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. 2004 Mar;89(3):217–221. doi: 10.1136/adc.2003.025999

Relation of arterial stiffness with gestational age and birth weight

Y Cheung 1, K Wong 1, B Lam 1, N Tsoi 1
PMCID: PMC1719813  PMID: 14977693

Abstract

Background: The cardiovascular risk of individuals who are born small as a result of prematurity remains controversial. Given the previous findings of stiffer peripheral conduit arteries in growth restricted donor twins in twin–twin transfusion syndrome regardless of gestational age, we hypothesised that among children born preterm, only those with intrauterine growth retardation are predisposed to an increase in cardiovascular risks.

Aim: To compare brachioradial arterial stiffness and systemic blood pressure (BP) among children born preterm and small for gestational age (group 1, n = 15), those born preterm but having birth weight appropriate for gestational age (group 2, n = 36), and those born at term with birth weight appropriate for gestational age (group 3, n = 35).

Methods: Systemic BP was measured by an automated device (Dinamap), while stiffness of the brachioradial arterial segment was assessed by measuring pulse wave velocity (PWV). The birth weight was adjusted for gestational age and expressed as a z score for analysis.

Results: The 86 children were studied at a mean (SD) age of 8.2 (1.7) years. Subjects from group 1, who were born at 32.3 (2.0) weeks' gestation had a significantly lower z score of birth weight (-2.29 (0.63), p<0.001), compared with those from groups 2 and 3. They had a significantly higher mean blood pressure (p<0.001) and their diastolic blood pressure also tended to be higher (p = 0.07). Likewise, their brachioradial PWV, and hence arterial stiffness, was the highest of the three groups (p<0.001). While subjects from group 2 were similarly born preterm, their PWV was not significantly different from that of group 3 subjects (p = 1.00) and likewise their z score of birth weight did not differ (-0.01 (0.71) v -0.04 (1.1), p = 1.00). Brachioradial PWV correlated significantly with systolic (r = 0.31, p = 0.004), diastolic (r = 0.38, p<0.001), and mean (0.47, p<0.001) BP, and with z score of birth weight (r = -0.43, p<0.001). Multiple linear regression identified mean BP and z score of birth weight as significant determinants of PWV.

Conclusion: The findings of the present study support the hypothesis that among children born preterm, only those with intrauterine growth retardation are disadvantaged as a result of increase in systemic arterial stiffness and mean blood pressure.

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Figure 1 .

Figure 1

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Box plots of pulse wave velocity of subjects in the three groups. Bold lines represent the medians in each group. *p<0.001 v group 1.

Figure 2 .

Figure 2

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Scatter plot of pulse wave velocity v the z score of body weight adjusted for gestational age.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akalin-Sel T., Campbell S. Understanding the pathophysiology of intra-uterine growth retardation: the role of the 'lower limb reflex' in redistribution of blood flow. Eur J Obstet Gynecol Reprod Biol. 1992 Sep 23;46(2-3):79–86. doi: 10.1016/0028-2243(92)90250-3. [DOI] [PubMed] [Google Scholar]
  2. Barker D. J., Bull A. R., Osmond C., Simmonds S. J. Fetal and placental size and risk of hypertension in adult life. BMJ. 1990 Aug 4;301(6746):259–262. doi: 10.1136/bmj.301.6746.259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barker D. J. Fetal origins of coronary heart disease. BMJ. 1995 Jul 15;311(6998):171–174. doi: 10.1136/bmj.311.6998.171. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Barker D. J., Winter P. D., Osmond C., Margetts B., Simmonds S. J. Weight in infancy and death from ischaemic heart disease. Lancet. 1989 Sep 9;2(8663):577–580. doi: 10.1016/s0140-6736(89)90710-1. [DOI] [PubMed] [Google Scholar]
  5. Cheung Y. F., Taylor M. J., Fisk N. M., Redington A. N., Gardiner H. M. Fetal origins of reduced arterial distensibility in the donor twin in twin-twin transfusion syndrome. Lancet. 2000 Apr 1;355(9210):1157–1158. doi: 10.1016/s0140-6736(00)02068-7. [DOI] [PubMed] [Google Scholar]
  6. Irving R. J., Belton N. R., Elton R. A., Walker B. R. Adult cardiovascular risk factors in premature babies. Lancet. 2000 Jun 17;355(9221):2135–2136. doi: 10.1016/S0140-6736(00)02384-9. [DOI] [PubMed] [Google Scholar]
  7. Joannides R., Richard V., Haefeli W. E., Benoist A., Linder L., Lüscher T. F., Thuillez C. Role of nitric oxide in the regulation of the mechanical properties of peripheral conduit arteries in humans. Hypertension. 1997 Dec;30(6):1465–1470. doi: 10.1161/01.hyp.30.6.1465. [DOI] [PubMed] [Google Scholar]
  8. Kiortsis D. N., Elisaf M. S., Evangelou A. Adult cardiovascular risk factors in premature babies. Lancet. 2000 Sep 9;356(9233):938–939. doi: 10.1016/S0140-6736(00)02692-1. [DOI] [PubMed] [Google Scholar]
  9. Kontis S., Gosling R. G. On-line Doppler ultrasound measurement of aortic compliance and its repeatability in normal subjects. Clin Phys Physiol Meas. 1989 May;10(2):127–135. doi: 10.1088/0143-0815/10/2/002. [DOI] [PubMed] [Google Scholar]
  10. Law C. M., Shiell A. W., Newsome C. A., Syddall H. E., Shinebourne E. A., Fayers P. M., Martyn C. N., de Swiet M. Fetal, infant, and childhood growth and adult blood pressure: a longitudinal study from birth to 22 years of age. Circulation. 2002 Mar 5;105(9):1088–1092. doi: 10.1161/hc0902.104677. [DOI] [PubMed] [Google Scholar]
  11. Leeson C. P., Kattenhorn M., Morley R., Lucas A., Deanfield J. E. Impact of low birth weight and cardiovascular risk factors on endothelial function in early adult life. Circulation. 2001 Mar 6;103(9):1264–1268. doi: 10.1161/01.cir.103.9.1264. [DOI] [PubMed] [Google Scholar]
  12. Leeson C. P., Whincup P. H., Cook D. G., Donald A. E., Papacosta O., Lucas A., Deanfield J. E. Flow-mediated dilation in 9- to 11-year-old children: the influence of intrauterine and childhood factors. Circulation. 1997 Oct 7;96(7):2233–2238. doi: 10.1161/01.cir.96.7.2233. [DOI] [PubMed] [Google Scholar]
  13. Leon D. A., Koupilova I., Lithell H. O., Berglund L., Mohsen R., Vagero D., Lithell U. B., McKeigue P. M. Failure to realise growth potential in utero and adult obesity in relation to blood pressure in 50 year old Swedish men. BMJ. 1996 Feb 17;312(7028):401–406. doi: 10.1136/bmj.312.7028.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Leon D. A., Lithell H. O., Vâgerö D., Koupilová I., Mohsen R., Berglund L., Lithell U. B., McKeigue P. M. Reduced fetal growth rate and increased risk of death from ischaemic heart disease: cohort study of 15 000 Swedish men and women born 1915-29. BMJ. 1998 Jul 25;317(7153):241–245. doi: 10.1136/bmj.317.7153.241. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Martin H., Gazelius B., Norman M. Impaired acetylcholine-induced vascular relaxation in low birth weight infants: implications for adult hypertension? Pediatr Res. 2000 Apr;47(4 Pt 1):457–462. doi: 10.1203/00006450-200004000-00008. [DOI] [PubMed] [Google Scholar]
  16. Martin H., Hu J., Gennser G., Norman M. Impaired endothelial function and increased carotid stiffness in 9-year-old children with low birthweight. Circulation. 2000 Nov 28;102(22):2739–2744. doi: 10.1161/01.cir.102.22.2739. [DOI] [PubMed] [Google Scholar]
  17. Martyn C. N., Barker D. J., Jespersen S., Greenwald S., Osmond C., Berry C. Growth in utero, adult blood pressure, and arterial compliance. Br Heart J. 1995 Feb;73(2):116–121. doi: 10.1136/hrt.73.2.116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Martyn C. N., Gale C. R., Jespersen S., Sherriff S. B. Impaired fetal growth and atherosclerosis of carotid and peripheral arteries. Lancet. 1998 Jul 18;352(9123):173–178. doi: 10.1016/S0140-6736(97)10404-4. [DOI] [PubMed] [Google Scholar]
  19. Martyn C. N., Greenwald S. E. Impaired synthesis of elastin in walls of aorta and large conduit arteries during early development as an initiating event in pathogenesis of systemic hypertension. Lancet. 1997 Sep 27;350(9082):953–955. doi: 10.1016/s0140-6736(96)10508-0. [DOI] [PubMed] [Google Scholar]
  20. Newman D. L., Sipkema P., Greenwald S. E., Westerhof N. High frequency characteristics of the arterial system. J Biomech. 1986;19(10):817–824. doi: 10.1016/0021-9290(86)90132-6. [DOI] [PubMed] [Google Scholar]
  21. Rich-Edwards J. W., Stampfer M. J., Manson J. E., Rosner B., Hankinson S. E., Colditz G. A., Willett W. C., Hennekens C. H. Birth weight and risk of cardiovascular disease in a cohort of women followed up since 1976. BMJ. 1997 Aug 16;315(7105):396–400. doi: 10.1136/bmj.315.7105.396. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Safar M. E., Levy B. I., Laurent S., London G. M. Hypertension and the arterial system: clinical and therapeutic aspects. J Hypertens Suppl. 1990 Dec;8(7):S113–S119. [PubMed] [Google Scholar]
  23. Sinaiko A. R., Donahue R. P., Jacobs D. R., Jr, Prineas R. J. Relation of weight and rate of increase in weight during childhood and adolescence to body size, blood pressure, fasting insulin, and lipids in young adults. The Minneapolis Children's Blood Pressure Study. Circulation. 1999 Mar 23;99(11):1471–1476. doi: 10.1161/01.cir.99.11.1471. [DOI] [PubMed] [Google Scholar]
  24. Singhal A., Kattenhorn M., Cole T. J., Deanfield J., Lucas A. Preterm birth, vascular function, and risk factors for atherosclerosis. Lancet. 2001 Oct 6;358(9288):1159–1160. doi: 10.1016/S0140-6736(01)06276-6. [DOI] [PubMed] [Google Scholar]
  25. Smulyan H., Mookherjee S., Warner R. A. The effect of nitroglycerin on forearm arterial distensibility. Circulation. 1986 Jun;73(6):1264–1269. doi: 10.1161/01.cir.73.6.1264. [DOI] [PubMed] [Google Scholar]
  26. Woo J. S., Li D. F., Ma H. K. Intrauterine growth standards for Hong Kong Chinese. Aust N Z J Obstet Gynaecol. 1986 Feb;26(1):54–58. doi: 10.1111/j.1479-828x.1986.tb01529.x. [DOI] [PubMed] [Google Scholar]

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