Within pair association between birth weight and blood pressure at age 8 in twins from a cohort study

BMJ 1999;319:1325-1329 ( 20 November )

Papers

Within pair association between birth weight and blood pressure at age 8 in twins from a cohort study

Editorial by Leon

Terence Dwyer, professor, ^a Leigh Blizzard, biostatistician, ^a Ruth Morley, senior research fellow, ^b Anne-Louise Ponsonby, public health physician. ^c

^a Menzies Centre for Population Health Research, University of Tasmania, Hobart 7001, Tasmania, Australia, ^b Clinical Epidemiology and Biostatistics Unit, University of Melbourne Department of Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia, ^c Academic Unit of General Practice and Community Care, Canberra Clinical School, University of Sydney, Canberra, Australian Capital Territory, Australia

Correspondence to: T Dwyer T.Dwyer{at}utas.edu.au

Objectives: To study the association between birth weightand blood pressure in children from multiple pregnancies (multiplets),mostly twins, to determine whether maternal or genetic factorsare responsible for theassociation.
Design: Cohortstudy.
Setting: SouthernTasmania.
Subjects: 888 children including 104 multiplets (32monozygotic, 72dizygotic).
Main outcome measure: Systolic blood pressure (mmHg).
Results: Blood pressure decreased with birth weightand increased with current body mass. After adjustment for ageand body mass, systolic blood pressure changed by $-$ 1.94 mm Hg(95% confidence interval $-$ 2.89 to -0.98) per 1 kg increase inbirth weight of singletons. For multiplets, blood pressure changedby $-$ 7.0 mm Hg ( $-$ 10.1 to $-$ 3.9) for each 1 kg increase in birthweight. This was little altered in within pair analyses ( $-$ 5.3, $-$ 13.8 to 3.2) and was similar for both monozygotic ( $-$ 6.5, $-$ 22.5to 9.4) and dizygotic ( $-$ 4.9, $-$ 15.8 to 6.0)pairs.
Conclusion: Because the association between birth weightand blood pressure was largely unchanged in within pair analyses,exposures originating in the mother (such as nutritional status)cannot be wholly responsible. The association also remained withinmonozygotic pairs, suggesting that genetic predisposition is notwholly responsible either. The principal causal pathway must concernmechanisms within the fetoplacental unit. The stronger associationin multiplets suggests that factors adversely influencing bothblood pressure and birth weight are more prevalent in multiplepregnancies.

Key messages

Low birthweight is associated with high blood pressure from an early age
Maternal factors, including diet during pregnancy, cannot wholly explain the association between fetal development and later risk of cardiovascular disease
Because the association between blood pressure and birthweight remained in monozygotic twins, genetic factors are unlikely to be responsible for the association
Important causes of the association seem to be operating within the fetoplacental unit during fetal life
Further research should now focus on placental function and fetal exposures

© BMJ 1999

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Relevant Articles

Fetoplacental factors may explain relation of low birth weight with high blood pressure
BMJ 1999 319: 0. [Full Text]

Twins and fetal programming of blood pressure: David A Leon
BMJ 1999 319: 1313-1314. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Sun, C., Ponsonby, A.-L., Wong, T. Y., Brown, S. A., Kearns, L. S., Cochrane, J., MacKinnon, J. R., Ruddle, J. B., Hewitt, A. W., Liew, G., Dwyer, T., Scurrah, K., Mackey, D. A. (2009). Effect of Birth Parameters on Retinal Vascular Caliber: The Twins Eye Study in Tasmania. Hypertension 53: 487-493 [Abstract] [Full text]
Dwyer, T, Blizzard, L, Patterson, B, Ponsonby, A-L, Martin, K, Quinn, S, Sale, M M, Richards, S M, Morley, R, Rich, S, Dickinson, J L (2008). Association between birth weight and adolescent systolic blood pressure in a caucasian birth cohort differs according to skin type, CRH promoter or 11{beta}-HSD2 genotype. Arch. Dis. Child. 93: 760-767 [Abstract] [Full text]
Rumball, C. W. H., Harding, J. E., Oliver, M. H., Bloomfield, F. H. (2008). Effects of twin pregnancy and periconceptional undernutrition on maternal metabolism, fetal growth and glucose-insulin axis function in ovine pregnancy. J. Physiol. 586: 1399-1411 [Abstract] [Full text]
De Matteo, R., Stacy, V., Probyn, M., Desai, M., Ross, M., Harding, R. (2008). The Perinatal Development of Arterial Pressure in Sheep: Effects of Low Birth Weight Due to Twinning. Reproductive Sciences 15: 66-74 [Abstract]
Bloomfield, F. H., Oliver, M. H., Harding, J. E. (2007). Effects of twinning, birth size, and postnatal growth on glucose tolerance and hypothalamic-pituitary-adrenal function in postpubertal sheep. Am. J. Physiol. Endocrinol. Metab. 292: E231-E237 [Abstract] [Full text]
Leon, D. A., Koupil, I., Mann, V., Tuvemo, T., Lindmark, G., Mohsen, R., Byberg, L., Lithell, H. (2005). Fetal, Developmental, and Parental Influences on Childhood Systolic Blood Pressure in 600 Sib Pairs: The Uppsala Family Study. Circulation 112: 3478-3485 [Abstract] [Full text]
Carlin, J. B, Gurrin, L. C, Sterne, J. A., Morley, R., Dwyer, T. (2005). Regression models for twin studies: a critical review. Int J Epidemiol 34: 1089-1099 [Abstract] [Full text]
Iliadou, A, Cnattingius, S, Lichtenstein, P (2004). Low birthweight and Type 2 diabetes: A study on 11 162 Swedish twins. Int J Epidemiol 33: 948-953 [Abstract] [Full text]
McNeill, G, Tuya, C, Smith, W. (2004). The role of genetic and environmental factors in the association between birthweight and blood pressure: evidence from meta-analysis of twin studies. Int J Epidemiol 33: 995-1001 [Abstract] [Full text]
IJzerman, R. G., Stehouwer, C. D.A., de Geus, E. J., van Weissenbruch, M. M., Delemarre-van de Waal, H. A., Boomsma, D. I. (2003). Low Birth Weight Is Associated With Increased Sympathetic Activity: Dependence on Genetic Factors. Circulation 108: 566-571 [Abstract] [Full text]
McNeill, G., Tuya, C., Campbell, D. M., Haggarty, P., Smith, W. C. S., Masson, L. F., Cumming, A., Broom, I., Haites, N. (2003). Blood Pressure in Relation to Birth Weight in Twins and Singleton Controls Matched for Gestational Age. Am J Epidemiol 158: 150-155 [Abstract] [Full text]
Loos, R. J.F., Phillips, D. I.W., Fagard, R., Beunen, G., Derom, C., Mathieu, C., Verhaeghe, J., Vlietinck, R. (2002). The Influence of Maternal BMI and Age in Twin Pregnancies on Insulin Resistance in the Offspring. Diabetes Care 25: 2191-2196 [Abstract] [Full text]
Loos, R. J., Beunen, G., Fagard, R., Derom, C., Vlietinck, R. (2002). Birth weight and body composition in young women: a prospective twin study. Am. J. Clin. Nutr. 75: 676-682 [Abstract] [Full text]
Rahiala, E., Tenhola, S., Vanninen, E., Herrgard, E., Tikanoja, T., Martikainen, A. (2002). Ambulatory Blood Pressure in 12-Year-Old Children Born Small for Gestational Age. Hypertension 39: 909-913 [Abstract] [Full text]
Bajoria, R., Sooranna, S. R., Ward, S., Hancock, M. (2002). Placenta as a Link between Amino Acids, Insulin-IGF Axis, and Low Birth Weight: Evidence from Twin Studies. J. Clin. Endocrinol. Metab. 87: 308-315 [Abstract] [Full text]
Loos, R. J.F., Fagard, R., Beunen, G., Derom, C., Vlietinck, R. (2001). Birth Weight and Blood Pressure in Young Adults: A Prospective Twin Study. Circulation 104: 1633-1638 [Abstract] [Full text]
Christensen, K, Stovring, H, McGue, M (2001). Do genetic factors contribute to the association between birth weight and blood pressure?. J. Epidemiol. Community Health 55: 583-587 [Abstract] [Full text]
Zhang, J., Brenner, R. A., Klebanoff, M. A. (2001). Differences in Birth Weight and Blood Pressure at Age 7 Years among Twins. Am J Epidemiol 153: 779-782 [Abstract] [Full text]
Stevenson, C J, West, C R, Pharoah, P O D (2001). Dermatoglyphic patterns, very low birth weight, and blood pressure in adolescence. Arch. Dis. Child. Fetal Neonatal Ed. 84: 18F-22 [Abstract] [Full text]
IJzerman, R. G., Stehouwer, C. D. A., Boomsma, D. I. (2000). Evidence for Genetic Factors Explaining the Birth Weight-Blood Pressure Relation : Analysis in Twins. Hypertension 36: 1008-1012 [Abstract] [Full text]
Kramer, M. S. (2000). Invited Commentary: Association between Restricted Fetal Growth and Adult Chronic Disease: Is It Causal? Is It Important?. Am J Epidemiol 152: 605-608 [Full text]
Symonds, M. E, Budge, H., Stephenson, T. (2000). Current topic: Limitations of models used to examine the influence of nutrition during pregnancy and adult disease. Arch. Dis. Child. 83: 215-219 [Full text]
Leon, D. A (1999). Twins and fetal programming of blood pressure. BMJ 319: 1313-1314 [Full text]

Rapid Responses:

Read all Rapid Responses

Within pair association between birth weight and blood pressure at age 8 in twins: Collings
bmj.com, 26 Nov 1999 [Full text]
Authors' reply: T Dwyer, et al.
bmj.com, 13 Dec 1999 [Full text]
Syndrome X and the Fetal Origins Hypothesis: Patrick J Bradley
bmj.com, 19 Dec 1999 [Full text]
Early Growth Programs Later Blood Pressure in Twins Born Preterm: Atul Singhal
bmj.com, 11 Aug 2000 [Full text]
Why not report the result about diastolic and mean blood pressure?: Clayman ZK Zhang
bmj.com, 19 Apr 2002 [Full text]