Preterm Birth as a Risk Factor for Metabolic Syndrome and Cardiovascular Disease in Adult Life: A Systematic Review and Meta-Analysis

Abstract

To determine if preterm birth is associated with components of the metabolic syndrome in adult life. A structured literature search was performed using PubMed. All comparative studies reported metabolic and cardiovascular outcomes in adults (≥18years of age) born preterm (<37weeks of gestation) compared with adults born at term (37-42weeks of gestation) and published through March 2018 were included. The major outcomes assessed were body mass index, waist circumference, waist-to-hip ratio, fat mass, systolic blood pressure (SBP), diastolic blood pressure (DBP), 24-hour SBP, 24-hour DBP, endothelium-dependent brachial artery flow-mediated dilation, carotid intima-media thickness, pulse wave velocity, fasting glucose and insulin, Homeostasis Model Assessment-Estimated Insulin Resistance Index, and lipid profiles. Quality appraisal was performed using a modified version of the Newcastle-Ottawa scale. A meta-analysis was performed for comparable studies which reported sufficient data. Forty-three studies were included, including a combined total of 18 295 preterm and 294 063 term-born adults. Prematurity was associated with significantly higher fat mass (P=.03), SBP (P<.0001), DBP (P<.0001), 24-hour SBP (P<.001), and 24-hour DBP (P<.001). Furthermore, preterm-born adults presented higher values of fasting glucose (P=.01), insulin (P=.002), Homeostasis Model Assessment-Estimated Insulin Resistance Index (P=.05), and total cholesterol levels (P=.05) in comparison with adults born at term, in random effect models. No statistically significant difference was found between preterm and term-born adults for the other outcomes studied. Preterm birth is strongly associated with a number of components of the metabolic syndrome and cardiovascular disease in adult life.