Fetal Growth and Preterm Birth Influence Cardiovascular Risk Factors and Arterial Health in Young Adults

Abstract

Objective— Impaired fetal growth is associated with cardiovascular disease in adulthood. The mechanisms of this association remain poorly described. We aimed to determine the associations of impaired fetal growth and preterm birth with cardiovascular risk factors and arterial health in a large cohort of young adults. Methods and Results— Carotid intima-media thickness, brachial flow-mediated dilatation and cardiovascular risk factors were compared between young adults (24–45 years) born at term with impaired fetal growth (birth weight <10th percentile; n=207), born preterm (<37 weeks' gestation; n=253), and a control group born at term with normal fetal growth (birth weight 50–90th percentile; n=835), in the Cardiovascular Risk in Young Finns study. Compared with controls, those with impaired fetal growth had elevated triglycerides ( P =0.006), C-reactive protein ( P =0.004), low-density lipoprotein cholesterol, systolic blood pressure (both P =0.06), and intima-media thickness and impaired flow-mediated dilatation (both P =0.02), the latter partially mediated by systolic blood pressure, C-reactive protein, and triglycerides. Those born preterm had higher intima-media thickness ( P =0.005) and lower flow-mediated dilatation ( P =0.03) compared with controls, although this was restricted to those with concurrent fetal growth restriction. Conclusion— Impaired fetal growth is associated with impaired endothelial function and elevated preclinical atherosclerosis in young adults, partly mediated by inflammation, blood pressure, and triglycerides. This association is most marked for those also born preterm.