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Birth weight and risk of cardiovascular disease in a cohort of women followed up since 1976

BMJ 1997; 315 doi: (Published 16 August 1997) Cite this as: BMJ 1997;315:396
  1. Janet W Rich-Edwards, instructor (nhjre{at},
  2. Meir J Stampfer, professord,
  3. JoAnn E Manson, associate professorb,
  4. Bernard Rosner, professorc,
  5. Susan E Hankinson, assistant professorc,
  6. Graham A Colditz, professorc,
  7. Charles H Hennekens, professorb,
  8. Walter C Willet, professord
  1. a Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA
  2. b Division of Preventive Medicine
  3. c Channing Laboratory
  4. d Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA
  1. Correspondence to: Dr J W Rich-Edwards Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, 126 Brookline Avenue, Suite 200, Boston, MA 02215, USA
  • Accepted 2 July 1997


Objective: To examine the association between birth weight and non-fatal adult cardiovascular disease while controlling for potential confounders such as socioeconomic group and adult lifestyle.

Design: Retrospective self report of birth weight in an ongoing longitudinal cohort of nurses followed up by postal questionnaire every two years.

Setting: Nurses' health study, a cohort of 121 700 women followed up since 1976.

Main outcome measures: Non-fatal cardiovascular disease, including myocardial infarction, coronary revascularisation, and stroke.

Results: Among the 70 297 women free of cardiovascular disease at baseline who reported birth weight in the 1992 questionnaire there were 1309 first cases of non-fatal cardiovascular disease. Increasing birth weight was associated with decreasing risk of non-fatal cardiovascular disease. There were 1216 first cases of non-fatal cardiovascular disease among women who were singletons and had been born full term; their relative risks adjusted for several cardiovascular risk factors were 1.49 (95% confidence interval 1.05 to 2.10) for birth weight <2268 g (<5 lb 0 oz); 1.25 (0.98 to 1.61) for birth weight 2268-2495 g (5 lb 0 oz to 5 lb 8 oz); 1.12 (0.98 to 1.27) for birth weight >2495-3175 g (>5 lb 8 oz to 7 lb 0 oz); 1.00 (referent) for birth weight >3175-3856 g (>7 lb 0 oz to 8 lb 8 oz); 0.96 (0.80 to 1.15) for birth weight >3856-4536 g (>8 lb 8 oz to 10 lb 0 oz); and 0.68 (0.46 to 1.00) for birth weight >4536 g (>10 lb 0 oz) (P value for trend=0.0004). The inverse trend was apparent for both coronary heart disease and stroke.

Conclusions: These data provide strong evidence of an association between birth weight and adult coronary heart disease and stroke.

Key messages

  • Birth weight and mortality from cardiovascular disease are inversely associated in adult women

  • This study found that birth weight and the risk of non-fatal cardiovascular disease is also inversely associated in adult women for both coronary heart disease and stroke

  • This association is driven by the 13% of women born at the extremes of birth weight

  • It seems to be largely independent of established cardiovascular risk factors also associated with birth weight: adult body weight, hypertension, and diabetes

  • It is not weakened by controlling for childhood socioeconomic group or adjusting for adult lifestyle


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