Fetal and infant growth and cardiovascular risk factors in women

Abstract

Objective: To examine whether cardiovascular risk factors in women are related to fetal and infant growth. Design: Follow up study of women born 1923-30 whose birth weights and weights at one year were recorded. Setting: Hertfordshire. Subjects: 297 women born and still living in East Hertfordshire. Main outcome measures: Plasma glucose and insulin concentrations during a standard oral glucose tolerance test; fasting plasma proinsulin and 32-33 split proinsulin concentrations; blood pressure; fasting serum total, low density lipoprotein and high density lipoprotein cholesterol, triglyceride, and apolipoprotein A I and B concentrations; and plasma fibrinogen and factor VII concentrations. Results: Fasting plasma concentrations of glucose, insulin, and 32-33 split proinsulin fell with increasing birth weight (P=0.04, P=0.002, and P=0.0002 respectively, when current body mass index was allowed for). Glucose and insulin concentrations 120 minutes after an oral glucose load showed similar trends (P=0.03 and P=0.02). Systolic blood pressure, waist:hip ratio, and serum triglyceride concentrations also fell with increasing birth weight (P=0.08, P=0.07, and P=0.07 respectively), while serum high density lipoprotein cholesterol concentrations rose (P=0.04). At each birth weight women who currently had a higher body mass index had higher levels of risk factors. Conclusion: In women, as in men, reduced fetal growth leads to insulin resistance and the associated disorders: raised blood pressure and high serum triglyceride and low serum high density lipoprotein cholesterol concentrations. The highest values of these coronary risk factors occur in people who were small at birth and become obese. In contrast with men, low rates of infant growth did not predict levels of risk factors in women. Key messages They have increased levels of cardiovascular risk factors associated with insulin resistance The highest levels of these risk factors are in people who were small at birth and obese as adults Unlike in men, low rates of growth in infancy are not linked to coronary heart disease in women