Published Online
on August 18, 2003

A more recent version of this article appeared on August 26, 2003

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Submitted on December 31, 2002
Revised on April 10, 2003
Accepted on May 29, 2003

Preterm Birth Attenuates Association Between Low Birth Weight and Endothelial Dysfunction

Mikael Norman MD, PhD^* and Helena Martin MD, PhD

From the Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden.

^* To whom correspondence should be addressed. E-mail: mikael.norman{at}ks.se.

Background--Low birth weight predisposes to later coronary disease. To further elucidate the mechanisms behind this association and their timing, vascular endothelial function--a key factor in early pathophysiology of atherosclerosis--was studied in 54 infants born either before the third trimester or at term.

Methods and Results--All subjects were studied at 3 months of postnatal age. A laser-Doppler technique was used to measure skin perfusion before and after transdermal iontophoresis of acetylcholine (ACh; an endothelium-dependent vasodilator). In infants born at term (n=19; birth weight range: 2230 to 4205 g), maximum perfusion after ACh was 109±8 perfusion units (PU, mean±SEM) in normal-birth weight controls compared with 56±13 PU among those who had been small for gestational age at birth (P<0.01). In infants born preterm (n=35; birth weight range, 722 to 1868 g), ACh induced similar perfusion responses among subjects appropriate for gestational age (113±16 PU) and in those small for gestational age at birth (109±19 PU).

Conclusions--Impairment in human endothelial function associated with low birth weight occurs or emerges late in pregnancy. Very preterm birth attenuates this association. Different gene-environment interactions in the third trimester may contribute to this finding.

Key words: acetylcholine • coronary disease • endothelium • vasodilation

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