Abstract
Background: Sex-related differences in cardiovascular parameters have been well documented in adults, and the impact of birthweight on cardiovascular health in later life has been acknowledged. However, data was limited regarding the association between birthweight and cardiovascular outcomes at an early age, and the sex-disparity in the association remained unclear.Objective: To investigate the association between birthweight and cardiovascular parameters in 4-year-old children. Furthermore, to explore whether sex-disparity exist in this association or in cardiovascular risk.Methods: Follow-up data from the Shanghai Birth Cohort (SBC) was analyzed. Detailed perinatal information including both maternal and offspring datum were recorded. Blood pressure, echocardiography, and anthropometry assessment were conducted during the follow-up of 4-year-old children. Linear regression models were used to analyze the association between birthweight and left ventricle (LV) structure and function changes in each sex and birthweight category. Multivariable logistic regression models were used to compare risk of left ventricular hypertrophy (LVH) in different birthweight subgroups.Results: Overall, macrosomia was significantly associated with thickened LV posterior wall thickness in systole [LVPWs, (β = 0.26, 95% CI: 0.06, 0.45)] and diastole [LVPWd, (β = 0.18, 95% CI: 0.06, 0.30)], and thickened interventricular septal thickness in diastole [IVSd, (β = 0.16, 95% CI: 0.05, 0.28)]. Boys with macrosomia showed a higher left ventricle mass index [LVMI, (β = 1.29, 95% CI: 0.14, 2.43)], thickened LVPWs (β = 0.30, 95% CI: 0.05, 0.56) and LVPWd (β = 0.21, 95% CI: 0.06, 0.36), and thickened IVSd (β = 0.23, 95% CI: 0.09, 0.36). However, no significant association of structural changes was found in girls. Furthermore, an increased risk of LVH was found solely in macrosomic boys (OR = 2.79, 95% CI: 1.17, 6.63).Conclusion: Children with macrosomia developed cardiovascular changes as early as 4 years of age. Macrosomia was associated with LV structural changes and higher LVH risk in pre-school-aged boys, while no association was found in girls.
Highlights
The impact of birthweight on cardiovascular health in later life has been acknowledged [1, 2]
M, male; F, female; LBW, low birthweight; Normal birthweight (NBW), normal birthweight; SBP, systolic blood pressure; DBP, diastolic blood pressure; Body mass index (BMI), body mass index; LV, left ventricle; LVM index (LVMI), LV mass indexed to the height in m2.7; LV posterior wall thickness in systole (LVPWs), LV posterior wall thicknesses in systole; LV posterior wall thickness in diastole (LVPWd), LV posterior wall thicknesses in diastole; LVDs, LV internal diameter in systole; LVDd, LV internal diameter in diastole; IVSs, interventricular septum thickness in systole; IVSd, interventricular septum thickness in diastole; Relative wall thickness (RWT), relative wall thickness; E, mitral early wave velocities; a, mitral late wave velocities; left ventricular ejection fraction (LVEF), LV ejection fraction; GLS, global longitudinal strain; Carotid intima-media thickness (cIMT), carotid intima-media thickness; left ventricular hypertrophy (LVH), left ventricle hypertrophy
Positive association was found between children with macrosomia and LVPWs (β = 0.26, 95% CI: 0.06, 0.45), LVPWd (β = 0.18, 95% CI: 0.06, 0.30), IVSd (β = 0.16, 95% CI: 0.05, 0.28), and RWT (β = 0.01, 95% CI: 0.001, 0.02)
Summary
The impact of birthweight on cardiovascular health in later life has been acknowledged [1, 2]. Previous studies found that children diagnosed with low birthweight (LBW) or macrosomia were prone to develop increased risk of cardiovascular disease in later life [3,4,5]. This phenomenon was in accordance with the Barker hypothesis [6], which proposed that adverse prenatal exposure could alter metabolism and physiology in later life, and lead to increased risk of adult cardiovascular disease [3, 4, 7]. Sex-related differences in cardiovascular parameters have been well documented in adults, and the impact of birthweight on cardiovascular health in later life has been acknowledged. Data was limited regarding the association between birthweight and cardiovascular outcomes at an early age, and the sex-disparity in the association remained unclear
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