Abstract
Preterm birth accounts for over 15 million global births per year. Perinatal interventions introduced since the early 1980s, such as antenatal glucocorticoids, surfactant, and invasive ventilation strategies, have dramatically improved survival of even the smallest, most vulnerable neonates. As a result, a new generation of preterm-born individuals has now reached early adulthood, and they are at increased risk of cardiovascular diseases. To better understand the sequelae of preterm birth, cardiovascular follow-up studies in adolescents and young adults born preterm have focused on characterizing changes in cardiac, vascular, and pulmonary structure and function. Being born preterm associates with a reduced cardiac reserve and smaller left and right ventricular volumes, as well as decreased vascularity, increased vascular stiffness, and higher pressure of both the pulmonary and systemic vasculature. The purpose of this review is to present major epidemiological evidence linking preterm birth with cardiovascular disease; to discuss findings from clinical studies showing a long-term impact of preterm birth on cardiac remodeling, as well as the systemic and pulmonary vascular systems; to discuss differences across gestational ages; and to consider possible driving mechanisms and therapeutic approaches for reducing cardiovascular burden in individuals born preterm.
Highlights
Preterm birth accounts for over 15 million global births per year
There is a large cohort of preterm-born survivors across gestational age categories reaching adulthood
We present the latest epidemiological and observational data in humans investigating the cardiovascular impact of being born preterm, broken down into sections covering the cardiac, systemic vascular, and pulmonary vascular systems, highlighting differences in disease risk across gestational ages (Figure 2)
Summary
Heart Failure and Young Adult Ischemic Heart Disease Risk: an Independent Effect of Gestational Age? In 2017, Carr et al[9] published a register-based cohort study of 2 665 542 individuals born in Sweden from 1987 to 2012 to. Crump et al[10] published a similar register-based cohort study in 2019 to investigate the association between prematurity and increased risk of ischemic heart disease in adulthood. Gestational age was inversely associated with ischemic heart disease risk across ages 18 to 43 years, including a strong association among individuals born late preterm. The strength of this relationship was higher in those individuals currently 30 to 43 years of age; interestingly, both preterm birth and early-term birth (37–38 weeks’ gestation) were associated with increased relative risks of ischemic heart disease (53% and 19%, respectively) compared with individuals born full term between 39 to 41 weeks’ gestation
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