1. This retrospective cohort study using the TARGet Kids! Cohort demonstrated that late and moderate preterm birth was significantly associated with higher cardiometabolic risk (CMR) scores in children ages 3- to 12-years-old.

2. Additionally, each additional gestational week was associated with a significant decrease in CMR scores.

Evidence Rating Level: 2 (Good)

Study Rundown: Complications of preterm birth in adulthood are well-described. Most literature on preterm birth outcomes is based on those born <32 weeks’ gestation; however, late preterm birth (34-36 weeks) accounts for the majority of preterm births. Given that risk factors for preterm delivery, such as maternal age, obesity, and diabetes have increased, it is critical to better understand these consequences. Some studies have demonstrated increased cardiometabolic risk (CMR) factors in adults born preterm. Utilizing a CMR score may serve to further recognize disease risk, yet the association between CMR score and late preterm birth has yet to be elucidated. This retrospective cohort study examined whether preterm birth (using gestational age as a continuous measure) and size for gestational age were associated with higher CMR scores among children aged 3- to 12-years-old. Gestational age at birth was divided into moderately preterm, late preterm, early term, and full term. The primary outcome was CMR score, and the reference cohort was those born at full term. Using the fully adjusted model, late and moderate preterm birth were associated with significantly increased mean overall CMR. When assessing the components of CMR, systolic blood pressure and triglyceride level were significantly increased in moderately preterm. Glucose level and waist circumference did not significantly differ between any group. Furthermore, there was no significant association between small for gestational age (SGA) status or large for gestational age (LGA) status and CMR, when compared to appropriate for gestational age (AGA). Overall, late and moderate preterm birth were associated with higher CMR scores when compared to full-term births in children aged 3- to 12-years-old; conversely, CMR scores did not differ based on size for gestational age. Notably, this sample of children was from families with relatively high income, which may not generalize to the entire population. Given that CMR scores in childhood often persist into adulthood, early intervention for this cohort is essential to consider.

Click to read the study in JAMA Network Open

Click to read an accompanying editorial in JAMA Network Open

Relevant Reading: The association between late preterm birth and cardiometabolic conditions across the life course: a systematic review and meta-analysis

In-Depth [retrospective cohort]: This study was conducted between April 1, 2006, and September 30, 2014, using data from children 3- to 12-years old from the TARGet Kids! Cohort in Toronto, Canada. Children were excluded if they had current health conditions affecting growth or had any acute or chronic health conditions. The primary exposure was gestational age, which was split into the four groups: moderately preterm (<34 weeks), late preterm (34-36 weeks), early term (37-38 weeks), and full-term (>39 weeks). The primary outcome was CMR score. Compared to full-term birth, late preterm birth (adjusted b = 0.27 U [95% CI: 0.06-0.47]) and moderate preterm birth (adjusted b = 0.50 [95% CI: 0.24-0.75]) were associated with higher mean overall CMR scores. As a continuous variable, each additional gestational week was associated with a -0.06 U (adjusted b; 95% CI: -0.08 to -0.03) decrease in mean overall CMR. Additionally, there was no association between SGA status (adjusted b = -0.09 [95% CI: -0.28 to 0.10]) or LGA status (adjusted b = 0.16 [95% CI: -0.03 to 0.35]) when compared to AGA status. However, SGA status was associated with increased systolic blood pressure (adjusted b = 0.21 [95% CI: 0.04-0.38]), and LGA status was associated with increased waist circumference (adjusted b = 1.06 [95% CI: 0.23-1.89]) compared to AGA status.

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