Fatores ambientais do pré-natal e nascimento associados ao risco cardiovascular em adolescentes: coorte rps São Luís - MA

Abstract

According to the fetal programming hypothesis, environmental factors related to fetal and perinatal period could cause changes the structure and function of vascular wall, affecting the vascular phenotype and increasing cardiovascular risk. The purpose of this study was to evaluate the association of prenatal and birth environmental factors (baseline) with cardiovascular risk in teenager in the RPS cohort - 1997/98, in the city of São Luis, Brazil. "Vascular risk phenotype" was a latent variable composed of the variables systolic blood pressure, diastolic blood pressure and pulse wave velocity. A theoretical model of direct and indirect paths between prenatal factors (socioeconomic status, pre-gestational body mass index, maternal age, gestational age, birth weight, type of delivery), adolescent BMI, and the outcome variable "vascular risk phenotype"(VRF) latent, was constructed and analyzed by the structural equations modeling. A high weight in adolescence was directly associated to high values of VRF (SC 0,529; p ≤ 0,001). The adolescent BMI, moreover, was path of positive indirect associations of pre-gestational BMI (SC 0.096; p ≤ 0,001) and weight birth (SC 0.013; p ═ 0.013) with the VRF. The direct effect (SC -0,103; p ═ 0,039) and the indirect effect (SC 0,079; p ═ 0,002) of birth weight on the VRF were significant, but in opposite directions, resulting in an apparent absence of total birth weight effect on the VRF. The cesarean delivery had a total effect (SC 0,163; p ═ 0,068), although of borderline significance, on the VRF. Closer to the outcome variable, exerting a direct effect, but also participating in the indirect pathways, excess weight in adolescence was the most important factor in the association of pre-natal and birth environmental factors with cardiovascular risk.