International Journal of Epidemiology 2001;30:52-57
© International Epidemiological Association 2001
Special Theme: Fetal Origins of Health and Disease |
Body size at birth and blood pressure among children in developing countries
a MRC Environmental Epidemiology Unit, Southampton General Hospital, Southampton SO16 6YD, UK. E-mail: claw{at}mrc.soton.ac.uk
c Obafemi Awolowo College of Health Sciences, Ogun State University Teaching Hospital, Sagamu, Nigeria.
d Instituto de Nutricion de Centro America y Panama, Guatemala City, Guatemala.
e Section for International Maternal and Child Health, Department for Women's and Children's Health, Uppsala University, Sweden.
f Subterraneo Maternidad, Hospital Barros Luco, Santiago, Chile.
g Family Planning Research Institute of Sichuan, Chengdu, People's Republic of China.
h UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Switzerland.
Abstract
Background Studies in developed countries have shown that reduced fetal growth is related to raised blood pressure in childhood and adult life. Little is known about this association in developing countries, where fetal growth retardation is common.
Methods In 1994–1995, we measured blood pressure in 1570 3–6-year-old children living in China, Guatemala, Chile, Nigeria and Sweden. We related their blood pressure to patterns of fetal growth, as measured by body proportions at birth. The children were all born after 37 weeks gestation and weighed more than 2.5 kg at birth.
Results In each country, blood pressure was positively related to the child's current weight. After adjusting for this and gender, systolic pressure was inversely related to size at birth in all countries except Nigeria. In Chile, China and Guatemala, children who were proportionately small at birth had raised systolic pressure. For example, in Chile, systolic pressure adjusted for current weight increased by 4.9 mmHg (95% CI : 2.1, 7.7) for every kilogram decrease in birthweight, by 1 mmHg (95% CI : 0.4, 1.6) for every centimetre decrease in birth length, and by 1.3 mmHg (95% CI : 0.4, 2.2) for every centimetre decrease in head circumference at birth. In Sweden, systolic pressure was higher in children who were disproportionately small, that is thin, at birth. Systolic pressure increased by 0.3 mmHg (95% CI : 0.0, 0.6) for every unit (kg/m3) decrease in ponderal index at birth. These associations were independent of the duration of gestation.
Conclusions Raised blood pressure among children in three samples from China, Central and South America is related to proportionate reduction in body size at birth, which results from reduced growth throughout gestation. The relation between fetal growth and blood pressure may be different in African populations. Proportionately reduced fetal growth is the prevalent pattern of fetal growth retardation in developing countries, and is associated with chronic undernutrition among women. Improvement in the nutrition and health of girls and young women may be important in preventing cardiovascular disease in developing countries.
Keywords Blood pressure, population, pregnancy, epidemiology
Accepted 15 February 2000
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