The aim of our study was to verify the associations between perinatal variables and cardiometabolic profile in school-aged children and adolescents. We found out some interesting results regarding birth weight (BW) and anthropometric measurements, those associations showed a positive relation between BW and BMI, BF% and WC during school-age. Cesarean also showed positive association with BMI in our sample, meaning that children born through this surgical method of birth delivery could have higher BMI than those born via vaginal birth or forceps delivery. Additionally, we discovered significant findings related to a pregnancy with no complications, gestational age and school-children’s cardiorespiratory fitness (CRF) where babies born from a healthy pregnancy had better CRF during childhood and adolescence and babies born extremely premature had a negative impact on its current CRF. Those variables assessed in our research are some of early life health predictors in children and adolescents [19].
The higher likelihood of developing obesity in adulthood among children with greater BW, indicates that the prenatal period represents a pivotal phase for shaping future body adiposity [20]. In our sample we found out that BW was positively associated with an increase in BMI, BF% and WC measurements that could represent risk for overweight and obesity in this population, which we could hypothesized that possibly indicate a higher cardiometabolic risk (CMR).
The links between an elevated risk of cardiovascular and metabolic disorders transcend a spectrum of birth weights and postnatal growth patterns [21]. Gestational age, for example, can also play a role in CMR. Studies have demonstrated that preterm labor heightens the likelihood of hypertension, elevated insulin levels, and even early onset heart failure in offspring [22]. These individuals are more prone to having augmented left ventricular mass, irregular ventricular function, systemic arterial stiffness, and higher mean blood pressure [22]. These factors may predispose them to an elevated risk of cardiovascular disease (CVD) later in life [23]. In our study, preterm babies showed association with two indicators of increased cardiovascular risk: BMI and CRF. Those born extremely premature had worst CRF during school-age we can, therefore, hypothesized that those children had poor cardiovascular and/or respiratory system development, consequently, elevating those kids’ risk of having a CVD in the future since CRF is a determinant of morbidity and mortality [24–26]. It is also noteworthy that elevated BMI could also contribute to a poorer CRF [27].
Complications during pregnancy can have long-lasting effects on the health of the child, several risk factors like the obstetric complications as preterm labor and their long-term maternal effects serve as indicators for an elevated risk of acute cardiovascular complications during delivery and pose a long-term risk for CVD for both the mother and the offspring [28, 29]. These complications can impact various metabolic traits in the offspring, its fetal growth and development [30]. In our research, the offspring of mothers without complications during pregnancy exhibited higher levels of CRF, suggesting better physical development and overall cardiorespiratory health.
It is evidenced that that there is a significant contrast in the physiological stress experienced by the fetus during vaginal delivery compared to cesarean delivery (CD). The stress encountered in natural delivery plays a crucial role in triggering the release of stress-induced hormones in the fetus, subsequently influencing physiological changes, particularly in terms of immunological and metabolic development that could be a protective factor against CMR [22]. Despite the fact that there are some research associating CD and propensity to different kinds of infections, neurological and respiratory morbidities, the evidence regarding this type of delivery and CMR in school-aged children and adolescents is still little. There is a suggested elevated risk for young individuals born via CD where signs of overweight have been noted from infancy through young adulthood as demonstrated by Horta et al. same fact as seen is our study in which those kids born via this surgical method had higher body mass index during school-age [31].
It is well known that certain chronic diseases have their roots in early life, and these conditions can be influenced by exposure to various risk factors during the early stages of development and lifespan, these factors have a role in increasing health risks in adulthood [32]. By appraising perinatal biomarkers and obstetrical history linked to the presence of traditional cardiometabolic risk indicators an early assessment risk is facilitated. The relation between perinatal conditions and the early emergence of cardiometabolic risk biomarkers may be contingent on epigenetic programming [33]. Therefore, it is relevant to investigate those perinatal variables in order to identify factors that can be changed during children’s development window through early prevention and by changing lifestyle habits.
Despite the valuable findings from this study, it is necessary to recognize its limitations. The self-reported questionnaire used to collect previous data could lead to bias, as the mothers and the children could have some trouble to recall information from the past. Furthermore, there are other factors that could have effects on cardiometabolic profile and increase cardiometabolic risk in this population that were not evaluated in this study, i.e lifestyle. The small sample size in the extremely born and post-term babies’ categories could be limitation. Nonetheless, it is important to recognize that this study, conducted in a sample from southern Brazil, stands out as a significant contribution to a low to middle-income country, such as Brazil. This research adopted an innovative approach by using a school-based sample that is representative of the population of its municipality. It is worth noting that, to the best of our knowledge, there have been no studies that have shown similar results in this specific population. This study not only fills a gap in the existing literature but also significantly advances our understanding of the impact that perinatal variables can have on outcomes during childhood and adolescence, providing valuable insights for future research and interventions.