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Premature Birth impacts hearts, into adulthood

Medical science has advanced to the point where we can save premature babies at only 32 weeks of gestation or less. Normally medical science considers 37-40 weeks of gestation to be a “normal” preganacy. At less than the 37 week mark the pregancy is considered premature. Did you know that the current rate of premi’s in the US is 1 in 10 births ? And it’s higher is those without good prenatal care and in lower socioeconomic groups.

However its not surprising that the lack of time to develope has a lifelong impact on the premi’s organs. This was specifically seen in the heart as reported in a new study published in JAMA  entitled, “Association Between Preterm Birth and Arrested Cardiac Growth in Adolescents and Young Adults”

We see a host of complications with premi’s including breathing problems, feeding difficulties, disorders such as cerebral palsy,  developmental delays   along with both vision and hearing losses.

WHY:

What’s the underlying factors for premature births. Let’s start by stating that often times we don’t know. There are contributing factors to consider such as:

Smoking: Being significantly overweight or underweight, before a pregnancy:

Not getting adaquate prenatal care:  Drinking alcohol or using street drugs during pregnancy:

Having health conditions, such as high blood pressure, preeclampsia, diabetes, blood clotting disorders, or infections:

Being pregnant with a baby that has certain birth defects: A pregnancy from in vitro fertilization:

Being pregnant with twins or other multiples: A family or personal history of premature labor:

Getting pregnant too soon after having a baby

With all of this in mind keep perspective that you can address many of the risk factors, let’s consider some options. And don’t forget to tell your health care provider if you or your family member was born prematurely.

 

      Take Aways:

       

      Pay more attention to good heart theraputics which should include:

  •      Never smoke
  •      Have an adequate vitamin K2 intake
  •      Avoid any heart damaging drug therapies,  See this list: CLINICAL UPDATES ON DRUG – INDUCED CARDIOTOXICITY
  •      Eat a diet low in saturated fats, preferably oriented towards a whole foods plant based approach (see Dean Ornish’s work),
  •      Exercise with a focus on aerobic conditioning,
    Consider an ultrasound examination periodically……

 Association Between Preterm Birth and Arrested Cardiac Growth in Adolescents and Young Adults

Kara N. Goss, MD1,2; Kristin Haraldsdottir, PhD1,3; Arij G. Beshish, PhD1; et al

Key Points

Question  What are the consequences of premature birth for later cardiac structure and function?

Findings  In this cardiac magnetic resonance imaging–based cross-sectional cohort study, adolescents (n = 20) and young adults (n = 38) born moderately to extremely preterm (≤32 weeks) demonstrated statistically significantly smaller biventricular cardiac chamber size and lower biventricular mass compared with 52 age-matched participants who were born at term. Cardiac function was preserved, with a hypercontractile strain pattern in adults.

Meaning  Adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size with preserved function, notably without a hypertrophic response, which may contribute to their increased lifetime cardiovascular risk.

Abstract

Importance  Premature birth is associated with substantially higher lifetime risk for cardiovascular disease, including arrhythmia, ischemic disease, and heart failure, although the underlying mechanisms are poorly understood.

Objective  To characterize cardiac structure and function in adolescents and young adults born preterm using cardiac magnetic resonance imaging (MRI).

Design, Setting, and Participants  This cross-sectional cohort study at an academic medical center included adolescents and young adults born moderately to extremely premature (20 in the adolescent cohort born from 2003 to 2004 and 38 in the young adult cohort born in the 1980s and 1990s) and 52 age-matched participants who were born at term and underwent cardiac MRI. The dates of analysis were February 2016 to October 2019.

Exposures  Premature birth (gestational age ≤32 weeks) or birth weight less than 1500 g.

Main Outcomes and Measures  Main study outcomes included MRI measures of biventricular volume, mass, and strain.

Results  Of 40 adolescents (24 [60%] girls), the mean (SD) age of participants in the term and preterm groups was 13.3 (0.7) years and 13.0 (0.7) years, respectively. Of 70 adults (43 [61%] women), the mean (SD) age of participants in the term and preterm groups was 25.4 (2.9) years and 26.5 (3.5) years, respectively. Participants from both age cohorts who were born prematurely had statistically significantly smaller biventricular cardiac chamber size compared with participants in the term group: the mean (SD) left ventricular end-diastolic volume index was 72 (7) vs 80 (9) and 80 (10) vs 92 (15) mL/m2 for adolescents and adults in the preterm group compared with age-matched participants in the term group, respectively (P < .001), and the mean (SD) left ventricular end-systolic volume index was 30 (4) vs 34 (6) and 32 (7) vs 38 (8) mL/m2, respectively (P < .001). Stroke volume index was also reduced in adolescent vs adult participants in the preterm group vs age-matched participants in the term group, with a mean (SD) of 42 (7) vs 46 (7) and 48 (7) vs 54 (9) mL/m2, respectively (P < .001), although biventricular ejection fractions were preserved. Biventricular mass was statistically significantly lower in adolescents and adults born preterm: the mean (SD) left ventricular mass index was 39.6 (5.9) vs 44.4 (7.5) and 40.7 (7.3) vs 49.8 (14.0), respectively (P < .001). Cardiac strain analyses demonstrated a hypercontractile heart, primarily in the right ventricle, in adults born prematurely.

Conclusions and Relevance  In this cross-sectional study, adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size and decreased cardiac mass. Although function was preserved in both age groups, these morphologic differences may be associated with elevated lifetime cardiovascular disease risk after premature birth.