by on September 26, 2014

in Monthly

It has been said that cardiovascular problems such as high blood pressure and elevated lipids have a beginning in childhood, or even earlier, in the womb. One author uses the analogy of a dynamite stick with a long fuse: the fuse gets lit once a baby is born, but the explosion takes place many years later.

In an upcoming edition of Pediatrics, a study done in Finland, at the University of Oulu, looked at the cardiovascular risk factors in adolescents who were born preterm. It is already known that adolescents and adults born before 34 weeks gestation (early preterm) have higher blood pressures and an altered glucose metabolism compared with their term-born peers. What prompted the authors to do their research is that it is unknown if the same risk factors apply to babies born less preterm, between 34 and 36 weeks.

Scandinavian countries are well respected for their ability to do long term epidemiological research. Their medical system allows for close follow up of their populations— often from cradle to grave. In this particular study 6642 sixteen year-old adolescents of a population based in Northern Finland, born around 1986, were tracked well into their late teenage years.

Data showed that preterm birth was associated with higher blood pressure in adolescent girls and an abnormal lipid profile in boys, predisposing them to early atherosclerosis. These associations were the strongest among those born early preterm, but babies born between 34 and 36 weeks were also at an increased risk. The bottom line is that the shorter the time a baby spends in the mother’s womb, the higher the risks are for cardiovascular disease later in life.

Results showed that the differences between term and preterm babies were not influenced by maternal smoking, parental education, the stage of puberty, smoking and physical activity. Other unknown mechanisms were at work and scientists, limited by a rudimentary grasp of what happens in the womb, can only speculate.

The Finish study showed that teenage boys born early preterm have higher levels of total cholesterol, LDL cholesterol and ApoB, the apolipoprotein component of the low-density cholesterol which is a very accurate indicator of cardiovascular risk. This is new information and it is unclear if it may pass the test of time (Previous findings concerning later life serum lipid levels of those born preterm were inconsistent)

Approximately 11% of all live-born infants worldwide are born before 37 weeks gestation. (I often am told by parents when taking a history “my baby was born too early.” I have learned that to some parents, “early” means before 40 weeks gestation. Babies born between 37 and 40 weeks gestation are not considered preterm)

In Europe over 80 % of preterm births take place between 32 and 36 weeks gestation. In North America close to 74% of preterm births are born between 34 and 36 weeks. It varies depending on socioeconomic status (SES) and the quality of prenatal care. Over the past few years the Canadian Medical Association has done its best to convince government that health outcomes are very dependent on the SES of society. The hope is that by improving everyone’s SES we may end up saving money over the long term.

The care of babies born preterm has improved dramatically over the past four decades. It’s a quantum leap for older pediatricians to stroll through a neonatal ICU, so vastly different from the 70’s and 80’s. There is however still one major knot that remains tightly knotted and difficult to fix: we still do not have a cure for prematurity.

What this fascinating study also fails to address is the role of relatively new science: epigenetics. Epigenetics is the science of studying why genes express themselves the way they do, and more excitingly, how lifestyle changes can impact genetic expression (I have written a previous column on this topic which can be accessed via the Herald archives online)

In the study there was no mention of the role of consuming more fruits and vegetables. It is well known that a vegan lifestyle has benefits such as lower blood pressure and a higher likelihood of normal lipids. We also know that when children are picky eaters, sadly, too many doctors suggest a synthetic man-made multivitamin—as opposed to a fruit and vegetable supplement for those who refuse any plant based nutrients even after relentless efforts by the well-meaning parents.

The point of this research from Finland is not to feel doomed. Experiencing cardiovascular complications later in life because a baby was born preterm is a risk, but other factors may modify this risk if we pay closer attention. The point is for parents and doctors to become more vigilant at screening these babies later in life and well into adulthood; this population also deserves diligent encouragement to follow a healthy lifestyle in terms of nutrition, exercise, sleep and stress management.

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