Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
ICES (formerly the Institute for Clinical Evaluative Sciences), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
JAMA Netw Open. 2022 May 2;5(5):e2214379. doi: 10.1001/jamanetworkopen.2022.14379.
The long-term cardiometabolic consequences of late preterm birth (34-36 weeks' gestation) are not well understood.
To assess whether late preterm birth and size for gestational age are associated with cardiometabolic risk (CMR) in childhood.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included 1742 children born in Ontario, Canada, between April 1, 2006, and September 30, 2014, and followed up until September 30, 2019. Data from children enrolled in The Applied Research Group for Kids (TARGet Kids!) primary care practice-based research network were linked to administrative health care data at ICES (formerly known as the Institute for Clinical Evaluative Sciences). Participants were excluded if they had conditions affecting growth (eg, failure to thrive or cystic fibrosis), any acute or chronic conditions (other than asthma and high-functioning autism), severe developmental delay, or families who were unable to communicate in English.
Late preterm birth, gestational age as a continuous measure, and size for gestational age.
The primary outcome was composite CMR score (overall age- and sex-standardized z score of CMR components, including waist circumference, log triglyceride level, glucose level, systolic blood pressure, and high-density lipoprotein cholesterol level). Secondary outcomes were the individual CMR components. Multivariable linear regression analysis was used to separately evaluate the associations of late preterm birth, continuous gestational age, and size for gestational age with CMR at ages 3 to 12 years.
Among 2440 eligible children, 1742 (mean [SD] age, 5.6 [2.2] years; 951 boys [54.6%]) were included in the final cohort. Overall, 87 children (5.0%) were born moderately preterm (<34 weeks' gestation), 145 (8.3%) were born late preterm (34-36 weeks' gestation), 455 (26.1%) were born early term (37-38 weeks' gestation), and 1055 (60.6%) were born full term (≥39 weeks' gestation). Compared with children born full term, those born moderately preterm (adjusted β = 0.50; 95% CI, 0.24-0.75) and late preterm (adjusted β = 0.27; 95% CI, 0.06-0.47) had higher CMR scores. Each additional gestational week was associated with a 0.06 U (adjusted β; 95% CI, -0.08 to -0.03 U) decrease in CMR.
In this study, children born late preterm and moderately preterm had higher CMR. These results suggest that screening and early-life interventions for these children may prevent cardiometabolic outcomes.
人们对晚期早产儿（34-36 周妊娠）的长期心脏代谢后果了解甚少。
评估晚期早产儿出生和胎龄大小与儿童期心脏代谢风险（CMR）之间的关系。
设计、地点和参与者：这是一项回顾性队列研究，纳入了 2006 年 4 月 1 日至 2014 年 9 月 30 日期间在加拿大安大略省出生的 1742 名儿童，并随访至 2019 年 9 月 30 日。来自参加应用研究小组儿童（TARGet Kids！）初级保健实践基础研究网络的儿童的数据与 ICES（以前称为临床评估科学研究所）的行政医疗保健数据相关联。如果儿童存在影响生长的疾病（例如生长不良或囊性纤维化）、任何急性或慢性疾病（哮喘和高功能自闭症除外）、严重发育迟缓，或无法用英语交流，则将其排除在外。
晚期早产儿、连续的胎龄和胎龄大小。
主要结果是复合 CMR 评分（CMR 成分的整体年龄和性别标准化 z 评分，包括腰围、对数甘油三酯水平、血糖水平、收缩压和高密度脂蛋白胆固醇水平）。次要结果是个别 CMR 成分。使用多变量线性回归分析分别评估晚期早产儿出生、连续胎龄和胎龄大小与 3 至 12 岁 CMR 的关系。
在 2440 名符合条件的儿童中，最终队列纳入了 1742 名（平均[标准差]年龄为 5.6[2.2]岁；951 名男孩[54.6%]）。总体而言，87 名儿童（5.0%）为中度早产（<34 周妊娠），145 名（8.3%）为晚期早产（34-36 周妊娠），455 名（26.1%）为早期足月产（37-38 周妊娠），1055 名（60.6%）为足月产（≥39 周妊娠）。与足月产儿相比，中度早产（校正β=0.50；95%置信区间，0.24-0.75）和晚期早产（校正β=0.27；95%置信区间，0.06-0.47）的儿童 CMR 评分更高。每增加一周的胎龄，CMR 就会降低 0.06 U（校正β；95%置信区间，-0.08 至-0.03 U）。
在这项研究中，晚期早产儿和中度早产儿出生的儿童 CMR 更高。这些结果表明，对这些儿童进行筛查和生命早期干预可能预防心脏代谢结局。
