Abstract
BackgroundAdverse developmental programming by early-life exposures might account for higher blood pressure (BP) in children born extremely preterm. We assessed associations between nutrition, growth and hyperglycemia early in infancy, and BP at 6.5 years of age in children born extremely preterm.MethodsData regarding perinatal exposures including nutrition, growth and glycemia status were collected from the Extremely Preterm Infants in Sweden Study (EXPRESS), a population-based cohort including infants born <27 gestational weeks during 2004–2007. BP measurements were performed at 6.5 years of age in a sub-cohort of 171 children (35% of the surviving children).ResultsHigher mean daily protein intake (+1 g/kg/day) during postnatal weeks 1–8 was associated with 0.40 (±0.18) SD higher diastolic BP. Higher mean daily carbohydrate intake (+1 g/kg/day) during the same period was associated with 0.18 (±0.05) and 0.14 (±0.04) SD higher systolic and diastolic BP, respectively. No associations were found between infant growth (weight, length) and later BP. Hyperglycemia and its duration during postnatal weeks 1–4 were associated primarily with higher diastolic BP z-scores.ConclusionsThese findings emphasize the importance of modifiable early-life exposures, such as nutrition and hyperglycemia, in determining long-term outcomes in children born extremely preterm.
Highlights
Children born extremely preterm (EPT) have higher systolic and diastolic blood pressures (SBP and DBP) than term-born controls already at 2.5 and 6.5 years of age, and preterm birth has previously been linked with higher SBP later in life.[1,2,3] The mechanisms behind these findings have not been fully understood
Mean daily protein intakes during postnatal weeks 1–4 and 5–8 were not significantly associated with either SBP or DBP z-scores at follow-up (Table 2; results not shown for postnatal weeks 5–8)
Mean daily protein intake given during the first 8 postnatal weeks was significantly associated with DBP zscore—an increase of 1 g/kg/day in the protein intake during this period was associated with an increase of 0.40 standard deviations (SD) in the DBP at follow-up (P = 0.028)
Summary
Children born extremely preterm (EPT) have higher systolic and diastolic blood pressures (SBP and DBP) than term-born controls already at 2.5 and 6.5 years of age, and preterm birth has previously been linked with higher SBP later in life.[1,2,3] The mechanisms behind these findings have not been fully understood. Adverse developmental programming by early-life exposures might account for higher blood pressure (BP) in children born extremely preterm. We assessed associations between nutrition, growth and hyperglycemia early in infancy, and BP at 6.5 years of age in children born extremely preterm. CONCLUSIONS: These findings emphasize the importance of modifiable early-life exposures, such as nutrition and hyperglycemia, in determining long-term outcomes in children born extremely preterm.
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