Weight at birth and subsequent risk of preeclampsia as an adult

doi:10.1067/S0002-9378(03)00491-5

American Journal of Obstetrics and Gynecology

Volume 189, Issue 2, August 2003, Pages 494-500

https://doi.org/10.1067/S0002-9378(03)00491-5 Get rights and content

Abstract

OBJECTIVE: We examined the influence of maternal birth weight on the risk of the development of preeclampsia, a likely precursor to adult chronic disease.

STUDY DESIGN: This hospital-based case-control study included 181 preeclampsia cases and 349 control subjects. Participants provided information about their birth weight and other covariates that included medical and reproductive history, prepregnancy weight, and adult height. Odds ratios and 95% CIs were estimated by logistic regression.

RESULTS: The risk of preeclampsia decreased as maternal birth weight increased (P = .01). After an adjustment was made for confounders, data showed that women with a low birth weight (<2500 g) had a 2.3-fold increased risk of experiencing preeclampsia (95% CI, 1.0–5.3) as compared with women who weighed 2500 to 2999 g at birth. Conversely, women with a birth weight of ≥4000 g appeared to have a nonstatistically significant, but >50%, reduction in the risk of experiencing preeclampsia (95% CI, 0.2–1.2). This relationship differed for lean and overweight women (body mass index, <25 kg/m² vs ≥25 kg/m²). Among lean women, those who were low birth weight had a near doubling in risk of the development of preeclampsia (odds ratio, 1.9; 95% CI, 0.8–4.6), although this association did not reach statistical significance. However, among overweight women, those women who weighed <2500 g at birth had an almost 4-fold increased risk of experiencing preeclampsia (odds ratio, 3.8; 95% CI, 1.1–13.8).

CONCLUSION: These results confirm two earlier reports and expand the literature by showing that women who are small at birth and who become overweight as adults are at particularly high risk of the development of preeclampsia.

Section snippets

Study design and population

This case-control study was conducted at Swedish Medical Center in Seattle, Wash, and Tacoma General Hospital in Tacoma, Wash, from April 1998 through February 2001. During this study period, we identified 233 women with preeclampsia. We used the then-current American College of Obstetricians and Gynecologists guidelines to create an operational clinical research definition for preeclampsia.¹⁶ These guidelines defined preeclampsia as sustained pregnancy-induced hypertension with proteinuria.

Results

The sociodemographic, medical, and reproductive characteristics of cases and control subjects are presented in Table I. Cases tended to be younger, nulliparous, heavier, and more likely to have a family history of hypertension.

Unadjusted and adjusted odds ratios of preeclampsia risk according to maternal birth weight category are shown in Table II. Those women who were in the lowest birth weight category had the greatest risk of preeclampsia; those women who had weighed the most at birth had

Comment

Women who reported a birth weight of <2500 g were found to be at an increased risk of the development of preeclampsia in this case-control study. After an adjustment for confounders was made, women who were in this lowest birth weight group had a 2.3-fold increased risk compared with women who weighed between 2500 and 2999 g at birth. Women who weighed 3000 to 3999 g or ≥4000 g at birth had a 44% and 54% reduced risk of preeclampsia, respectively, although these associations were not

Acknowledgements

We thank the participants of the Alpha Study for their cooperation and Malou Andresen, Penny Anders-Bartolo, Ihunnaya Frederick, Raymond Miller, Trudi Witt, and Kathy Ramsey for their technical expertise.

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Advancements in medical technology and pharmacologic interventions have drastically improved survival of infants born preterm and low birth weight, but knowledge regarding the long-term health impacts of these individuals is limited and inconsistent.
To investigate whether an individual's birthweight or history of being born preterm increases the risk of an adverse reproductive outcome.
Nested case-control study within the Women's Health Initiative.
79,934 individuals who self-reported their personal birthweight category and/or preterm birth status.
Self-reported pregnancy outcomes: subfertility, miscarriage, stillbirth, preeclampsia, gestational diabetes, gestational hypertension, preterm birth, low birthweight infant, high birthweight infant. Logistic regression models were used to estimate unadjusted and adjusted odds ratios (OR).
After adjustments, individuals reporting their birthweight <6lbs. were 20 % more likely to have a stillbirth or 70 % more likely to have a low birthweight infant and were less likely to have a full-term birth or high birthweight infant during their pregnancy. Individuals reporting a birthweight ≥10 lbs. were more likely to have a high birthweight infant (OR 3.49, 95 % CI 2.73–4.39) and less likely to have a low birthweight infant (OR 0.64, 95 % CI 0.47–0.82). Individuals born preterm were at increased risk for infertility, miscarriage, preeclampsia, gestational diabetes, and delivering a preterm or low birthweight infant.
As more individuals born preterm and/or low birthweight survive to adulthood, the incidence and prevalence of poor reproductive outcomes may increase. Women born at extremes of birthweight and prematurity may need to be monitored more closely during their own pregnancies.
Maternal low birth weight and hypertensive disorders of pregnancy
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Compared with previous reports, the odds ratio for HDP among women born with low birth weight in this study was lower, and there was no statistically significant association between maternal low birth weight and preeclampsia (p = 0.09). Although this is also in line with a previous study [12], possible explanations for the lack of association between maternal low birth weight and preeclampsia were: (1) the pathophysiological difference between HDP and preeclampsia; (2) differences in race and country, and (3) the potential risk for developing preeclampsia may be different between women born at preterm without growth restrictions and women born at term with growth restrictions, despite comparable birth weights. Firstly, HDP not only refers to preeclampsia, but also to gestational hypertension, superimposed preeclampsia, and chronic hypertension, indicating a heterogeneous pathophysiology [24].
To investigate the association between maternal own low birth weight (<2500 g) and subsequent risks for hypertensive disorders of pregnancy (HDP) and preeclampsia.
A multicenter retrospective study was conducted using clinical data from 12 primary maternity care units from 2012 to 2018. A total of 17,119 women with information about their own birth weight, who delivered at term, were subdivided into four groups according to maternal birth weights [(<2500, 2500–3499, 3500–3999, and ≥4000) g].
Multivariate regression analyses were conducted to evaluate the risks for HDP and preeclampsia among women born with low birth weight compared with women born with a birth weight of 2500–3499 g. We evaluated these risks, stratified by pre-pregnancy BMI or their infants’ birth weight categories.
Maternal low birth weight was an independent risk factor for HDP after adjustment for several covariates, but not for preeclampsia. A 100-g increase in maternal birth weight was associated with a 3% risk reduction for HDP. Additionally, women born with low birth weight had the highest risk for HDP among those with a pre-pregnancy BMI of ≥25 kg/m². Conversely, women born with high birth weight (≥4000 g) had the highest risk for preeclampsia if they complicate with fetal growth restrictions.
Women born with low birth weight had an increased risk for HDP. Collection of information on maternal birth weight may facilitate the prediction of HDP and patients’ self-awareness of such risk, allowing the modification of lifestyle factors associated with HDP.
Low birth weight and abnormal pre-pregnancy body mass index were at higher risk for hypertensive disorders of pregnancy
2020, Pregnancy Hypertension
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The association between low birth weight and HDP in Asian people has not been well explored, and there has been no study of Japanese women. It was reported that women who were born small and became overweight in later life had a particularly high risk for subsequent HDP [14]. On the other hand, there was no study that statistically assessed the risk for HDP in women who were born small and were underweight in later life.
Low birth weight is known to be associated with hypertension, cardiovascular disease and hypertensive disorders of pregnancy (HDP); however, this association might vary by race/ethnicity. This study aimed to clarify the association between women’s own birth weight and their subsequent risk for HDP in a Japanese population, in combination with pre-pregnancy body mass index (BMI). We conducted a cohort study as part of the Tohoku Medical Megabank Birth and Three-Generation Cohort Study in Miyagi, Japan. Our study’s population included 4810 women. A multivariate logistic regression analysis was performed to calculate the adjusted odds ratio (aOR) and the 95% confidence interval (CI) of the women’s own birth weight for HDP, in the combination categories of birth weight and pre-pregnancy BMI. As a result, the group with a low birth weight of <2500 g had a significant association with HDP (the aOR, 1.50; 95% CI, 1.02–2.21). In the subtype analysis, the odds ratio for only preeclampsia was significantly increased in the low birth weight group (aOR, 3.37; 95% CI, 1.84–6.16). In the group with a low birth weight, the prevalence of HDP was higher in both the underweight and overweight groups. In conclusion, there was a significant association between low birth weight and subsequent HDP in Japanese women. Furthermore, a significant association with HDP was found for women born with a low birth weight who were underweight or overweight as adults. Maintaining a normal weight may be effective for preventing HDP even if a woman was born small.
Prematurity, smallness-for-gestational age and later hospital admissions: A nation-wide registry study
2015, Early Human Development
Citation Excerpt :
The hypothesis of the developmental origins of adult disease, also known as the Barker hypothesis, states that intrauterine conditions affect the risk of disease later in life, especially cardiovascular disease [2,3]. Many studies have confirmed this hypothesis, and SGA has been shown to be associated with development of gestational diabetes mellitus, pre-eclampsia as well as type 2 diabetes later in life [4–7]. Preterm birth is also a risk factor for the same diseases, partly due to the high incidence of SGA in the preterm population, and possibly due to postnatal growth restriction [7].
Being born premature or small for gestational age (SGA) is known to be associated with diseases later in life, such as gestational diabetes, hypertension and pre-eclampsia. In this study we examined the association between being born premature or SGA and all diseases diagnosed during hospital admissions later in life.
Using Danish nation-wide registries we created a cohort of 1,348,106 persons born 1974–1996 and assessed all unique diagnoses registered in the Danish Patient Registry (DPR) for hospital admissions in the period 1994–2007 (n = 27,910,558). We determined the odds ratios for persons born premature or SGA using multivariate logistic regression.
A total of 15,059 unique ICD‐10 diagnosis codes were represented in the period. Only diagnoses used at least 100 times were included in the analysis (n = 4175). Of these 838 showed an odds ratio that was statistically significantly different from unity for people born premature or SGA. After correcting for multiple testing, 250 remained significant. The diagnoses covered diseases in most organ systems, including cardiovascular, endocrinological, infectious, neurological/neurosurgical, obstetric, orthopedic, psychiatric, lung & urological diseases, and occurred throughout childhood and early adulthood. Novel findings included increased risks for delayed puberty, neurofibromatosis type 1 and ileus and decreased risks of mononucleosis, peritonsillar abscesses, chronic hypothyroidism and several types of fractures and contusions later in life.
Being born premature or SGA was associated with significantly altered risks of being admitted to a hospital with a wide range of diseases later in life, affecting almost all organ systems throughout childhood and early adulthood. Our findings may motivate testing in other cohorts and search for novel mechanisms of pathogenesis.
Effect of low birth weight on women's health
2014, Clinical Therapeutics
The theory of the developmental origins of health and disease hypothesizes that low birth weight (≤5.5 lb) indicative of poor fetal growth is associated with an increased risk of chronic, noncommunicable disease in later life, including hypertension, type 2 diabetes mellitus, and osteoporosis. Whether women are at greater risk than men is not clear. Experimental studies that mimic the cause of slow fetal growth are being used to examine the underlying mechanisms that link a poor fetal environment with later chronic disease and investigate how sex and age affect programmed risk. Thus, the aims of this review are to summarize the current literature related to the effect of low birth weight on women’s health and provide insight into potential mechanisms that program increased risk of chronic disease across the lifespan.
A search of PubMed was performed with the keywords low birth weight, women’s health, female, and sex differences; additional terms included blood pressure, hypertension, renal, cardiovascular, obesity, glucose intolerance, type 2 diabetes, osteoporosis, bone health, reproductive senescence, menopause, and aging.
The major chronic diseases associated with low birth weight include high blood pressure and cardiovascular disease, impaired glucose homeostasis and type 2 diabetes, impaired bone mass and osteoporosis, and early reproductive aging.
Low birth weight increases the risk of chronic disease in men and women. Low birth weight is also associated with increased risk of early menopause. Further studies are needed to fully address the effect of sex and age on the developmental programming of adult health and disease in women across their lifespan.
Pre-eclampsia: Risk factors and causal models
2011, Best Practice and Research: Clinical Obstetrics and Gynaecology
Citation Excerpt :
They are also more likely to have hypertension that is independent of pregnancy.58 Similar results were reported by Dempsey et al.,59 who also found the risk in African–American women to be higher than the risk in white or Hispanic women, and by Knuist et al., who found black women to have a doubled risk compared with white women.60 Women of other ethnic origins (Mediterranean, Asian or other) also had higher risks, but the numbers were small, and the estimates did not reach significance.
Pre-eclampsia is a disease of many risk factors and theoretical speculations.
It is, for unknown reasons, more prevalent among primiparous women. Some observations show that a change of sexual partner before the next pregnancy increases the risk, but this association disappears when correction is made for time interval since the last birth. Risk factors may be pregnancy-specific, such as twinning or mole, whereas others are linked to the woman, such as obesity and diabetes. Genetic risk factors are being searched for, but as yet with relatively little success. A previous pregnancy complicated by pre-eclampsia is probably the strongest risk factor. For practical purposes, women at increased risk can be identified and should be followed closely. No effective primary preventative action is available. Prevention of the serious consequences of pre-eclampsia still relies on early detection of increases in blood pressure and proteinuria.

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^☆: Supported in part by awards from the National Institutes of Health (HD/HL R01-34888) and from the Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services (MCJ-530837).

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Weight at birth and subsequent risk of preeclampsia as an adult☆

Abstract

Section snippets

Study design and population

Results

Comment

Acknowledgements

Am J Clin Nutr

Obstet Gynecol

Am J Kidney Dis

Fetal origins of adult disease: epidemiology and mechanisms

J Clin Pathol

Rate of intra-uterine growth

Nature

Maternal birth weight and subsequent pregnancy outcome

JAMA

Low birth weight across generations

JAMA

The Washington State Intergenerational Study of Birth Outcomes: methodology and some comparisons of maternal birthweight and infant birth weight and gestation in four ethnic groups

Paediatr Perinat Epidemiol

Fetal programming of human disease

Birth weight and adult hypertension and obesity in women

Circulation

Fetal and infant growth and cardiovascular risk factors in women

BMJ

A population-based cohort study of the relation between maternal birth weight and risk of gestational diabetes mellitus in four race/ethnic groups

Paediatr Perinat Epidemiol

Association of a woman's own birth weight with subsequent risk for gestational diabetes

JAMA