Abstract P144: Being Born Small for Gestational Age and Later Cardiac Structure and Function in Adolescence
Background: Evidence suggests that impaired fetal growth is associated with increased risks of ischemic heart disease, atrial fibrillation, and stroke. Less is known about the potential association between low birth weight (small for gestational age; SGA) and cardiac structure and function later in life.
Methods: 1,592 participants (54% females) from a UK birth cohort were examined with echocardiography at mean age 17.7 years (SD 0.3). Using regression models we investigated the association between being born SGA and adolescent cardiac structure and function; left ventricular mass indexed to height2.7 (LVMI), relative wall thickness (RWT), left atrial size indexed to height2.7, ejection fraction, s’, and E/e’. Birth weight Z-score (by gestational week and sex) was defined according to an external reference based on UK data from the same time period as the births of the participants. SGA was defined as Z-score ≤5th percentile. Birth weight was also analyzed using linear splines with predefined knots at the 5th, 50th and 95th percentile to allow for potential non-linearity in associations. Main models were adjusted for age, sex and several maternal factors: height, pre-pregnancy BMI, gestational diabetes, gestational week at birth, hypertensive disorders of pregnancy, smoking, and education.
Results: Adolescents born SGA had smaller LVMI (-2.12 g/m2.7; 95% Confidence Interval (CI) -3.69 to -0.55). SGA was also associated with greater mean ejection fraction (2.24, 95% CI 0.62 to 3.87) compared to non-SGA adolescents. In the linear spline analyses, we observed a positive increase in LVMI per one unit increase in birth weight Z-score among those born SGA (3.56 g/m2.7, 95% CI 0.95 to 6.17) and a negative change of slope in the next interval (birth weight between 5th and 50th percentile, p=0.02). There was no support for any associations between SGA, including the spline analyses, and the other outcomes (RWT, left atrial size indexed to height2.7, s’, and E/e’). The association between SGA and left ventricular mass was evident also without indexing for body size, and when indexing by body surface area or (height in m)1.6.
Conclusion: Being born SGA appears to be associated with certain aspects of cardiac structure and function in adolescence, which later in life predict the development of clinical heart disease. Smaller left ventricular mass in adolescence might predispose those born SGA to be more susceptible to adverse cardiac remodeling later in life.
Author Disclosures: S. Timpka: None. A.D. Hughes: None. N. Chaturvedi: None. P.W. Franks: None. D.A. Lawlor: None. A. Fraser: None.
- © 2017 by American Heart Association, Inc.