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IJE Advance Access published online on June 9, 2006
International Journal of Epidemiology, doi:10.1093/ije/dyl080
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Published by Oxford University Press 2006
Accepted March 30, 2006

Original paper

The association between intrauterine growth restriction in the full-term infant and high blood pressure at age 7 years: results from the Collaborative Perinatal Project

Anusha H. Hemachandra 1 *, Mark A. Klebanoff 2, Anne K. Duggan 3, Janet B. Hardy 4, and Susan L. Furth 5

1 Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Epidemiology, Statistics, and Prevention Research, Department of Health and Human Services, National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
2 Division of Epidemiology, Statistics, and Prevention Research, Department of Health and Human Services, National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
3 Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Pediatrics, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
4 Division of General Pediatrics, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
5 Division of Pediatric Nephrology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

* To whom correspondence should be addressed.
Anusha H. Hemachandra, E-mail: hemachaa{at}mail.nih.gov


  Abstract

Objective To use neonatal and placental anthropometry as proxy measures of intrauterine growth restriction (IUGR) and to relate these to blood pressure later in childhood.

Study design A post hoc analysis of full-term white and black children from the Collaborative Perinatal Project, followed from birth until age 7 years (n = 29 710). Blood pressure above the 90th percentile by gender and race was considered high blood pressure. Anthropometric measures at birth included birth weight, ponderal index (PI, birth weight/birth length3), head to chest circumference (HCC) ratio, and placental ratio percentage (PRP, placental weight*100/birth weight).

Results Among anthropometric measures, PI, HCC, and birth weight were not associated with high systolic blood pressure at age 7 years, but PRP was. In multiple logistic regression, high systolic blood pressure and widened pulse pressure were both predicted by increased PRP [odds ratio (OR) 1.03 and 1.04, P < 0.001] but not by birth weight, when adjusted for gender, race, and maternal education. High diastolic blood pressure was weakly predicted by birth weight (OR 1.10, P = 0.05) but not by PRP.

Conclusions PRP is associated with an increased risk for high systolic blood pressure and pulse pressure later in childhood, whereas birth weight, PI, and HCC are not. The proportion of placental weight to birth weight is a useful marker of IUGR for studying the developmental origins of adult disease hypothesis.

Keywords: Hypertension; fetal programming; placenta; anthropometry; neonatal.
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