Dalziel Stuart R, Parag Varsha, Rodgers Anthony, Harding Jane E
Clinical Trials Research Unit, The University of Auckland, Auckland, New Zealand.
Int J Epidemiol. 2007 Aug;36(4):907-15. doi: 10.1093/ije/dym067. Epub 2007 Apr 27.
Recent epidemiological evidence has shown increased rates of cardiovascular mortality and associated risk factors in those born small. However, scarce information exists concerning cardiovascular risk factors in adulthood following pre-term birth, or distinguishing the relative contributions of length of gestation and fetal growth to small size at birth.
Prospective follow-up of 458 30-year-olds whose mothers took part in a randomized controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome (147 born at term, 311 born pre-term). Follow-up assessments included anthropometry, blood pressure, blood lipids, early morning cortisol levels and 75 g oral glucose tolerance test.
Gestational age at birth, pre-term birth, and birth weight z-score were not associated with serum cholesterol, triglyceride or cortisol at age 30 (P > 0.1 for all). However, pre-term birth was associated with increased systolic blood pressure (3.5 mmHg, 95% CI 0.9-6.1 mmHg, P = 0.009) and insulin resistance at age 30 [Log (Insulin area under the curve) = 0.17, 95% CI 0.05-0.28, P = 0.006]. Low gestational age at birth was also associated with these outcomes, whereas birth weight, adjusted for gestational age, was not.
Adults who were born moderately pre-term have increased blood pressure and insulin resistance at 30 years of age. Pre-term birth rather than poor fetal growth is the major determinant of this association. As both the incidence of pre-term birth and survival amongst those born pre-term are increasing, this group may contribute an increasing proportion to overall cardiovascular disease burden.
近期的流行病学证据表明，出生时体重较轻者心血管疾病死亡率及相关危险因素的发生率有所上升。然而，关于早产成年后的心血管危险因素，或区分妊娠期长短和胎儿生长对出生时低体重的相对影响的信息却很匮乏。
对458名30岁成年人进行前瞻性随访，这些人的母亲参与了一项预防新生儿呼吸窘迫综合征的产前倍他米松随机对照试验（147名足月出生，311名早产）。随访评估包括人体测量、血压、血脂、清晨皮质醇水平和口服75克葡萄糖耐量试验。
出生时的孕周、早产和出生体重Z评分与30岁时的血清胆固醇、甘油三酯或皮质醇无关（所有P>0.1）。然而，早产与30岁时收缩压升高（3.5 mmHg，95%CI 0.9 - 6.1 mmHg，P = 0.009）和胰岛素抵抗有关[Log(胰岛素曲线下面积)= 0.17，95%CI 0.05 - 0.28，P = 0.006]。出生时孕周短也与这些结果有关，而根据孕周调整后的出生体重则无关。
中度早产出生的成年人在30岁时血压和胰岛素抵抗增加。早产而非胎儿生长受限是这种关联的主要决定因素。由于早产的发生率和早产出生者的存活率都在上升，这一群体可能在总体心血管疾病负担中所占比例越来越大。
