age with CMR in the patient population.

A total of 2440 children were identified as eligible, with 1742 children included in the final cohort and had a mean age of 5.6 years and were 64.6% male (n = 951). Data show 87 children (5.0%) were born moderately preterm, 145 (8.3%) were born late preterm, 455 (26.1%) were born early term, and 1055 (60.6%) were born full term.

Investigators found that late preterm birth compared with full-term birth was associated with a 0.27 U (adjusted β; 95% CI, 0.06 - 0.47 U) higher mean overall cardiometabolic risk. Then, they observed moderately preterm birth was associated with a 0.50 U (adjusted β; 95% CI, 0.24-0.75 U) higher mean overall cardiometabolic risk.

They noted that when gestational age was evaluated as a continuous variable, each additional gestational week was associated with a –0.06 U (adjusted β; 95% CI, –0.08 to –0.03 U) lower mean overall cardiometabolic risk.

“Future studies could evaluate whether cardiovascular risk screening for children born preterm improves outcomes among children and young adults and whether population health interventions targeted at children born both early and late preterm mitigate adverse outcomes,” Anderson concluded.

The study, “Association of Late Preterm Birth and Size for Gestational Age With Cardiometabolic Risk in Childhood,” was published in JAMA Network Open.