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

Abstract

OBJECTIVE\nTo determine if preterm birth is associated with components of the metabolic syndrome in adult life.\n\n\nSTUDY DESIGN\nA structured literature search was performed using PubMed. All comparative studies reported metabolic and cardiovascular outcomes in adults (≥18\xa0years of age) born preterm (<37\xa0weeks of gestation) compared with adults born at term (37-42\xa0weeks 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.\n\n\nRESULTS\nForty-three studies were included, including a combined total of 18\u2008295 preterm and 294\u2008063 term-born adults. Prematurity was associated with significantly higher fat mass (P\xa0=\xa0.03), SBP (P\xa0<\xa0.0001), DBP (P\xa0<\xa0.0001), 24-hour SBP (P\xa0<\xa0.001), and 24-hour DBP (P\xa0<\xa0.001). Furthermore, preterm-born adults presented higher values of fasting glucose (P\xa0=\xa0.01), insulin (P\xa0=\xa0.002), Homeostasis Model Assessment-Estimated Insulin Resistance Index (P\xa0=\xa0.05), and total cholesterol levels (P\xa0=\xa0.05) 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.\n\n\nCONCLUSIONS\nPreterm birth is strongly associated with a number of components of the metabolic syndrome and cardiovascular disease in adult life.