Extreme Preterm Infants at Risk for Early Age High Blood Pressure

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Maternal gestational diabetes may also influence the likelihood of high blood pressure developing in young children.
Maternal gestational diabetes may also influence the likelihood of high blood pressure developing in young children.

Children at ages 6 to 7 years who were born extremely preterm had a higher risk for high blood pressure (BP; ≥90th percentile) and hypertension (BP ≥95th percentile), according to the results of a study published in Pediatrics.

BP measurements and anthropometrics of children who were born extreme preterm in the Eunice Kennedy Shriver National Institutes of Child Health and Human Development Neonatal Research Network SUPPORT Neuroimaging Cohort were recorded. The primary objective was to assess BP and determine rates of high BP and hypertension in children at ages 6 to 7 years. Secondary objectives were the assessment of the relationship between other risk factors such as insurance type and weight gain velocities on BP.

Of the 379 participants, 20.6% had high systolic BP, 10.8% had systolic hypertension, 21.4% had high diastolic BP, and 11.4% had diastolic hypertension. For the entire cohort, the mean systolic BP was 101±9 mm Hg and the mean diastolic BP was 63±8 mm Hg. For the secondary objectives, it was found that children of mothers with gestational diabetes were more likely to have high BP. No additional characteristics, including birth weight, weight gain velocities, or abnormal magnetic resonance imaging or cranial ultrasound findings, were associated with BP.

In addition, children who had systolic BP ≥90th percentile were more likely to be overweight (body mass index ≥85th percentile). In children with higher body mass index, 29% had systolic BP and 26% had diastolic BP ≥90th percentile. Of note, in children with BP ≥90th percentile, boys were more likely than girls to have high systolic and diastolic BP (59% vs 41% and 43% vs 25%, respectively).

The study authors wrote, “These findings sound the alarm for long-term surveillance and management of BP of former [preterm] infants by both pediatricians and internists.”

They also noted “a possible genetic contribution” related to the association between maternal gestational diabetes and child BP, which has been demonstrated in twin studies, “or an environmental contribution as maternal diabetes affecting the intrauterine environment.”

Reference

Vohr BR, Heyne R, Bann C, Das A, Higgins RD, Hintz SR, for the Eunice Kennedy Shriver National Institute of Child Health, Development Neonatal Research Network. High blood pressure at early school age among extreme preterms. Pediatrics. 2018;142(2).

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