Premature birth can have long-term health complications, including heart diseases, according to experts. Babies born before 37 weeks of pregnancy are called premature. According to a report by the World Health Organisation (WHO), the incidence of preterm birth has been increasing in many countries, with India having recorded 30,16,700 preterm births in 2020.
Dr Santosh Kumar, consultant, pediatrics and neonatology, Motherhood Hospitals, Bengaluru, says, “The exact reasons for this increase are complex and multifactorial, involving factors such as maternal age, multiple pregnancies (e.g. twins or triplets), chronic health issues like diabetes mellitus and hypertension and lifestyle and environmental factors.”
Premature babies are at an increased risk of various health complications not just at birth but also later in life if proper healthcare measures are not taken at the time of birth and in the neonatal intensive care unit (NICU). Dr Kumar adds that some of these complications include neurodevelopmental issues, respiratory problems, vision and hearing impairments, metabolic disorders, hypertension and cardiovascular issues.
Birth defects can be picked up in a scan
During pregnancy, different parts of the baby’s heart develop and mature at different periods. Dr Navaneetha Sasikumar, associate professor, pediatric cardiology and in-charge of the Adult Congenital Heart Disease Program, Amrita Institute of Medical Sciences, Kochi, Kerala, explains, “The primitive heart tube forms as early as 22 days of gestation. By 16 to 22 weeks, heart structure is formed. From this time, birth defects of the heart (congenital heart disease) can be picked up in the scans by experts. Maturation happens throughout gestation and in the first few months after life,” she says.
What is the most common heart defect in premature babies?
As premature babies come out of the mother’s womb before the heart is fully mature, they may have heart-related problems when they are born. Dr Kumar says the heart undergoes critical development during the third trimester of pregnancy, and premature birth disrupts this process. “The premature heart may have structural and functional differences, including thinner walls, abnormal communications between chambers and altered electrical conduction,” he says.
The most common problem that these newborn babies have is patent ductus arteriosus (PDA). The ductus arteriosus is a tube that is essential for the survival of the baby in the mother’s womb. Dr Sasikumar says, “Once the baby is born, this is not necessary. It naturally must close in a few days. If it doesn’t, it can lead to heart failure in the premature newborn. This is an easily diagnosable and treatable problem,” she says.
Heart problems in adulthood
Dr Kumar says that premature babies may be more prone to certain cardiac issues in their adulthood including:
- Structural heart abnormalities: Premature babies are at a higher risk of congenital heart problems, such as ventricular septal defects, patent ductus arteriosus and abnormalities in the heart valves.
- Cardiac remodelling: Preterm birth can lead to alterations in the structure and function of the heart, potentially increasing the risk of cardiac remodelling and heart failure later in life.
- Hypertension: Preterm-born individuals may have an increased likelihood of developing high blood pressure, which is a significant risk factor for cardiovascular disease.
Some recent studies have shown a connection between preterm birth and heart failure/ischemic heart disease in adulthood. “Those born prematurely, when tested are found to have smaller heart chamber sizes, thicker walls and reduced heart function compared to those born at term. Adults who were born prematurely may thus be more susceptible to the usual factors that can cause heart failure and ischemic heart disease,” adds Dr Sasikumar.
Heart failure and ischemic heart disease have also been linked to various factors. Some factors like age, family history and ethnicity cannot be modified to prevent heart disease. Prematurity is like a non-modifiable risk factor. But several easily modifiable risk factors contribute to the majority of heart diseases. These include:
- Smoking and tobacco
- High blood pressure
- High blood sugar
- High blood cholesterol
- Obesity
- Unhealthy diet
- Sedentary lifestyle/lack of exercise.
Dr Sasikumar says, “A healthy lifestyle is key to preventing heart disease for the general public. The same applies to anyone more susceptible to heart diseases, including prematurely born babies as they grow up.”
Ways to prevent heart problems
Dr Kumar says a routine health check-up with a physician and gynecologist before planning the pregnancy will help identify health-related problems and address them. “Adopting a healthy lifestyle that includes eating a balanced diet, regular physical activity, avoiding smoking and excessive alcohol, and stress management can help reduce the risk of complications,” he adds.
Those born preterm should have regular multidisciplinary check-ups with neonatologists and specialists in retinopathy of prematurity (ROP) and child development in the first five years to monitor their growth, development and potential health issues. Experts say although prematurity is not a major cause of heart failure in adulthood, educating individuals and their families about preventive measures and self-care strategies is important to help make informed decisions and take appropriate actions in time.
Takeaways
- Babies born preterm are at an increased risk of various health complications not just at birth but also later in life.
- They could also develop cardiovascular diseases in their adulthood.
- The heart undergoes critical development during the third trimester of pregnancy, and premature birth disrupts this process, causing structural and functional differences in the heart.
- They are at higher risk of developing congenital heart defects, such as ventricular septal defects, patent ductus arteriosus, abnormalities in the heart valves and heart failure later in life.
- They also have an increased likelihood of developing high blood pressure, a risk factor for heart issues.
- A healthy lifestyle is key to preventing any heart disease, even in adults born prematurely.
