Association Between Infant Birth Weight and Maternal Cardiovascular Risk Factors in the Health, Aging, and Body Composition Study

doi:10.1016/j.annepidem.2006.02.007

Annals of Epidemiology

Volume 17, Issue 1, January 2007, Pages 36-43

https://doi.org/10.1016/j.annepidem.2006.02.007 Get rights and content

Purpose

Mothers who deliver a low-birth-weight (LBW) infant may themselves be at excess risk for cardiovascular disease. We investigated whether older women who bore LBW infants had higher blood pressure, lipid, glucose, insulin, interleukin 6 (IL-6), and C-reactive protein concentrations, and pulse wave velocity compared to women with normal-weight births.

Methods

Participants were 446 women with a mean age of 80 years and 47% black. Women reported birth weight and complications for each pregnancy. Analysis was limited to first births not complicated by hypertension or preeclampsia.

Results

Women who had delivered a first-birth infant weighing less than 2500 g had a lower body mass index (BMI) compared with women with a normal-weight (≥2500 g) infant (26.7 versus 28.4 kg/m²; p = 0.02), but they had a larger abdominal circumference for BMI (97.9 versus 95.5 cm; p = 0.05). They also were marginally more likely to be administered antihypertensive medication (p = 0.06). After adjustment for BMI, race, and age, women with a history of a small infant had elevations in systolic blood pressure (p = 0.05) and greater IL-6 levels (p = 0.02) and were more insulin resistant (p = 0.05) compared with women with a normal-weight infant.

Conclusions

These findings suggest that a history of LBW delivery identifies women with elevated cardiovascular risk factors.

Introduction

Mothers who deliver a low-birth-weight (LBW) infant may themselves be at excess risk for cardiovascular disease (CVD). Large registry-based observational studies found that a LBW delivery increased maternal risk for cardiovascular death by 7- to 11-fold 1, 2, and risk for cardiovascular death was two to three times greater for women who delivered a preterm infant compared with those who delivered an infant at term 3, 4. In two studies that related reproductive history to later occurrence of cardiovascular risk factors, bearing a LBW infant was related inversely to systolic blood pressure 5, 6 and maternal insulin resistance (6).

LBW and its components, idiopathic preterm delivery and intrauterine growth restriction, share many risk factors with CVD. These include black race 7, 8, young maternal age 8, 9, inflammation and infection (10), cigarette smoking 8, 11, hypertension 12, 13, and nongestational diabetes (14). It was proposed that unsuccessful adaptation to the profound biologic demands of pregnancy may result in growth restriction and perhaps other causes of LBW, and reasons for maladaptation to pregnancy could involve metabolic and vascular disease pathways (15).

Most studies of LBW and CVD to date used large registries of delivery data matched to mortality data. As such, they had limited ability to adjust for such potential confounders as lifetime smoking exposure and weight gain. Furthermore, they did not characterize outcomes beyond 10 to 20 years postpartum. We sought to assess the association between delivery of a LBW infant and increased cardiovascular risk among older women. Specifically, we investigated whether women who bore LBW infants had later elevations in blood pressure, pulse pressure, lipid profiles, glucose, insulin, interleukin 6 (IL-6), C-reactive protein (CRP), and pulse wave velocity.

Section snippets

Participants

The Health, Aging, and Body Composition Study is a large ongoing epidemiologic study of how changes in body composition affect morbidity, disability, and mortality. A total of 3075 well-functioning community-dwelling participants (50% female) were enrolled in Pittsburgh, PA, and Memphis, TN, in 1997 to 1998. Recruitment procedures have been described elsewhere in detail (16). All participants signed an informed consent approved by the Institutional Review Board at the University of Pittsburgh.

Results

For 446 women who recalled the birth weight of their first born, mean birth weight was 3117 ± 582 (SD) g, and 56 women (12.6%) recalled having a baby of birth weight less than 2500 g. Thirty first births were reported as premature (6.2%); 18 of these also were LBW. Mean age at the study baseline visit was 73.1 ± 2.8 (SD) years, average maternal age at first birth was 23.5 ± 4.4 (SD) years, and mean number of live births was 3.0 ± 1.5 (SD).

Women who delivered a LBW infant (<2500 g.) were

Discussion

In this group of older women, those who delivered a infant who weighed less than 2500 g had elevations in levels of vascular, inflammatory, and metabolic markers independent of age, race, BMI, and lifetime exposure to cigarette smoking. These associations were present in women evaluated up to 60 years postpartum. These data support a small, but emerging, body of evidence that LBW pregnancies, because of either fetal growth restriction or preterm delivery, may involve pathways that lead to poor

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Cited by (44)

Adverse pregnancy outcomes are associated with an increased risk of postpartum prediabetes and diabetes in Chinese women with gestational diabetes
2022, Diabetes Research and Clinical Practice
Citation Excerpt :
Women with GDM have a chronic inflammatory state with elevated levels of inflammatory factors. Elevated levels of inflammatory markers (i.e., interleukin 6) were associated with higher risk of preterm birth and low birth weight [31]. Epidemiology studies have showed that inflammatory biomarkers were also associated with the occurrence of T2DM and complications.
To explore associations between adverse pregnancy outcomes and risk of postpartum diabetes and prediabetes among Chinese women with gestational diabetes mellitus (GDM).
A total of 507 women with GDM who participated in a randomized controlled trial were successfully followed up at a median of 9.1 (interquartile range: 7.7–11.3) weeks after delivery and underwent a 75 g 2-h oral glucose tolerance test. GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Group's criteria. Postpartum diabetes and prediabetes were defined by the World Health Organization's. Generalized logit model was used to obtain odds ratios (OR) and 95% confidence interval (CI) of adverse pregnancy outcomes for postpartum diabetes, prediabetes and abnormal glucose regulation (AGR).
Of 507 women with GDM, 3.7% (19) women developed postpartum diabetes, 35.1% (178) women developed postpartum prediabetes. Preterm birth was associated with increased risk of postpartum prediabetes and AGR (adjusted OR: 3.24, 95%CI: 1.48–7.07 & 3.16, 1.46–6.85). Low birth weight was associated with the risk of postpartum prediabetes, diabetes and AGR (adjusted OR: 2.78, 95%CI: 1.13–6.86; 5.21, 1.13–24.02 & 2.99, 1.24–7.21).
Preterm birth and low birth weight were predictive of postpartum prediabetes, diabetes or AGR in Chinese women with GDM.
Female offspring birth weight is associated with Body Mass Index, waist circumference and metabolic syndrome in Latin American women at 10-years postpartum
2018, Diabetes Research and Clinical Practice
Citation Excerpt :
Moreover, there seem to be associations between increased offspring BW and risk of obesity as well as mortality in the parents postpartum [17,18]. Until now, research assessing the associations between offspring anthropometry and future parental morbidity focused on Asia, Europe and North America [12,14–19]. Thus, little is known about parents and their offspring in Latin America, despite known differences in lifestyle and genetic predispositions.
We aimed to assess whether female offspring birth weight (BW) is associated with anthropometric and metabolic outcomes in Chilean mothers at 10-years postpartum.
We assessed data from 396 Chilean mother-daughter pairs participating in the longitudinal Chilean Growth and Obesity Cohort (GOCS) and Determinants of Breast Cancer Risk (DERCAM) studies. Multivariate linear and logistic regression models were performed to associate female offspring BW with maternal Body Mass Index (BMI), waist circumference, type 2 diabetes mellitus, metabolic syndrome and its components at 10-years postpartum.
At 10-years postpartum, 69% of mothers were overweight, 65% had central adiposity and 26% had metabolic syndrome. Adjusted linear regression models showed associations between female offspring BW and (1) maternal BMI (%Δ GM = 4.46; 95% CI 0.25–8.85); and (2) waist circumference (%Δ GM = 3.25; 95% CI 0–6.60). Adjusted logistic regression models showed associations between female offspring BW and (1) maternal metabolic syndrome (OR = 3.48; 95% CI 1.50–8.11); (2) central adiposity (OR = 2.37; 95% CI 1.08–5.22); and (3) hypertriglyceridemia (OR = 3.19; 95% CI 1.40–7.23).
Female offspring BW was associated with maternal anthropometric and metabolic outcomes at 10-years postpartum. Our findings add to the emerging evidence that offspring BW might be a potential indicator for future maternal anthropometric and metabolic risks.
Reproductive history and physical functioning in midlife: The Bogalusa Heart Study
2018, Maturitas
To examine the relationship between reproductive history, pregnancy complications, and later physical function.
The Bogalusa Heart Study is a long-running study of cardiovascular health in a semirural community. 761 women were interviewed about their pregnancy history and complications, and underwent tests of physical function. Logistic models for dichotomous outcomes and linear models for continuous outcomes were used, adjusted for covariates.
Overall scores on the Short Physical Performance Battery (SPPB), which combines scores for balance, gait speed, and chair stands. Additional tests were a 6-min walk, knee extension strength, grip strength, and a pegboard challenge.
Nulliparity was associated with lower scores on the walking and balance portions of the SPPB, less distance covered in the 6-min walk, less knee and grip strength, and higher pegboard time, especially among pre-menopausal women. A history of gestational diabetes was associated with more problems on the walk portion of the SPPB (aOR 2.44, 1.06–5.65), higher chair stand time, and lower knee strength. Young age at first birth (<16 or 18 years) was associated with a shorter chair stand time and a better pegboard score.
Nulliparity was associated with worse physical functioning, while high parity and early pregnancy were not, suggesting that fertility is associated with better health later in life. Pregnancy complications were associated with worse physical functioning, even after controlling for body mass index. Future studies should attempt to establish the pathways by which reproductive health relates to overall physical functioning.
Pregnancy complications and later vascular ultrasound measures: A cohort study
2017, Pregnancy Hypertension
Citation Excerpt :
A number of studies indicate that pregnancy complications predict or even predispose to later cardiovascular disease. Women who deliver a preterm or low birthweight infant have a higher risk of cardiovascular disease [1], elevated blood pressure, and insulin resistance later in life [2]. Women who develop pre-eclampsia have elevated blood pressure and lipids after pregnancy [3,4] and are at higher risk of developing diabetes [4,5], metabolic syndrome [6], and cardiovascular disease [7].
Pregnancy complications predict or even predispose to later cardiovascular disease in the mother. We examined whether pregnancy complications are associated with post-pregnancy measures of endothelial dysfunction and arterial stiffness.
Prospective cohort; Data for 847 women female participants in the Cardiovascular Risk in Young Finns study were linked with the national birth registry. Preterm birth (<37 weeks), low birthweight (<2500 g), small-for-gestational-age (weight <10th percentile for gestational age), and hypertensive disorders of pregnancy were examined as predictors of later vascular measures.
Flow-mediated dilatation (FMD), carotid intima-media thickness (IMT), Young’s elastic modulus (YEM), and carotid artery distensibility.
In some analyses, gestational hypertension and pre-eclampsia were associated with increased YEM. Low birthweight was also associated with an increase in IMT, and this increased risk was present prior to the pregnancy.
The increased cardiovascular risk in the mother observed after low birthweight and hypertensive disorders may be due to vascular changes, and some of this increased risk may be present before pregnancy.
Delivery of a small-for-gestational-age infant and risk of maternal cardiovascular disease - a population-based record linkage study
2015, Heart Lung and Circulation
Citation Excerpt :
Additionally, the complex interplay between maternal, placental, and foetal hormones that maintain foetal growth has been implicated to contribute to the elevated risk of maternal CVD associated with delivery of SGA infant. Notably, low levels of insulin-like growth factor that result in impaired glucose and lipid metabolism [39] (an important biological antecedent of CVD) are also found in pregnancies complicated by intrauterine growth restriction. [40] Furthermore, lower concentrations of placental growth factor in the circulation of women who give birth to SGA infant have been shown to increase risk of subsequent CHD.
Delivery of small for gestational age (SGA) infants has been associated with increased risk of future maternal cardiovascular disease (CVD). However, whether the risk increases progressively with the greater severity of SGA and number of SGA infants has not been explored.
A population-based record linkage study was conducted among 812,732 women delivering live born, singleton infants at term between 1994 and 2011 in New South Wales, Australia. Birth records were linked to the mothers’ subsequent hospitalisation or death records to identify CVD events (coronary heart disease, cerebrovascular events, and chronic heart failure) after a median of 7.4 years. Cox proportional hazard regression was used to estimate adjusted hazard ratios (AHR) [95% confidence interval (CI)] for the associations between the severity (moderate or extreme) of SGA and number of SGA infants and subsequent risk of maternal CVD, accounting for maternal age at last birth, socioeconomic status, parity, smoking, (pre-gestational and gestational) diabetes, and (chronic and pregnancy) hypertension.
Compared to mothers of non-SGA infants, AHRs [95%CI] of CVD among mothers of moderately and extremely SGA infants were 1.36 [1.23-1.49], and 1.66 [1.47-1.87], respectively, while AHRs among mothers with 1, 2, and ≥3 SGA infants were 1.42 [1.30-1.54], 1.65 [1.34-2.03], and 2.42 [1.52-3.85], respectively, indicating a dose-response relationship. AHRs of specific CVD categories showed a similar pattern.
Delivery of an SGA infant was associated with a dose-dependent increase in the risk of maternal CVD according to both the severity of SGA and number of previous SGA infants.
An association between preterm delivery and long-term maternal cardiovascular morbidity
2013, American Journal of Obstetrics and Gynecology
The purpose of this study was to investigate whether a history of preterm delivery (PTD) poses a risk for subsequent maternal long-term cardiovascular morbidity.
A population-based study compared the incidence of cardiovascular morbidity in a cohort of women who delivered preterm (<37 weeks' gestation) and those who gave birth at term at the same period. Deliveries occurred during the years 1988-1999 with follow up until 2010. Kaplan-Meier survival curves were used to estimate cumulative incidence of cardiovascular hospitalizations. Cox proportional hazards models were used to estimate the adjusted hazard ratios for cardiovascular hospitalizations.
During the study period 47,908 women met the inclusion criteria; 12.5% of the patients (n = 5992) delivered preterm. During a follow-up period of >10 years, patients with PTD had higher rates of simple and complex cardiovascular events and higher rates of total cardiovascular-related hospitalizations. A linear association was found between the number of previous PTD and future risk for cardiovascular hospitalizations (5.5% for ≥2 PTDs; 5.0% for 1 PTD vs 3.5% in the comparison group; P < .001). The association remained significant for spontaneous vs induced PTD and for early (<34 weeks) and late (34 weeks to 36 weeks 6 days' gestation) PTD. In a Cox proportional hazards model that adjusted for pregnancy confounders such as labor induction, diabetes mellitus, preeclampsia, and obesity, PTD was associated independently with cardiovascular hospitalizations (adjusted hazard ratio, 1.4; 95% confidence interval, 1.2–1.6).
PTD is an independent risk factor for long-term cardiovascular morbidity in a follow-up period of more than a decade.

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: This study was supported by contracts N01-AG-6-2101, N01-AG-6-2103, and N01-AG-6-2106. No conflicts of interest to disclose.

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Association Between Infant Birth Weight and Maternal Cardiovascular Risk Factors in the Health, Aging, and Body Composition Study

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Participants

Results

Discussion

Lancet

Am J Obstet Gynecol

Am J Obstet Gynecol

Placenta

Am J Obstet Gynecol

Am J Obstet Gynecol

Ann Epidemiol

Am J Obstet Gynecol

Am J Clin Nutr

Lancet

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Metabolism

Am J Obstet Gynecol

J Clin Epidemiol

Relation between infants' birth weight and mothers' mortality: Prospective observational study

BMJ

Birth dimensions of offspring, premature birth, and the mortality of mothers

Lancet

Long term mortality of mothers and fathers after pre-eclampsia: Population based cohort

BMJ

Contribution of parental blood pressures to association between low birth weight and adult high blood pressure: Cross sectional study

BMJ

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BMJ

Differing birth weight among infants of US-born blacks, African-born blacks and US-born whites

N Engl J Med

Ethnic differences in preterm and very preterm delivery

Am J Public Health

Maternal weight gain and preterm delivery

Obstet Gynecol

The preterm prediction study: The value of new vs. standard risk factors

Am J Public Health

Birth weight and smoking during pregnancy—Effect modification by maternal age

Am J Epidemiol