The following is a summary of “Early Life Determinants of Vascular Structure in Fetuses, Infants, Children, and Adolescents: A Systematic Review and Meta-Analysis,” published in the JANUARY 2023 issue of Pediatrics by Varley, et al.
For a study, researchers sought to examine the relationship between early life experiences throughout the first 1,000 days (from conception to age 24 months) and aortic intima-media thickness (aIMT), a precursor to the risk of cardiovascular disease (CVD), in children.
From the beginning until July 2021, the databases for Allied and Complementary Medicine, MEDLINE, Embase, Scopus, and CINAHL were searched. AIMT measures (unadjusted mean ±SD) and observational controlled studies in adolescents aged <20 years with risk factors/exposures within the first 1,000 days were required for eligibility. A random-effects meta-analysis was used to combine the outcome data. To look at confounders, meta-regression was employed.
There were 8,657 papers found in total, 34 of which were used in the meta-analysis. Participants’ ages ranged from 22.9 weeks gestation in utero to 10.9 years. The following factors were found to be associated with higher aIMT in the meta-analysis (n = 1,220 cases, n = 1,997 controls): small for gestational age (SGA) status (14 studies, mean difference, 0.082 mm; 95% CI, 0.051-0.112; P< .001; I2 = 97%), intrauterine growth restriction (6 studies, mean difference, 0.198 mm; 95% CI, 0.088-0.309; P< .001; I2 = 97%), preeclampsia (2 studies; mean difference, 0.038 mm; 95% CI, 0.024-0.051; P < .001; I2 = 38%), & large for gestational age (LGA) status (3 studies; mean difference, 0.089 mm; 95% CI, 0.043-0.0136; P < .001; I2 = 93%). In a meta-regression, preterm participants’ aIMT was significantly different from controls compared to older age (P< .001), higher prevalence of maternal smoking (P =.04), and SGA (P <.001). High levels of heterogeneity found in the majority of meta-analyses and the breadth of meta-regression were limitations.
Adverse early-life exposures were linked to higher aIMT in young people, which was consistent with an elevated risk for CVD in later life. Whether prevention and intervention measures improved cardiovascular health in the future, more research was required to verify this.
Reference: jpeds.com/article/S0022-3476(22)00769-7/fulltext
