Abstract
Preterm birth is associated with higher blood pressure, which could be because preterm birth alters early aortic elastin and collagen development to cause increased arterial stiffness. We measured central and conduit artery size and multiple indices of arterial stiffness to define the extent and severity of macrovascular changes in individuals born preterm. A total of 102 young adults born preterm and 102 controls who were born after an uncomplicated pregnancy underwent cardiovascular magnetic resonance on a Siemens 1.5 T scanner to measure the aortic cross-sectional area in multiple locations. Ultrasound imaging with a Philips CX50 and linear array probe was used to measure carotid and brachial artery diameters. Carotid-femoral pulse wave velocity and the augmentation index were measured by SphygmoCor, brachial-femoral pulse wave velocity by Vicorder and aortic pulse wave velocity by cardiovascular magnetic resonance. The cardio-ankle vascular index (CAVI) was used as a measurement of global stiffness, and ultrasound was used to assess peripheral vessel distensibility. Adults born preterm had 20% smaller thoracic and abdominal aortic lumens (2.19±0.44 vs. 2.69±0.60 cm2, P<0.001; 1.25±0.36 vs. 1.94±0.45 cm2, P<0.001, respectively) but similar carotid and brachial diameters to adults born at term. Pulse wave velocity was increased (5.82±0.80 vs. 5.47±0.59 m s−1, P<0.01, 9.06±1.25 vs. 8.33±1.28 m s−1, P=0.01, 5.23±1.19 vs. 4.75±0.91 m s−1, P<0.01) and carotid distensibility was decreased (4.75±1.31 vs. 5.60±1.48 mm Hg−1103, P<0.001) in this group compared with the group born at term. However, the global and peripheral arterial stiffness measured by CAVI and brachial ultrasound did not differ (5.95±0.72 vs. 5.98±0.60, P=0.80 and 1.07±0.48 vs. 1.19±0.54 mm Hg−1103, P=0.12, respectively). Adults who are born preterm have significant differences in their aortic structure from adults born at term, but they have relatively small differences in central arterial stiffness that may be partially explained by blood pressure variations.
Highlights
Advances in neonatal care have led to a rise in perinatal survival of those born preterm.[1,2] Interestingly, follow-up of these individuals into early adulthood has demonstrated that they tend to have higher blood pressure as they age, compared with those born at term, with the increase proportional to their degree of prematurity.[3,4,5] This trend may be due to the premature transition of their cardiovascular system to an ex utero physiological state,[6,7] which leads to adverse early cardiovascular growth and development
The aortic lumen cross-sectional area is markedly reduced in adults born preterm. This reduction in aortic size is out of proportion to the body surface area, which is similar in the two groups
Our findings suggest that conduit vessels may respond differently to preterm birth compared with the aorta
Summary
Advances in neonatal care have led to a rise in perinatal survival of those born preterm.[1,2] Interestingly, follow-up of these individuals into early adulthood has demonstrated that they tend to have higher blood pressure as they age, compared with those born at term, with the increase proportional to their degree of prematurity.[3,4,5] This trend may be due to the premature transition of their cardiovascular system to an ex utero physiological state,[6,7] which leads to adverse early cardiovascular growth and development. Perinatal interventions used in preterm neonates, such as antenatal glucocorticoids and intravenous lipids, are known to modify connective tissue architecture and function in the aortic arch and abdominal aorta, respectively.[9,10] permanent changes in arterial size and stiffness may underlie the observed increase in hypertension risk in the offspring of women with complicated pregnancies,[11] in individuals who are born preterm.[12,13]
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