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Independent Effects of Prematurity on Metabolic and Cardiovascular Risk Factors in Short Small-for-Gestational-Age Children

Department of Paediatrics (R.H.W., S.W.K.d.K., D.C.M.v.d.K., A.C.S.H.-K.), Division of Endocrinology, Erasmus MC Sophia, 3015 GJ Rotterdam, The Netherlands; and Dutch Growth Foundation (D.C.M.v.d.K., A.C.S.H.-K.), 3001 KB Rotterdam, The Netherlands

Address all correspondence and requests for reprints to: Ruben Willemsen, M.D., Erasmus MC Sophia, Room SB-2603, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands. E-mail: r.h.willemsen{at}erasmusmc.nl.

Context: Both small-for-gestational-age (SGA) and preterm birth have been associated with an increased incidence of adult cardiovascular disease and diabetes mellitus type 2. However, it is unclear whether preterm birth has an additional effect on cardiovascular risk factors in short children born SGA.

Objective: Our objective was to investigate whether prematurity has an independent influence on several cardiovascular risk factors within a population of short SGA children.

Design: A cross-sectional observational study was performed.

Patients: A total of 479 short SGA children (mean age 6.8 yr), divided into preterm (<36 wk) and term (36 wk) children, was included in the study.

Outcome Measure: Insulin sensitivity, β-cell function, body composition, and lipid levels were studied in subgroups, and blood pressure (BP), anthropometry at birth and during childhood in the total group.

Results: Preterm SGA children were significantly lighter and shorter at birth after correction for gestational age than term SGA children (P < 0.001) but had a comparable head circumference. In preterm SGA children, we found a significantly higher systolic (P = 0.003) and diastolic BP SD score (P = 0.026), lower percent body fat SD score (P = 0.011), and higher insulin secretion (P = 0.033) and disposition index (P = 0.021), independently of the degree of SGA. Insulin sensitivity, serum lipid levels, muscle mass, and body fat distribution were comparable for preterm and term SGA children.

Conclusions: Within a population of short SGA children, preterm birth has divergent effects on several cardiovascular risk factors. Whereas preterm SGA children had a higher systolic and diastolic BP, they also had a lower percent body fat and a higher insulin secretion and disposition index than term SGA children.

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