Objective. To determine relative influences of intrauterine growth restriction (IUGR) and preterm birth on risks of cardiovascular, renal, or metabolic dysfunction in adolescent children. Study Design. Retrospective cohort study. 71 periadolescent children were classified into four groups: premature small for gestational age (SGA), premature appropriate for gestational age (AGA), term SGA, and term AGA. Outcome Measures. Systolic blood pressure (SBP), augmentation index (Al), glomerular filtration rate (GFR) following protein load; plasma glucose and serum insulin levels. Results. SGA had higher SBP (average 4.6？mmHg) and lower GFR following protein load (average 28.5？mL/min/1.73？m2) than AGA. There was no effect of prematurity on SBP ( ) or GFR ( ). Both prematurity and SGA were associated with higher AI (average 9.7%) and higher serum insulin levels 2？hr after glucose load (average 15.5？mIU/L) than all other groups. Conclusion. IUGR is a more significant risk factor than preterm birth for later systolic hypertension and renal dysfunction. Among children born preterm, those who are also SGA are at increased risk of arterial stiffness and metabolic dysfunction. 1. Introduction Low birth weight (LBW) is associated with increased risk of cardiovascular disease (CVD) and the related disorders, hypertension, stroke, and type-2 diabetes, later in life [1–3]. LBW may be due to preterm birth, poor fetal growth, or a combination of both. Although their relative importance is unknown, it is thought that intrauterine growth restriction (IUGR) is more important than preterm birth per se in the development of subsequent CVD [4]. With the increasing survival of extremely preterm infants, this may no longer be true. Early postnatal growth restriction, common in very preterm babies, may be as important in development of later organ dysfunction as IUGR at a similar gestational age (GA). Furthermore, such infants might have been exposed to glucocorticoids, either antenatally to accelerate lung maturation or postnatally to facilitate weaning from mechanical ventilation. This therapy may also result in later adverse renal or cardiovascular outcomes [5, 6]. Approximately 7% of babies are born preterm (<37 weeks gestation) [7] with 1% being with very LBW (<1500？g) or very preterm (<29 weeks gestation) [8]. To date, most long-term followup of very preterm infants have focused on neurodevelopmental and respiratory complications, with little attention to cardiovascular, renal, or metabolic outcomes. Suboptimal intrauterine nutrition may alter fetal programming during critical
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