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www.jped.com.br

ORIGINAL

ARTICLE

Growth

of

preterm

low

birth

weight

infants

until

24

months

corrected

age:

effect

of

maternal

hypertension

Alice

M.

Kiy

a,∗

,

Ligia

M.S.S.

Rugolo

b

,

Ana

K.C.

De

Luca

a

,

José

E.

Corrente

c

a

NeonatalUnit,HospitaldasClínicas,FaculdadedeMedicinadeBotucatu,UniversidadeEstadualPaulista(UNESP), Botucatu,SP,Brazil

bDepartmentofPediatrics,FaculdadedeMedicinadeBotucatu,UniversidadeEstadualPaulista(UNESP),Botucatu,SP,Brazil c

InstitutodeBiociênciasdeBotucatu,UniversidadeEstadualPaulista(UNESP),Botucatu,SP,Brazil

Received26June2014;accepted25July2014 Availableonline26November2014

KEYWORDS

Child;

Lowbirthweight; Premature; Maternal hypertension; Growth

Abstract

Objective: Toevaluatethegrowthpatternoflowbirthweightpreterminfantsbornto hyper-tensivemothers,theoccurrenceofgrowthdisorders,andriskfactorsforinadequategrowthat 24monthsofcorrectedage(CA).

Methods: Cohortstudyofpretermlowbirthweightinfantsfolloweduntil24monthsCA,ina universityhospitalbetweenJanuary 2009andDecember 2010.Inclusioncriteria:gestational age<37weeksandbirthweightof1,500-2,499g.Exclusioncriteria:multiplepregnancies,major congenitalanomalies,andlosstofollowupinthe2ndyearoflife.Thefollowingwereevaluated: weight,length,andBMI.Outcomes:growthfailureandriskofoverweightat0,12,and24months CA.Student’st-test,RepeatedmeasuresANOVA(RM-ANOVA),andmultiplelogisticregression wereused.

Results: Atotalof80pretermlowbirthweightinfantsborntohypertensivemothersand101 borntonormotensivemotherswerestudied.Therewasahigherriskofoverweightinchildren ofhypertensivemothersat24months;however,maternalhypertensionwasnotariskfactor forinadequategrowth. Logisticregressionshowedthatbeingbornsmallforgestationalage andinadequategrowthinthefirst12monthsoflifewereassociatedwithpoorergrowthat24 months.

Conclusion: Pretermlowbirthweightborninfantstohypertensivemothershaveanincreased riskofoverweightat24monthsCA.Beingbornsmallforgestationalageandinadequategrowth inthe1styearoflifeareriskfactorsforgrowthdisordersat24monthsCA.

©2014SociedadeBrasileiradePediatria.PublishedbyElsevierEditoraLtda.Allrightsreserved.

Pleasecitethisarticleas:KiyAM,RugoloLM,LucaAK,CorrenteJE.Growthofpretermlowbirthweightinfantsuntil24monthscorrected

age:effectofmaternalhypertension.JPediatr(RioJ).2015;91:256---62.

Correspondingauthor.

E-mail:alicekiy@zipmail.com.br(A.M.Kiy).

http://dx.doi.org/10.1016/j.jped.2014.07.008

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PALAVRAS-CHAVE

Crianc¸a;

Baixopesoaonascer; Prematuro;

Hipertensãomaterna; Crescimento

Crescimentodeprematurosdebaixopesoatéaidadede24mesescorrigidos:efeito dahipertensãomaterna

Resumo

Objetivo: Avaliar opadrão de crescimento de prematuros de baixopeso nascidosde mães hipertensas,aocorrênciadedistúrbiosdecrescimentoeosfatoresderiscoparainadequado crescimentoaos24mesesdeidadecorrigida(IC).

Métodos: Estudodecoortedeprematurosdebaixopesoacompanhadosaté24mesesIC,em um HospitalUniversitário,entreJaneiro2009eDezembro2010.Critériosdeinclusão:idade gestacional<37semanasepesodenascimentode1500-2499g.Excluídas:gestac¸õesmúltiplas, anomaliascongênitasmaioreseperdadeseguimentonosegundoanodevida.Foramavaliados: peso,comprimentoeIMC.Desfechos:falhadecrescimentoeriscodesobrepesocom0,12e 24mesesdeIC.TestetStudent,X2,ANOVA-RMeregressãologísticamúltiplaforamusados.

Resultados: Foramestudados80prematurosdebaixopesonascidosdemãeshipertensase101 demãesnormotensas.Houvemaiorriscodesobrepesoemcrianc¸asdemãeshipertensasaos24 meses,entretantoahipertensãomaternanãofoifatorderiscoparainadequadocrescimento. A regressão logística mostrouque nascerpequenopara idade gestacional eter inadequado crescimentonosprimeiros12mesesdevidaassociaram-secompiorcrescimentoaos24meses.

Conclusão: Prematurosdebaixopesonascidosdemãeshipertensastêmriscoaumentadode sobrepesoaos24mesesdeIC.Serpequenoparaidadegestacionaleterinadequadocrescimento noprimeiroanosãofatoresderiscoparadistúrbiosnocrescimentoaos24mesesdeIC. ©2014SociedadeBrasileiradePediatria.PublicadoporElsevierEditoraLtda.Todososdireitos reservados.

Introduction

Amongthecausesofprematurity,hypertensivedisorderof pregnancyisoneofthemostimportant,affecting5%to10% ofpregnanciesanddemonstratinganincreasingincidencein developingcountries.1,2Thisdiseaseisanimportantcause

of maternal and fetalmortality andmorbidity, aswell as oneofthemainmedicalindicationsofpretermbirth,often associatedwithfetalgrowthrestriction.1,3

Preterminfantsbornsmallforgestationalage(SGA)due tointrauterinegrowthrestrictionareathigherriskof neona-talmorbimortalityandgrowthanddevelopmentdisorders, whencomparedwiththosebornwithadequate weightfor gestationalage(AGA).4,5Anotherpointofconcernregarding

theconsequencesofprematurityorlowbirthweightinthe long-termisthatinadequategrowthduringthefetalperiod andin theearlyyearsof lifeincreasestherisk ofchronic diseases such ashypertension, myocardial infarction, and diabetesinadulthood.6

Therearescarceandcontradictorystudiesonthe prog-nosis of infants born to hypertensive mothers. There is evidence that exposure to oxidative stress in utero, trig-geredbymaternalhypertensivedisease,hasimplicationsin thepathogenesisofseveraldiseasesofpreterminfants,3and

isassociatedwithhigherneonatalmorbimortality,although ithasnotbeenestablishedwhethertheworseprognosisof thesepreterminfantsisduetomaternaldiseaseordegreeof prematurity.3,7However,somestudiesfoundnodifferences

in the prognosis of preterm infants born to hypertensive mothers8,9 and othershave suggestedthat stress in utero

triggeredbyhypertensioncanacceleratethematurationof organsandimprovetheprognosisofthesepreterminfants.10

Arecent study showedthat most preterminfants born to

motherswithseverehypertensionsyndromehave intrauter-inegrowthrestrictionandachievecomplete‘‘catchup’’in thefirst4years,butatthatage,thesechildrenaresmaller andthinnercomparedtothepopulationmean.11

The scarcity and the lack of consensus of studies on the prognosis of prematureinfants born to mothers with gestational hypertension syndrome justify the need for surveillance of neonatal complications, and follow-up of theseinfants,forbetterunderstandingtheimpactof mater-naldiseaseongrowthanddevelopment.

This studyaimedtoanalyzethe growthpatternof low birth-weightpreterminfantsborntohypertensivemothers, aswellasevaluatetheoccurrenceofgrowthdisordersand riskfactorsforinadequategrowthat 24monthscorrected age(CA).

Methods

This was a prospective cohort study of low birth weight preterm infants admitted to the Neonatal Care Unit and followed during the first 2 years of life at the Low Birth Weight InfantOutpatient Clinicof Faculdade de Medicina deBotucatu-UNESP,fromJanuaryof2009 toDecemberof 2010.

ThestudywasapprovedbytheResearchEthics Commit-teeoftheinstitution.Maternalandneonataldataofinterest wereobtainedfrommedicalrecordsatthefirstoutpatient routineconsultation, after obtaining the signed informed consent.

Aconveniencesamplewasstudied,correspondingtothe totalnumberofpatientswhomettheinclusioncriteria dur-ingatwo-yearenrollmentperiod,acceptingamaximumloss of20%ofthecohort.

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IntheLow BirthWeight InfantOutpatientClinic, start-ingin Januaryof2009,allpreterminfantsyoungerthan1 yearwereselectedonthedayofconsultationandincluded inthestudy,whentheymetthefollowingcriteria:bornin the Clinic’s maternity ward, single gestation, gestational age<37 weeks, birth weight between 1,500 and 2,499g, without multiple congenital anomalies and no congenital infection,andwhohad atleastthreeconsultationsinthe 1styearoflife.Lackoffollow-upinthe2ndyearoflifewas consideredasaloss.

Thestudyvariablesincluded:maternal data(age,level ofschooling,height, andsmokingstatus);pregnancydata (hypertensivedisorderofpregnancy,regardlessofthetype andseverityofthedisease,diabetesmellitus;intrauterine growth restriction, preterm premature rupture of mem-branes,fetaldistress,andtypeofdelivery);neonataldata (gestationalageaccording tothebestobstetric estimate, birth weight and AGA according to Alexander et al.,12

gender,Apgarscoreat1and5minutesafterbirth, neona-tal morbidity,and length of hospitalstay). After hospital discharge,thefollowingvariableswereconsidered: breast-feedinginthe1styearoflife;hospitalizationinthefirst2 years,anthropometricmeasurements(weightandlength), andbodymassindex.

Anthropometric measurements were obtained at each visit by the previously trained medical and nursing staff of the service. Patients were weighed on a digital scale (Filizzola®,SP,Brazil)forchildren,withanaccuracyof5g. Lengthwasmeasuredinthesupineposition,usingawooden stadiometerorinthestandingposition,usingarulerin mil-limeters.

CAwasusedforall preterminfants inthefirst2 years oflife,andanthropometricmeasurementswereevaluated bycalculating theZ-score tofollow growth,as classically donein theliterature. Growthassessment wasperformed byquartersinthe1styearandeverysixmonthsinthe2nd year of life, considering the consultation that wascloser tothe expecteddateof assessment,namely: 40weeks,3 months,6months,9months,12months,18months,and24 monthsCA.

Based on whether or not the cohort was exposed to gestational hypertension syndrome, the study groups wereformed:preterminfantsofhypertensivemothersand preterminfantsofnormotensivemothers.Theoutcomesof interestwere:growthfailureorriskofoverweightat12and 24monthsofage,accordingtothegrowthcurveoftheWorld HealthOrganization(WHO;2006).13

Definitionsusedinthestudy:

- Gestational hypertensive syndrome: blood pressure 140/90mmHgorhigher,ontwooccasions,withaninterval ≥4hours,accordingtothecriteriaoftheReportofthe NationalHighBloodPressureEducationProgramWorking Group onHighBloodPressure in Pregnancy.14

Hyperten-siondiagnosedafterthe20thweekofgestationassociated withproteinuria(>300mgin24-hoururine)characterized pre-eclampsia.

- SGA:birthweight<10thpercentile,accordingto Alexan-deretal.12

- Growthfailure:weightorlengthbelowthe3rdpercentile ontheWHOcurve(2006).13

- Thinness:BMI≥0.1percentileand<3rdpercentileonthe WHOcurve(2006).13

- Riskofoverweight:BMI>85thpercentileand≤97th per-centileaccordingtotheWHOcurve(2006).13

Statisticalanalysis

Dataweredescribedbycalculatingthedistributionof fre-quencies, means and standard deviations, medians, and percentiles.Associationsbetweennumericalvariableswere assessedbyStudent’st-testortheMann-Whitneytestwhen indicated,andthechi-squaredtestwasusedforcategorical variables.

RM-ANOVAfollowedbyTukey’stestwasusedformultiple comparisonsbetweengroups, andthechi-squaredtestfor trendwasusedtoassesschange ofproportionsovertime, withthesamplestratifiedaccordingtomaternal hyperten-sionandadequacyofbirthweightforgestationalage.

The outcomes of interest were analyzed by logistic regression for repeated measures. SAS software for Win-dows,release9.2(SASInstituteInc,NC,USA),wasusedin thestatisticalanalysesandthesignificancelevelwassetat 5%.

Results

From January 2009 to December 2010, 241 premature

infants eligible for the study were born in the Maternity WardofHospitaldasClínicasdaFaculdadedeMedicinade Botucatu-UNESP.Amongthese,therewerethreein-hospital deathsand238werereferredforfollow-upattheLowBirth WeightInfantOutpatientClinic,butinfourcasesthe consul-tation wasnotscheduled (2%).Thus, 234eligiblepreterm infantswereenrolledinthestudy,but40ofthesepreterm infants were twins, and 13 had malformations and were excluded. Therefore,thecohortconsisted of181 preterm infants,101borntonormotensivemothersand80to hyper-tensivemothers,ofwhom63(80%)hadpre-eclampsia.

Atthe end ofthe firstyear of life,69 preterminfants of hypertensive mothers (86%) and 84 preterm infants of normotensivemothers(83%)wereevaluated.At24months, 149preterminfantswereevaluated,withalossofcohortof 15%inthehypertensivegroupand20%inthenormotensive group.Therewerenodifferencesintheneonatal character-isticsofpreterminfantsfollowedupto24monthscompared tothosewhowerelosttofollow-up,exceptforgestational age,whichwaslowerinthelostcohortofthenormotensive group (32±2weeksvs. 33±2weeks inthe othergroups, p=0.035).

Mean maternal age was 25-26 years, meanheight was 1.59m,and40%ofthemothershadonlyelementary educa-tion,withnodifferencebetweengroups.Prematurerupture ofmembraneswasmorefrequentinthenormotensivegroup (41%vs.2.5%,p<0.001),whereascesareandelivery predom-inatedinthehypertensivegroup(82%vs.40%,p<0.001).

Table 1 shows the main neonatal characteristics. This table highlights the high percentage of infants born SGA in the two groups of preterm infants, and also the high frequency of breastfeeding at discharge, with exclusive breastfeeding more frequent in the normotensive group (p=0.033).

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Table1 Neonatalcharacteristicsofpretermlowbirthweightinfantsinhypertensiveandnormotensivemothers.

Neonatalvariables Hypertensive(n=80) Normotensive(n=101) p-value

Gestationalage(weeks)±SD 33±1.9 33±2 0.437

Birthweight(g)±SD 1,754±303 1,839±301 0.061

Length(cm)±SD 41.5±2.4 42.2±2.4 0.087

Headcircumference(cm)±SD 30.2±1.8 30.1±1.8 0.572

Smallforgestationalage 51% 40% 0.157

EBFatdischarge 54% 69% 0.033

Mixedfeedingatdischarge 22.5% 21% 0.782

Daysofhospitalization(mdQ1-Q3) 15(9.5-23) 13(7-23) 0.769

SD,standarddeviation;md,median;Q,quartile;EBF,exclusivebreastfeeding.

0 –0.5 –1 –1.5 –2 –2.5 –3 0 3 6 12 24 W eight Z-scores

Corrected age (months)

P=.118 P=.456 P=.456 P=.333 P=.302 Hypertensive Normotensive

Figure1 EvolutionoftheweightZ-scoresinpreterminfants of normotensive and hypertensive mothers up to 24 months correctedage.

Attheoutpatientfollow-upduringthefirst2yearsoflife, few preterm infantsrequired hospitalization (2%)and the incidenceofcomplicationswaslowinbothgroups;themost commonproblemwasanemia,diagnosedin8%ofpatients, withnodifferencebetweengroups.Thefeedingpatternof thepreterm infants,monitored bythemedicalteamwith supportfromanutritionist,wassatisfactoryinthe1styear oflife,withhighratesofexclusiveorpredominant breast-feeding(two-thirdsofthesampleinthetwogroups)inthe first6monthsoflife.Themediandurationofbreastfeeding was6.5(3-12)monthsforpreterminfantsbornto hyperten-sivemothersand6(3to11.5)monthsinthenormotensive group.

Inbothgroupsofpreterminfants,thecurvesofZ-scores forweightandlengthweresuperimposedinthefirst2years oflife(Figs.1and2).

Table 2shows the meanvalues ofZ scores for weight, height, and BMI, and the frequency of growth disorders at term, with12 and 24months CA. This table highlights the higher percentage of preterm infants born to hyper-tensivemotherswithBMI>85thpercentileat24monthsCA (Table2).

To determine whether gestational hypertension syn-drome is a risk factor for growth disorders in low birth weight preterm infants, logistic regression models were constructed, controlled for gestational age and gender,

0 –0.5 –1 –1.5 –2 –2.5 –3 0 3 6 12 24 Length Z-scores Hypertensive Normotensive

Corrected age (months)

P=.099

P=.563 P=.584

P=.406 P=.681

Figure2 EvolutionoflengthZ-scoresinpreterm infantsof normotensiveandhypertensivemothers upto24months cor-rectedage.

includingmaternalhypertension,adequacyofbirthweight forgestationalage,andeffectof timeonanthropometric measurements.

Logistic regression showed that maternal hypertension was not a risk factor for inadequate growth in weight (OR=0.47,95%CI:-0.10-1.05)andlength(OR=0.20,95%CI: -0.29-0.69)at24monthsCA.Tworiskfactorsforgrowth dis-orderswereidentifiedat24monthsCA:SGAandinadequate growthinthe1styearoflife.

SGAincreasedtheriskofinadequateweightby approx-imatelytwo-fold (OR=2.36,95% CI:1:34-4.14)andlength (OR=2.13, 95% CI: 1.30-3.50). Inadequate weight gain at 3 months (OR=5.89, 95% CI: 3.07-11.30), at 6 months (OR=2.95,95%CI:1.61-5.45),andat12months(OR=2.45, 95%CI:1.45-4.18)showedinfluenceonweightat24months

CA, whereas inadequate growth in length at 3 months

(OR=7.12,95%CI:3.80-13.35)andat6months(OR=2.78, 95%CI;1:45-5.35)wasariskfactor forinadequatestature at24monthsCA.

Discussion

Themain resultsofthisstudy indicateahigherfrequency ofgrowthdisordersinlowbirthweightpreterminfantsborn tohypertensivemothers,buttheeffectofmaternaldisease

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Table2 MeanvaluesofZ-scoresforweight,length,andbodymassindex(BMI)andfrequencyofgrowthdisordersatterm,12 months,and24monthscorrectedageinthegroupsofhypertensiveandnormotensivemothers.

Correctedage Variable Pretermofhypertensive

mother Pretermofnormotensive mother p-value Atterm(n=153) H=69;N=84 Zweight −2.12±1.61 −2.53±1.55 0.118 Weight<p5 27% 34% 0.452 Zlength 2.37±1.59 2.83±1.65 0.099 Length<p5 26% 28% 0.932 ZBMI −1.10±1.46 −1.60±1.45 0.046 BMI>p85 22% 14% 0.237 At12months(n=153) H=69;N=84 Zweight −0.02±1.15 −0.22±1.23 0.302 Weight<p5 7% 9.5% 0.833 Zlength 0.16±1.30 0.34±1.32 0.406 Length<p5 13.5% 18% 0.607 ZBMI 0.10±1.02 0.03±1.18 0.454 BMI>p85 15% 15.5% 0.962 At24months(n=149) H=68;N=81 Zweight −0.06±1.03 −0.23±1.06 0.333 Weight<p5 6% 4% 0.866 Zlength −0.34±1.20 −0.26±1.10 0.681 Length<p5 17.5% 12% 0.448 ZBMI 0.23±1.03 0.12±1.02 0.044 BMI>p85 27% 12% 0.029 H,hypertensive;N,normotensive.

wasindirect,withinadequatefetalgrowthandgrowth fail-ureinthefirstyearofliferepresentingtheriskfactorsfor theoccurrenceofgrowthdisordersat24monthsCA.

In the present study, the growth profiles of preterm infantsofnormotensiveandhypertensivemotherswere sim-ilarinthefirst2yearsoflifeandfoundtobesatisfactory accordingtotheWHOstandards.Itmustbeconsideredthat thesepreterminfants’birthweightwasbetween1,500and 2,499g,constitutingascarcelystudiedgroupwhose progno-sisforgrowthisnotwellestablished.Animportantfactthat mayhavepositivelyinfluencedtheresultswasthehighrate ofbreastfeedingathospitaldischarge,withameanduration ofbreastfeedingof6monthsinbothgroups.Theliterature highlightstheimportanceofbreastfeedingforpretermlow birth weightinfants, which results in a better pattern of growthanddevelopmentforthesechildren.15

The study sample was homogeneous regarding gesta-tionalageandbirthweight,andmaybeconsideredoflow neonatalrisk,exceptforthehighpercentageofSGApreterm infants in both groups (51% and 40% in the hypertensive andnormotensive groups, respectively).These figures are found in tertiary care services, with incidence reported in the literature of approximately 15-50% SGA newborns in pregnancies complicated by hypertension.1,16 Impaired

fetalgrowthisexpectedespeciallyinpre-eclampsiadueto the physiopathology of the disease, which involves alter-ations in placental blood flow.2 A study of pregnancies

under 34 weeks complicated by hypertensive syndrome demonstrated that alteration in the umbilical artery DopplervelocimentryincreasestheincidenceofSGAinfants by2.5-fold.17

Thegrowthprognosisforpreterminfantsbornto hyper-tensive mothers has been poorly studied and the results are controversial. Silveira et al.18 evaluated 40 very low

birth weight preterm infants born to mothers with pre-eclampsiaand46borntonormotensivemothers,andshowed that at 12 and 18 months CA, the preterm infants of mothers with pre-eclampsia showed no catch-up weight, whereasgrowthinheightandhead circumferencedidnot differ betweengroups. The authors attributedthe failure to thrive to the high percentage of SGA preterm infants in thepre-eclampsiagroup (62%vs.39% inthe normoten-sivegroup).Arecentstudyassessedthegrowthofpreterm infants born tomothers withhypertensive syndrome who hadfetalgrowthrestrictionandshowedgoodprognosisfor growthinstature,withcatch-upin94%ofchildren,although the children became thinner during the first 5 years of life.11

Postnatalgrowthrestrictionisaveryfrequent eventin verylowbirthweightpreterminfantsandthoseadmittedat theneonatalICU,whomostlydemonstrateretardedgrowth, withdecreasedZ-scoresforweightandlengthbetweenbirth and40 weeksCA.19,20 Consistentwiththis expectation,in

thisstudymorethanone-quarterofthesamplehadweight belowthe5thpercentilewhentheyreachedterm,butatthe endofthe1styearoflife,weightwashigherthanthe5th percentileinmorethan90%ofpreterminfantsinthetwo groups. Similar developments occurred in height growth. These resultsareinagreementwithliteraturedata show-ingthatmostpreterminfantsexperiencecatch-upgrowth, reachingtheirpercentisbetweenthelimitsofnormalityon referencecurvesby2-3yearsofage.21

Byanalyzing theevolutionof BMI,animportantaspect was demonstrated at 24 months; there wasan increased riskofoverweightinpreterminfantsofhypertensive moth-ers.Thereisnodataintheliteraturetojustifythisresult; therefore,theauthors’hypothesisisthatthisfindingcould reflect excessivecatch-up, which maybe associatedwith

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futurecomplications,includingobesityinchildhood, adoles-cence,andadulthood,aswellasincreasedriskofmetabolic syndrome.22,23 It is suggested that maternal hypertension

mayhaveanimpactongrowthinprematureinfants,which occursinthemediumorlongterm,andwarnsoftheneed forprolongedfollow-upofthesechildren.Morestudiesare neededtoconfirmthesefindings.

As there wasahigher risk of overweightin the hyper-tensivegroup,maternalhypertensionwasinvestigatedasa riskfactorforgrowthdisordersat24monthsofCAbylogistic regression.However,inthisanalysis,maternalhypertension wasnotanindependentriskfactorforgrowthdisordersin bothweightandheight.TheidentifiedriskfactorswereSGA andinadequategrowthinthefirstyear,especiallyinthefirst semesteroflife.

Thisstudyhassomelimitations,astheseverityof mater-nalhypertensivediseasewasnotassessedandthefollow-up timewaslimitedtothefirst2yearsof life.However,the studysamplewashomogeneous,thelossofthecohortwas acceptable(≤20%),andtheresultsbroughtnewknowledge onthegrowthofpreterminfantswithbirthweightbetween 1,500-2,499g.

The lack of effect of maternal hypertension on the preterm infant growth can be partly attributed to the fact that maternal disease severity was not evaluated. Nonetheless,thisstudyreinforcestwoissuesthathavebeen highlighted in theliterature: the directinfluence of fetal growthonpostnatalgrowthandtheimportanceoftheearly yearsoflife,acriticalperiodfortheoccurrenceofcatch-up growthinpreterminfants.21

Kelleher et al.24 documented an incidence of 20% of

growthfailureinlowbirthweightpreterminfantsfollowed untilage3yearsandidentifiedSGAasanindependentrisk factorforgrowthfailure.

The mostimportantresults ofthisstudyarerelatedto the lack of differences in the growth of preterm infants of normotensive and hypertensive mothers in the first 2 yearsof life; however,at 24 months,the preterminfants ofhypertensivemothersshowedhigherfrequencyof over-weight,which cantranslateasalate-manifestationeffect of maternal disease. These data indicate the importance offollow-upofpreterminfantsofhypertensivemothersin the long term, as excess adiposity in early life can later developintometabolicsyndrome,withnegativeeffectson adulthealth.22,25

Inconclusion,pretermlow birthweightinfants bornto hypertensivemothershaveanincreasedriskofoverweight at24monthsofCA.SGAandinadequategrowthinthefirst year arerisk factorsfor growthdisordersat 24monthsof CA.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

Acknowledgments

The authorswouldliketothankallthemedicaland nurs-ingstaffwhoparticipatedinthefollow-upof thepreterm infants.

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References

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