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Early fetal growth and risk factors for cardiovascular disease

BMJ 2014; 348 doi: (Published 23 January 2014) Cite this as: BMJ 2014;348:g175
  1. Catherine E M Aiken, academic clinical fellow,
  2. Gordon C S Smith, professor
  1. 1Department of Obstetrics and Gynaecology, University of Cambridge, Box 223, Rosie Hospital and NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge CB2 0SW, UK
  1. Correspondence to: G C S Smith gcss2{at}

Let’s start at the very beginning

Some readers’ principal response to the paper by Jaddoe and colleagues (doi:10.1136/bmj.g14) may be bemusement.1 Why would anyone link growth of the fetus in the first trimester to risk factors for the cardiovascular killers of middle age? However, the rationale for the study is based around two large bodies of work that have concluded that fetal growth restriction is associated with an increased risk of cardiovascular—and many other—diseases in later life,2 and also that fetal growth is profoundly influenced by conditions in the first trimester of pregnancy.3 Jaddoe and colleagues report new associations between apparently poor growth in the first trimester and a range of cardiovascular risk factors measured in school age children. Are the associations likely to be real? What mechanisms might be operating if they are? Lastly, what should we be doing about it?

Many aspects of this carefully conducted prospective cohort study support the validity of the conclusions. However, as the authors acknowledge, the possibility remains that some of their significant associations may …

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