Exercise capacity reduced in young adults born small for gestational age
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A cohort of young adults born small for gestational age demonstrated marked reductions in exercise capacity compared with a control group in a new study.
Fatima Crispi, MD, PhD, of the Universitat de Barcelona in Spain, and colleagues wrote that a child being born small for gestational age (SGA) occurs in approximately 10% of births and is associated with increased risk for CV mortality in adulthood, although mechanistic pathways remain unclear. This led the team to assess baseline cardiac function and structure, and exercise capacity in young adults born SGA.
The cohort study was conducted from January 2015 to January 2018 and included a perinatal cohort born at a tertiary university hospital in Spain from 1975 to 1995. The researchers randomly chose 158 young adults (aged 20 to 40 years) who were either born SGA — a birth weight below the 10th percentile — or with intrauterine growth within standard reference ranges, defined as the control arm.
The main outcomes were cardiac structure and function as assessed by cardiac MRI, including biventricular end-diastolic shape analysis, and exercise capacity as determined by incremental exercise stress testing.
Overall, the study involved 81 adults born SGA (median age at study, 34 years; 53% women) and 77 control participants (median age at study, 34 years; 43% women). All patients were white adults and underwent imaging, with 80% completing the exercise test.
According to cardiac shape analysis, those born SGA displayed minor changes at rest in right ventricular geometry (P = .02) with preserved cardiac function. Exercise capacity was reduced for adults born SGA, including decreased maximal workload (mean, 180 W vs. 214 W; P = .006) and oxygen consumption (median, 26 mL/min/kg vs. 29.5 mL/min/kg; P = .02). Additionally, exercise capacity correlated with LV mass in analysis both adjusted for age, sex and body surface area (P = .046), and unadjusted for those variables (P < .001).
If confirmed in future studies, Crispi and colleagues wrote, the findings would open new opportunities for disease prevention.
“The implications for public health are important because growth-restricted SGA affects 10% of the population,” they added. “Individuals born SGA can be easily detected by a clinician conducting a routine clinical history. Defining adults born SGA as a high-risk population may enable personalized information and intervention strategies, with a potential for reducing morbidity.”
Although the association of SGA with the adult CV mortality rate is not likely huge, ranging from 1% to 25%, “a conservative estimate of 5% attributed risk and 30% improvement may result in reductions of 12,000 deaths annually in the U.S.,” they wrote.
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