Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA.
Department of Obstetrics, Gynecology, and Reproductive Sciences University of Pittsburgh School of Medicine Pittsburgh PA.
J Am Heart Assoc. 2020 Aug 4;9(15):e015900. doi: 10.1161/JAHA.119.015900. Epub 2020 Jul 22.
Background Women who deliver preterm infants (<37 weeks) have excess cardiovascular risk; however, it is unclear whether the unfavorable changes in the cardiometabolic profile associated with preterm delivery initiate before, during, or after childbearing. Methods and Results We identified 1306 women (51% Black) with births between baseline (1985-1986) and year 30 in the CARDIA (Coronary Artery Risk Development in Young Adults) study. We compared life course changes in blood pressure, body mass index, waist circumference, and lipids in women with preterm deliveries (n=318) with those with all term deliveries (n=988), using piecewise linear mixed-effects models. Specifically, we evaluated group differences in rates of change before and after the childbearing period and change in level across the childbearing period. After adjusting for the covariates, women with preterm deliveries had a higher change in diastolic blood pressure across the childbearing period than those with all term deliveries (1.59 versus -0.73 mm Hg, <0.01); the rates of change did not differ by group, both prechildbearing and postchildbearing. Women with preterm deliveries had a larger body mass index increase across the childbearing period (1.66 versus 1.22 kg/m, =0.03) compared with those with all term deliveries, followed by a steeper increase after the childbearing period (0.22 versus 0.17 kg/m per year, =0.02). Conclusions Preterm delivery was associated with unfavorable patterns of change in diastolic blood pressure and adiposity that originate during the childbearing years and persist or exacerbate later in life. These adverse changes may contribute to the elevated cardiovascular risk among women with preterm delivery.
早产（<37 周）产妇的心血管风险较高；然而，与早产相关的代谢特征的不利变化是在生育前、生育期间还是生育后开始出现，目前尚不清楚。
我们在 CARDIA（年轻人冠状动脉风险发展）研究中确定了 1306 名女性（51%为黑人），她们的分娩时间在基线（1985-1986 年）和第 30 年之间。我们使用分段线性混合效应模型比较了有早产史的女性（n=318）和足月产史的女性（n=988）的血压、体重指数、腰围和血脂的生命历程变化。具体来说，我们评估了生育前和生育后变化率以及生育期间变化水平的组间差异。在调整了协变量后，与所有足月产的女性相比，有早产史的女性在生育期间的舒张压变化更高（1.59 与-0.73mmHg，<0.01）；生育前和生育后两组之间的变化率没有差异。与所有足月产的女性相比，有早产史的女性在生育期间体重指数增加更大（1.66 与 1.22kg/m，=0.03），之后在生育后阶段增加更为陡峭（每年增加 0.22 与 0.17kg/m，=0.02）。
早产与生育期间出现的舒张压和肥胖不利变化模式有关，这些变化模式在生育期间出现并持续存在，或在以后的生活中恶化。这些不良变化可能是导致早产产妇心血管风险升高的原因之一。
