BMJ 1999;319:1403-1407 ( 27 November )

Papers

Growth in utero and during childhood among women who develop coronary heart disease: longitudinal study

T Forsén, research fellow, a J G Eriksson, senior researcher, a J Tuomilehto, professor, a C Osmond, statistician, b D J P Barker, director. b

a National Public Health Institute, Department of Epidemiology and Health Promotion, Diabetes and Genetic Epidemiology Unit, Mannerheimintie 166, Helsinki, Finland, b Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD

Correspondence to: D J P Barker david.barker{at}mrc.soton.ac.uk

Objective: To examine whether women who develop coronary heart disease have different patterns of fetal and childhood growth from men in the same cohort who develop the disease.
Design: Follow up study of women whose body size at birth was recorded and who had an average of 10 measurements of height and weight during childhood.
Setting: Helsinki, Finland.
Subjects: 3447 women who were born in Helsinki University Central Hospital during 1924-33 and who went to school in Helsinki.
Main outcome measures: Hazard ratios for hospital admission for or death from coronary heart disease.
Results Coronary heart disease among women was associated with low birth weight (P=0.08 after adjustment for gestation, P=0.007 after adjustment for placental weight) and was more strongly associated with short body length at birth (P=0.001 and P<0.0001, respectively). The hazard ratio for women developing coronary heart disease increased by 10.2% (95% confidence interval 4.3 to 15.7) for each cm decrease in length at birth. The effect of short length at birth was greatest in women whose height "caught up" after birth so that as girls they were tall. Such girls tended to have tall mothers. In contrast, men in the same cohort who developed the disease were thin at birth rather than short, showed "catch up" growth in weight rather than height, and their mothers tended to be overweight rather than tall.
Conclusion: Coronary heart disease among both women and men reflects poor prenatal nutrition and consequent small body size at birth combined with improved postnatal nutrition and "catch up" growth in childhood. The disease is associated with reductions in those aspects of body proportions at birth that distinguish the two sexes---short body length in women and thinness in men.


Key messages

  • Coronary heart disease in women is associated with low birth weight but more strongly with short body length at birth

  • Among men in the same cohort coronary heart disease is also associated with low birth weight but more strongly with thinness at birth

  • In the whole cohort body proportions at birth differed in the two sexes: the girls were short and the boys were thin

  • These differences may reflect intrinsic sex differences in rates of fetal growth at similar levels of maternal nutrition

  • The slower fetal growth of females may underlie their lower rates of coronary heart disease




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Sex differences in programming of CVD
Simon Langley-Evans
bmj.com, 4 Apr 2000 [Full text]
Authors' reply
D J P Barker
bmj.com, 12 Apr 2000 [Full text]
Re: Authors' reply
Simon Langley-Evans
bmj.com, 10 May 2000 [Full text]
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