Title:Preterm Birth: Long Term Cardiovascular and Renal Consequences
VOLUME: 14 ISSUE: 4
Author(s):Hassib Chehade, Umberto Simeoni*, Jean-Pierre Guignard and Farid Boubred
Affiliation:Division of Pediatrics and DOHaD Lab, CHUV-UNIL, Lausanne, CH, Division of Pediatrics and DOHaD Lab, CHUV-UNIL, Lausanne, CH, University of Lausanne, CH, Lausanne, Medecine Neonatale, Hopital La Conception, APHM, Aix-Marseille Universite, Marseille
Keywords:Preterm infant, small for gestational age, preeclampsia, antenatal glucocorticoids, nephron number, hypertension,
cardiovascular disease, chronic kidney disease, DOHaD, programming, noncommunicable diseases, adult.
Abstract:Background: Cardiovascular and chronic kidney diseases are a part of noncommunicable
chronic diseases, the leading causes of premature death worldwide. They are recognized
as having early origins through altered developmental programming, due to adverse environmental
conditions during development. Preterm birth is such an adverse factor. Rates of preterm
birth increased in the last decades, however, with the improvement in perinatal and neonatal care, a
growing number of preterm born subjects has now entered adulthood. Clinical and experimental
evidence suggests that preterm birth is associated with impaired or arrested structural or functional
development of key organs/systems making preterm infants vulnerable to cardiovascular and
chronic renal diseases at adulthood. This review analyzes the evidence of such cardiovascular and
renal changes, the role of perinatal and neonatal factors such as antenatal steroids and potential
pathogenic mechanisms, including developmental programming and epigenetic alterations.
Conclusion: Preterm born subjects are exposed to a significantly increased risk for altered cardiovascular
and renal functions at young adulthood. Adequate, specific follow-up measures remain to
be determined. While antenatal steroids have considerably improved preterm birth outcomes, repeated
therapy should be considered with caution, as antenatal steroids induce long-term cardiovascular
and metabolic alterations in animals’ models and their involvement in the accelerated cellular
senescence observed in human studies cannot be excluded.
