Date of Award
Doctor of Philosophy in Nursing
Mary C Sullivan
Advances in perinatal and neonatal management, along with improved healthcare technologies, have increased the long-term survival of individuals who were born preterm. Millions of preterm birth survivors now reach adulthood. Premature birth, defined as birth before 37 weeks gestation, predisposes individuals to adverse health risks later in life. The Developmental Origins of Health and Disease (DOHaD) theory was used as a framework for this dissertation. The main tenets of the DOHaD theory are that early birth infers immature organ development and when coupled with maternal, neonatal, and environmental stressors, long-term health consequences and/or chronic disease may result. International studies report that preterm-born adults are at higher risk for hypertension and cardiovascular disease (CVD) compared to adults born full term. High blood pressure, beginning earlier in life, increasing faster in women, and often undiagnosed, is the strongest risk factor for CVD. In the U.S., preterm-born adult research is limited, raising questions about the development of hypertension and risk for CVD-associated comorbidities, especially in women. This dissertation examined preterm birth and adult hypertension, CVD risks, and comorbidity in three manuscripts. Manuscript I is a state-of-the-science report that informs nurse clinicians about emerging evidence on premature birth and adverse cardiovascular outcomes in adulthood. Manuscripts II and III are secondary data analyses of the Women’s Health Initiative Observational Study, a long-term national health study of 93,676 postmenopausal adult women, of which 2,303 were born preterm. Manuscript II examined the associations of hypertension and CVD in preterm-born women compared to their term-born peers. In Manuscript III, the cumulative prevalence of three CVD-associated conditions (hypertension, rheumatoid arthritis (RA), and hypothyroidism) were investigated by birth status (preterm vs. full term) in postmenopausal adult women. The results revealed that prematurity was associated with an elevated CVD risk. Women born preterm had higher prevalence, incidence, and earlier onset of hypertension that required more antihypertensive medications for blood pressure control than age-matched women born full term with hypertension. Preterm birth was also associated with higher occurrence of hypertension, RA, and hypothyroidism alone and in combination, potentially amplifying CVD risk. It is imperative for clinicians and preterm-born individuals to recognize that prematurity history may infer higher and earlier risk for CVD events. Early identification and treatment of hypertension and CVD comorbid conditions are important to mitigate the risk for CVD morbidity and mortality. In routine clinical encounters, birth history should be discussed and documented. Use of preemptive cardioprotective treatment strategies could prevent or reduce CVD for at-risk individuals who were born prematurely.
Brewer, Pamela L., "Hypertension, Rheumatoid Arthritis, and Hypothyroidism in Women Born Preterm of the Women's Health Initiative" (2022). Open Access Dissertations. Paper 1494.