Low birth weight is associated with higher blood pressure variability from childhood to young adulthood: the Bogalusa Heart Study

Effect of antenatal care on low birth weight: a systematic review and meta-analysis in Africa, 2022

Background

Risk identification, as well as the prevention and management of diseases associated with pregnancy or other conditions that may occur concurrently, is the essential component of ANC.

Method

The observational follow-up and cross-sectional studies on the effect of antenatal care on low birth weight in Africa were conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Five computerized bibliographic databases: Google Scholar, PubMed, Scopus, Cochrane Library, and Hinari Direct were searched for published studies written in English till May 2022. The risk of bias assessment tools developed by the Joanna Briggs Institute for cross-sectional and observational follow-up research was used, and the caliber of each included study was assessed. Seven papers were included, with a total of 66,690 children participating in the study.

Results

Seven studies met the selection criteria. Prenatal care and low birth weight were linked in four of the seven studies included in the review. The pooled odd ratio for low birth weight in the random-effects model was 0.46 (95% CI: 0.39, 0.53). The pooled odds ratio for low birth weight was 0.21 (95% CI: 0.19, 0.22) and 0.21 (95% CI: 0.19, 0.22), respectively, among pregnant women who had no antenatal care follow-up and those who had antenatal care follow up.

Conclusion

Women who attended at least one antenatal care appointment were more likely than their counterparts to have a baby of normal weight. Interventions to reduce low birth weight in Africa should focus on providing adequate antenatal care and quality healthcare services to women with low socioeconomic status.

Fetal growth restriction followed by early catch-up growth impairs pancreatic islet morphology in male rats

Fetal growth restriction (FGR), followed by postnatal early catch-up growth, is associated with an increased risk of metabolic dysfunction, including type 2 diabetes in humans. This study aims to determine the effects of FGR and early catch-up growth after birth on the pathogenesis of type 2 diabetes, with particular attention to glucose tolerance, pancreatic islet morphology, and fibrosis, and to elucidate its mechanism using proteomics analysis. The FGR rat model was made by inducing mild intrauterine hypoperfusion using ameroid constrictors (ACs). On day 17 of pregnancy, ACs were affixed to the uterine and ovarian arteries bilaterally, causing a 20.9% reduction in birth weight compared to sham pups. On postnatal day 4 (P4), the pups were assigned to either the good nutrition (GN) groups with 5 pups per dam to ensure postnatal catch-up growth or poor nutrition groups with 15 pups per dam to maintain lower body weight. After weaning, all pups were fed regular chow food ad libitum (P21). Rats in both FGR groups developed glucose intolerance; however, male rats in the FGR good nutrition (FGR-GN) group also developed hypertriglyceridemia and dysmorphic pancreatic islets with fibrosis. A comprehensive and functional analysis of proteins expressed in the pancreas showed that FGR, followed by early catch-up growth, severely aggravated cell adhesion-related protein expression in male offspring. Thus, FGR and early catch-up growth caused pancreatic islet morphological abnormalities and fibrosis associated with the disturbance of cell adhesion-related protein expressions. These changes likely induce glucose intolerance and dyslipidemia in male rats.

Antenatal Programming of Hypertension: Paradigms, Paradoxes, and How We Move Forward

PURPOSE OF REVIEW

Synthesize the clinical, epidemiological, and preclinical evidence for antenatal programming of hypertension and critically appraise paradigms and paradoxes to improve translation.

RECENT FINDINGS

Clinical and epidemiological studies persistently demonstrate that antenatal factors contribute to programmed hypertension under the developmental origins of health and disease framework, including lower birth weight, preterm birth, and fetal growth restriction. Preclinical mechanisms include preeclampsia, maternal diabetes, maternal undernutrition, and antenatal corticosteroid exposure. However, clinical and epidemiological studies to date have largely failed to adequately identify, discuss, and mitigate many sources and types of bias in part due to heterogeneous study designs and incomplete adherence to scientific rigor. These limitations have led to incomplete and biased paradigms as well as persistent paradoxes that have significantly limited translation into clinical and population health interventions. Improved understanding of these paradigms and paradoxes will allow us to substantially move the field forward.

Characterizing the supragingival microbiome of healthy pregnant women

The ecological characteristics and changes of the supragingival plaque microbial community during pregnancy are poorly understood. This study compared the microbial community characteristics of supragingival plaque in pregnant and non-pregnant women, with the aim of identifying specific microbial lineages and genera that may be associated with pregnancy. Thirty pregnant women were randomly selected from the First Affiliated Hospital of Xinjiang Medical University and divided into groups based on pregnancy trimester: first trimester (group P1, n=10, ≤12 weeks), second trimester (group P2, n=10, 13–27 weeks), and third trimester (group P3, n=10, 28–40 weeks). Ten healthy non-pregnant women (group N) were enrolled as the control group. Supragingival plaque samples of all subjects were collected and oral microbial composition was surveyed using a 16S rRNA gene sequencing approach. Statistical analysis was performed using a nonparametric test. The Chao 1 index of P3 was significantly lower compared with that of N, P1, and P2 (P<0.05). The Simpson indices of P2 and P3 were significantly higher than that of N (P<0.05). The Shannon index of P2 was significantly higher compared with that of N (P<0.05). Principal coordinate analysis (PCoA) showed different clustering according to the pregnancy status. Linear discriminant analysis effect size (LEfSe) revealed that the microbial species in group N that were significantly different from those of other groups were concentrated in the genus Neisseria. Species in P1 that were significantly different from those of other groups were concentrated in the genus Tannerella, while those in P2 and P3 were concentrated in the genus Leptotrichia. A total of 172 functional pathways were predicted for the bacterial communities in this study using PICRUSt2. Principal Component Analysis (PCA) showed that most predicted functional pathways clustered together in N and P1 and in P2 and P3. LEfSe analysis revealed that 11 pathways played a discriminatory role in the four groups. This work suggests a potential role of pregnancy in the formation of supragingival plaque microbiota and indicates that physiological changes during pregnancy may convert supragingival plaque into entities that could cause harm, which may be a risk factor for maternal health. Furthermore, findings from the study provide a basis for etiological studies of pregnancy-associated oral ecological disorders.

Low Birthweight as a Risk Factor for Non-communicable Diseases in Adults

According to studies undertaken over the past 40 years, low birthweight (LBW) is not only a significant predictor of perinatal death and morbidity, but also increases the risk of chronic non-communicable diseases (NCDs) in adulthood. The purpose of this paper is to summarize the research on LBW as a risk factor for NCDs in adults. The Barker hypothesis was based on the finding that adults with an LBW or an unhealthy intrauterine environment, as well as a rapid catch-up, die due to NCDs. Over the last few decades, terminology such as thrifty genes, fetal programming, developmental origins of health and disease (DOHaD), and epigenetic factors have been coined. The most common NCDs include cardiovascular disease, diabetes mellitus type 2 (DMT2), hypertension (HT), dyslipidemia, proteinuria, and chronic kidney disease (CKD). Studies in mothers who experienced famine and those that solely reported birth weight as a risk factor for mortality support the concept. Although the etiology of NCD is unknown, Barry Brenner explained the notion of a low glomerular number (nGlom) in LBW children, followed by the progression to hyperfiltration as the physiopathologic etiology of HT and CKD in adults based on Guyton's renal physiology work. Autopsies of several ethnic groups have revealed anatomopathologic evidence in fetuses and adult kidneys. Because of the renal reserve, demonstrating renal function in proportion to renal volume in vivo is more difficult in adults. The greatest impact of these theories can be seen in pediatrics and obstetrics practice.

Association between birth weight and risk of cardiovascular disease: Evidence from UK Biobank

BACKGROUND AND AIMS

Birth weight has been linked to cardiovascular disease (CVD) risk in adulthood, but no consensus has emerged on the threshold of birth weight for the lowest CVD risk and few studies have examined potential interaction between birth weight and adult adiposity.

METHODS AND RESULTS

A total of 256,787 participants, who had birth weight data and were free of CVD at baseline, were included from UK Biobank. Multivariate restricted cubic splines and Cox regression models were used to assess the association between birth weight and CVD. We observed nonlinear inverse associations of birth weight with the risk of coronary heart disease (CHD), stroke, and heart failure. Participants with the first quintile of birth weight (≤2.85 kg) had higher risks for CHD (hazard ratio [HR] = 1.23, 95% confidence interval [CI]: 1.15-1.32), stroke (HR = 1.19, 95% CI: 1.03-1.37), and heart failure (HR = 1.28, 95% CI: 1.11-1.48), as compared to the fourth quintile (3.41-3.79 kg). There was a significant interaction between birth weight and adult body mass index (BMI) on CHD and heart failure (both P for interaction <0.001), showing the highest risk for those who had birth weight ≤2.85 kg and BMI ≥30 kg/m² (HR = 1.96, 95% CI: 1.70-2.25 and HR = 2.39, 95% CI: 1.77-3.22, respectively).

CONCLUSIONS

Our findings indicate nonlinear inverse associations between birth weight and CVD risk, with a threshold of 3.41-3.79 kg for the lowest risk. Moreover, low birth weight may interact with adult obesity to increase the risk of CHD and heart failure.

Maternal investment, life-history trajectory of the off-spring and cardiovascular disease risk in Emirati females in the United Arab Emirates

Background

Variations in cardiovascular disease risk (CVD) are suggested to be partly influenced by factors that affect prenatal growth patterns and outcomes, namely degree of maternal investment (proxied by birth weight and gestational age). Using the life history trajectory model, this study investigates whether maternal investment in early prenatal life associates with menarcheal age and whether maternal investment affects CVD risk in adulthood and predicts adult size and adiposity levels.

Methods

A cross-sectional study was conducted among 94 healthy Emirati females. Birth weight, gestational age and menarcheal age were obtained. Anthropometrical measurements, body composition analysis, and blood pressure values were collected. Regression analyses were conducted to establish associations.

Results

There was no association between birth weight standard deviation score (SDS) and age at menarche. When investigating the associations of birth weight SDS and age at menarche with growth indices, it was found that only birth weight was positively and significantly associated with both height (β = 1.342 cm, 95% CI (0.12, 2.57), p = 0.032) and leg length (β = 0.968 cm, 95% CI (0.08, 1.86), p = 0.034). Menarcheal age was significantly and inversely associated with fat mass index (FMI) (β = − 0.080 cm, 95% CI (− 0.13, − 0.03), p = 0.002), but not with waist circumference and fat free mass index (FFMI) (p > 0.05). Birth weight SDS was positively and significantly associated with waist circumference (β = 0.035 cm, 95% CI (0.01, 0.06), p = 0.009), FMI (β = 0.087 cm, 95% CI (0.01, 0.16), p = 0.027), and FFMI (β = 0.485 cm, 95% CI (0.17, 0.80), p = 0.003). Birth weight SDS was not significantly associated with either systolic blood pressure (SBP) or diastolic blood pressure (DBP) (p > 0.05). However, FMI, waist circumference, and FFMI were positively and significantly associated with SBP. Regarding DBP, the relationship was negatively and significantly associated with only FFMI (β = − 1.6111 kg/m2, 95% CI (− 2.63, − 0.60), p = 0.002).

Conclusion

Although the results do not fully support that Emirati females fast-life history is associated with increased chronic disease risk, the data does suggest a link between restricted fetal growth in response to low maternal investment and metabolic and reproductive health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11182-0.

Long-Term Disturbed Expression and DNA Methylation of SCAP/SREBP Signaling in the Mouse Lung From Assisted Reproductive Technologies

Assisted reproductive technology (ART) has been linked to cholesterol metabolic and respiratory disorders later in life, but the mechanisms by which biosynthetic signaling remain unclear. Lung inflammatory diseases are tightly linked with the sterol regulatory element-binding protein (SREBP) and SREBP cleavage-activating protein (SCAP), but this has not been shown in an ART offspring. Here, mouse models from a young to old age were established including in vitro fertilization (IVF), intracytoplasmic injection (ICSI), and in vivo fertilized groups. In our results, significantly higher plasma levels of CRP, IgM, and IgG were identified in the aged ICSI mice. Additionally, pulmonary inflammation was found in four aged ART mice. At three weeks, ART mice showed significantly downregulated levels of Scap, Srebp-1a, Srebp-1c, and Srebf2 mRNA in the lung. At the same time, significant differences in the DNA methylation rates of Scap-Srebfs and protein expression of nuclear forms of SREBPs (nSREBPs) were detected in the ART groups. Only abnormalities in the expression levels of Srebp-1a and Srebp-1c mRNA and nSREBP1 protein were found in the ART groups at 10 weeks. However, at 1.5 years old, aberrant expression levels and DNA methylation of SCAP, SREBP1, and SREBP2, and their associated target genes, were observed in the lung of the ART groups. Our results indicate that ART increases long-term alterations in SCAP/SREBP expression that may be associated with their aberrant methylation status in mouse.

Associations of childhood adiposity with menstrual irregularity and polycystic ovary syndrome in adulthood: the Childhood Determinants of Adult Health Study and the Bogalusa Heart Study

STUDY QUESTION

Is high adiposity in childhood associated with menstrual irregularity and polycystic ovary syndrome (PCOS) in later life?

SUMMARY ANSWER

Overall, greater childhood BMI was associated with menstrual irregularity, and greater childhood BMI and waist/height ratio (WHtR) in white but not black participants were associated with PCOS in adulthood.

WHAT IS KNOWN ALREADY

Increased childhood BMI has been associated with irregular menstrual cycles and PCOS symptoms in adulthood in two longitudinal population-based studies, but no study has reported on associations with childhood abdominal obesity. Few studies have investigated whether there are racial differences in the associations of adiposity with PCOS though there has been some suggestion that associations with high BMI may be stronger in white girls than in black girls.

STUDY DESIGN, SIZE, DURATION

The study included 1516 participants (aged 26-41 years) from the Australian Childhood Determinants of Adult Health study (CDAH) and 1247 participants (aged 26-57 years) from the biracial USA Babies substudy of the Bogalusa Heart Study (BBS) who were aged 7-15 years at baseline. At follow-up, questions were asked about menstruation (current for CDAH or before age 40 years for BBS), ever having had a diagnosis of PCOS and symptoms of PCOS.

PARTICIPANTS/MATERIALS, SETTING, METHODS

In CDAH, a single childhood visit was conducted in 1985. In BBS, multiple childhood visits occurred from 1973 to 2000 and race was reported (59% white; 41% black). In childhood, overweight and obesity were defined by international age-sex-specific standards for BMI and WHtR was considered as an indicator of abdominal obesity. Multilevel mixed-effects Poisson regression estimated relative risks (RRs) adjusting for childhood age, highest parental and own education and age at menarche.

MAIN RESULTS AND THE ROLE OF CHANCE

The prevalence of childhood obesity was 1.1% in CDAH and 7.5% in BBS. At follow-up, menstrual irregularity was reported by 16.7% of CDAH and 24.5% of BBS participants. The prevalence of PCOS was 7.4% in CDAH and 8.0% in BBS participants. In CDAH, childhood obesity was associated with menstrual irregularity (RR = 2.84, 95% CI: 1.63-4.96) and PCOS (RR = 4.05, 95% CI: 1.10-14.83) in adulthood. With each 0.01 unit increase in childhood WHtR there was a 6% (95% CI: 1-11%) greater likelihood of PCOS. Overall, in BBS, childhood obesity was associated with increased risk of menstrual irregularity (RR = 1.44, 95% CI: 1.08-1.92) in adulthood. Significant interaction effects between race and childhood adiposity were detected in associations with PCOS. In BBS white participants, childhood obesity was associated with PCOS (RR = 2.93, 95% CI: 1.65-5.22) and a 0.01 unit increase in childhood WHtR was associated with an 11% (95% CI: 5-17%) greater likelihood of PCOS in adulthood. In BBS black participants, no statistically significant associations of childhood adiposity measures with PCOS were observed.

LIMITATIONS, REASONS FOR CAUTION

The classification of menstrual irregularity and PCOS was based on self-report by questionnaire, which may have led to misclassification of these outcomes. However, despite the limitations of the study, the prevalence of menstrual irregularity and PCOS in the two cohorts was consistent with the literature. While the study samples at baseline were population-based, loss to follow-up means the generalizability of the findings is uncertain.

WIDER IMPLICATIONS OF THE FINDINGS

Greater childhood adiposity indicates a higher risk of menstrual irregularity and PCOS in adulthood. Whether this is causal or an early indicator of underlying hormonal or metabolic disorders needs clarification. The stronger associations of adiposity with PCOS in white than black participants suggest that there are racial differences in childhood adiposity predisposing to the development of PCOS and other environmental or genetic factors are also important.

STUDY FUNDING/COMPETING INTEREST(S)

The CDAH study was supported by grants from the Australian National Health and Medical Research Council (grants 211316, 544923 and 1128373). The Bogalusa Heart Study is supported by US National Institutes of Health grants R01HD069587, AG16592, HL121230, HD032194 and P50HL015103. No competing interests existed.

School-based surveillance on visit-to-visit blood pressure variability and high blood pressure in children and adolescents

Background

The predictive importance of visit-to-visit blood pressure variability (VVV) for high blood pressure (HBP) in a pediatric population has been largely unsettled. We aimed to evaluate it based on Health Promotion Program for Children and Adolescents (HPPCA), a school-based surveillance conducted from 2012 to 2018 in Suzhou, China.

Methods

A total of 330,618 participants had BP measurement in 2018 and ≥ 3 BP records during 2012–2017, were recruited from HPPCA. Absolute BP values (in mmHg) were converted into age-, sex- and height- normalized z-scores. VVV was expressed as standard deviation (SD), coefficient of variation (CV) or average real variability (ARV) of BP z-scores during 2012–2017. Logistic regression models were used to assess the associations between VVV and HBP in 2018.

Results

In 2018, 42,554 (12.87%) subjects were defined as HBP. VVV, except for SBP-CV and DBP-CV, was significantly higher in the HBP group than normotensives group. After adjusting for covariates including mean BP values from 2012 to 2017, SBP-SD, SBP-ARV, DBP-SD and DBP-ARV, increased the risk of HBP by 5.70 [95% confidence interval (95% CI) 5.54–5.87], 4.10 (95% CI 4.01–4.20), 4.70 (95% CI 4.50–4.90) and 3.39 (95% CI 3.28–3.50) times, respectively. Notably, SBP-SD significantly improved risk discrimination of HBP based on other risk variables (c-statistics, net reclassification index and integrated discrimination improvement significantly increased).

Conclusions

Higher SD or ARV of BP, was independently related with higher probability of HBP in Chinese pediatric population. SBP-SD could be potentially helpful for detecting HBP. Future researches investigating the predictive value of VVV are warrant.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-01947-1.

Association between birthweight, cardiovascular risk factors, and depression in young Mexican adults

Introduction

Background: the aim of this study was to investigate the association between birthweight, cardiovascular disease (CVD) risk factors, and depression in young Mexican adults. Methods: birthweight reports, family history of CVD and diabetes-related diseases, anthropometrics, serum lipid profile (total cholesterol [TC], triglycerides [TG], high-density lipoprotein-cholesterol [HDL-C], low-density lipoprotein-cholesterol [LDL-C], and very-low density lipoprotein-cholesterol [VLDL-C]), and depressive symptoms were measured in 778 subjects of the UP-AMIGOS cohort study. To investigate the association between birthweight categories and CVD risk factors and depression, a one-way analysis of variance with post-hoc test was performed of quantitative variables, and 2 test for qualitative variables. Results: mean age was 17.8 years and 469 (60.3 %) of patients were female (n = 469, 60.3 %). The percentage of patients with low birthweight (LBW) was 8.1 % (n = 63), and 3.3 % (n = 26) reported high birthweight (HBW). Young adults with HBW were associated with elevated diastolic blood pressure (DBP), and high weight and body mass index (BMI) when compared to LBW subjects, the difference being statically significant (p < 0.05). Birthweight had no significant association with depression (p > 0.67). Conclusion: the findings from this population-based study revealed a positive relation between birthweight categories and some CVD risk factors. Depression was not related to birthweight.

Developmental origins of health and disease theory in cardiology

Numerous epidemiological and animal studies disclosed that birth weight is inversely associated with the incidence of the lifestyle-related disorders in adult life, such as cardiovascular disease, diabetes, and /or chronic kidney disease. Lower birth weight occurs in numerous undesired intrauterine environments including malnutrition, smoking, alcohol consumption, or stress.　The Developmental Origin of Health and Disease (DOHaD) theory is based on the concept that the origins of lifestyle-related disease is formed at the time of fertilization, embryonic, fetal, and neonatal stages by the interrelation between genes and the environments (nutrition, stress, or environmental chemicals). Adult disease develops after delivery facing to abnormal environments such as over-nutrition, much stress, or lack of exercise. Disease develops through these two insults. This concept was first proposed as the "Barker Hypothesis." David Barker had discovered the relation between the lower birth weight and the higher prevalence of ischemic heart disease mortality. Previous epidemiologic studies have found the people exposed to famine during early life had higher risks of cardiovascular diseases in adulthood. Yet, the exact mechanisms that permanently change the structure, physiology, and endocrine status of an individual across their lifespan following altered growth during fetal life are not entirely clear. Epidemiological studies including prospective cohort and observational analysis of the people exposed to malnutrition during fetal or infancy have disclosed the strong relation between the lower birth weight and the higher cardiovascular risks in adults. Recent progress of epigenetic studies unveiled strong genetic association. Hormonal regulation and epigenetic modifications have an important role for proper organ development and physiological functions. The molecular mechanism of predisposition is supposed to be the epigenetics modifications.　Their dysregulation is related to the acquisition of the disease-susceptible trait. In this review, we overview the concept of DOHaD and introduce related clinical and basic research.

Variabilities in Childhood Cardiovascular Risk Factors and Incident Diabetes in Adulthood: The Bogalusa Heart Study

OBJECTIVE

Although emerging evidence indicates that increased variability in cardiovascular risk factors (CVRFs) among populations at midlife or later is a reliable predictor of adverse health outcomes, it is unknown whether intraindividual CVRF variability during childhood or adolescence is an independent predictor of later-life diabetes. We aimed to examine the association of CVRF variability during childhood with diabetes in later life.

RESEARCH DESIGN AND METHODS

We included 1,718 participants who participated in the Bogalusa Heart Study and had measures at least four times during childhood (aged 4-19 years). The mean follow-up period was 20.5 years. Intraindividual CVRF variabilities during childhood were calculated using SD, coefficient of variation, deviation from age-predicted values, and residual SD based upon four to eight serial measurements in childhood.

RESULTS

Increased variability in BMI or HDL cholesterol (HDL-C) during childhood, irrespective of the indices used, was significantly positively associated with later-life diabetes risk independent of their respective mean levels in childhood and other possible confounding factors. In combined analysis, the magnitude of the association with diabetes risk was similar for high childhood BMI variability and high childhood HDL-C variability. After adjustments for potential confounding variables, other CVRF variabilities including systolic/diastolic blood pressure, total cholesterol, triglycerides, and LDL cholesterol were not significantly associated with diabetes.

CONCLUSIONS

Increased BMI and HDL-C variabilities during childhood were significant risk factors for the development of diabetes independently of diverse risk factors, which may offer new insights into the childhood origin of adult-onset diabetes.

Gap analysis on hospitalized health service utilization in floating population covered by different medical insurances ----- case study from Jiangsu Province, China

Objective

By analyzing the gap of hospitalization service among floating population covered by different medical insurance in Jiangsu Province, this paper aimed to understand the current situation of hospitalized health service utilization (HHSU) among floating population, and to provide policy suggestions for improving HHSU of floating population with different health insurance.

Methods

The data of this study were obtained from “the National Dynamic Monitoring Survey of Floating Population in 2014”. A total of 12,000 samples of floating population in Jiangsu Province were selected. 57.15% for men and 42.85% for women; 46.95% for those under 30 years old, 39.67% for 30 to 45 years old, 13.38% for over the age of forty-five. Using descriptive statistical analysis, chi-square test, exploratory factor analysis, logistic regression and stepwise multiple linear regression, the paper analyzed the difference of HHSU of floating population with different medical insurance in 2014. This study divided basic medical insurance into 3 categories: MIUE (Medical Insurance of Urban Employee), other medical insurances (including new rural cooperative medical system and the medical insurance for urban residents) and no medical insurance.

Results

The hospitalization rate of floating population with MIUE (89.95%) was higher than the rate of floating population with other medical insurances (74.76%) and the gap is 15.19%. It was also higher than the rate of floating population with no medical insurance (67.57%) and the gap is 22.38%. (chi-square = 24.958, p = 0.000). 15.34% of floating population with MIUE spent more than 1600 dollars during hospitalization. It was lower than floating population with other medical insurances (16.19%) and no medical insurance (21.62%). The gaps respectively were 0.85 and 6.28% (chi-square = 10.000, p = 0.040). There existed significant differences among hospitalization medical expenses that floating population with different basic medical insurances spent. (chi-square = 225.206, p = 0.000) The type of basic medical insurance had statistical significance on whether the patients were hospitalized (p = 0.003) and whether they were hospitalized (p = 0.014). Logistic regression analysis results showed that “Social structure” (Education, Hukou, Insurance status and Work status) were significantly associated with Should be hospitalized but not and “Education” were significantly associated with Inpatient facilities selection. The stepwise multiple linear regression results presented that “Demography” and “Floating area” influenced In-hospital medical cost and “Social structure” and “Gender” influenced Reimbursement of in-hospital medical cost.

Conclusion

Medical insurance type affects the hospitalization health service utilization of floating population, including Should be hospitalized but not and Reimbursement of in-hospital medical cost.

Effect of premature birth on long-term systolic blood pressure variability in women

Objective:

To investigate the effect of premature birth (PTB) on long-term systolic blood pressure (SBP) variability (SBPV) in women.

Methods:

A total of 1974 pregnant women were divided into PTB group and non-PTB (NPTB) group. The SBP standard deviation (SSD) was calculated by four annual SBP values measured in 2006–2007, 2008–2009, 2010–2011, and 2012–2013. SBP coefficient of variation (SCV) was calculated by dividing SSD with mean SBP. Multivariate logistic regression analysis was used to analyze the influence of PTB on long-time SSD and SCV in women.

Results:

SSD and SCV of the PTB group (10.95 mm Hg and 9.05%, respectively) were higher than those of the NPTB group (9.81 mm Hg and 8.23%, respectively), but there were no significant differences (p>0.05). The number of patients with SSD >9.87 mm Hg and SCV >8.28% in the PTB and NPTB groups was 57 (51.40%) and 62 (55.90%) and 747 (40.10%) and 841 (45.10%), respectively. The number of patients with SSD >9.87 mm Hg and SCV >8.28% in the PTB group was significantly higher than that in the NPTB group (p<0.05). Multiple logistic regression analysis showed that after adjusting other risk factors, the PTB group was at a risk of SSD and SCV elevations with OR values of 1.60 (95% CI: 1.06–2.40) and 1.64 (95% CI: 1.10–2.45), respectively.

Conclusion:

PTB is a risk factor of long-time SBPV in women, which might be a potential reason for cardiovascular events. Pregnancy may be an important opportunity for early identification of women at an increased risk of cardiovascular disease later in life.

Association of low birth weight with thinness and severe obesity in children aged 3-12 years: a large-scale population-based cross-sectional study in Shanghai, China

OBJECTIVES

Low birth weight (BW) is a general symbol of inadequate intrauterine conditions that elicit abnormal fetal growth and development. The aim of current study is to investigate the relationship between low BW and thinness or severe obesity during maturation.

DESIGN

A large-scale cross-sectional population-based survey.

SETTING

134 kindergartens and 70 elementary schools.

PARTICIPANTS

70 284 Chinese children aged 3-12 years.

OUTCOME MEASURES

International Obesity Task Force body mass index (BMI) cut-offs were used to define grade 1, grade 2 and grade 3 thinness, overweight, obesity and severe obesity. Multinomial logistic regression was used to estimate the association between BW and BMI category.

RESULTS

A total of 70 284 children participated in the survey. The percentage of grade 1 thinness and severe obesity in children with low BW is significantly higher than that in children with normal BW (p<0.05). Low BW was associated with an increased risk of grade 1 thinness (OR 1.56, 95% CI 1.38 to 1.75), grade 2 thinness (OR 1.34, 95% CI 1.10 to 1.64), grade 3 thinness (OR 1.99, 95% CI 1.63 to 2.42) and severe obesity (OR 1.27, 95% CI 1.03 to 1.55) but was not associated with obesity (OR 0.85, 95% CI 0.67 to 1.06).

CONCLUSION

There is a positive association between low BW and thinness or severe obesity risk.

Noninvasive assessment of autonomic function in human neonates born at the extremes of fetal growth spectrum

Birth weight is associated with adult cardiovascular disease, such that those at both ends of the spectrum are at increased risk. This may be driven in part by modification to autonomic control, a mechanistic contributor to hypertension. However, birth weight is a relatively crude surrogate of fetal growth; and newborn body composition may more accurately identify the "at risk" infant. Accordingly, we sought to determine whether newborns with high or low body fat have altered autonomic control of vasomotor function and cardiac contractility. Body fat was assessed by air-displacement plethysmography <24 h postnatal. Measures of spontaneous baroreflex sensitivity (sBRS), blood pressure variability (BPV), and dP/dt_max variability were compared between newborns categorized according to established body fat percentiles: high body fat (HBF, >90th percentile, n = 7), low body fat (LBF, ≤10th percentile, n = 12), and normal body fat (control, >25th to ≤75th percentile, n = 23). BPV was similar across body fat percentiles; similarly, low frequency dP/dt_max variability was similar across body fat percentiles. sBRS was reduced in HBF compared to controls (11.0 ± 6.0 vs. 20.1 ± 9.4 msec/mmHg, P = 0.03), but LBF did not differ (18.4 ± 6.0 msec/mmHg, P = 0.80). Across the entire body fat spectrum (n = 62), there was a nonlinear association between newborn body fat and sBRS (P = 0.03) that was independent of birth weight (P = 0.04). Autonomic modulation of vasomotor function and cardiac contractility in the newborn did not differ by body fat, but newborns born with high body fat show depressed baroreflex sensitivity.

Association of accelerated body mass index gain with repeated measures of blood pressure in early childhood

Background/objectives

We examined the association for rates of age- and sex-standardized body mass index (zBMI) gain between 0–3, 3–18, and 18–36 months with BP in children at 36–72 months of age.

Methods

We collected repeated measures of zBMI and BP in 2502 children. zBMI was calculated using the World Health Organization standards. Each child’s zBMI at birth and rates of zBMI gain in each period from birth to 36 months were estimated using linear spline multilevel models. Generalized estimating equations were used to determine whether zBMI at birth and zBMI gain between 0–3, 3–18, and 18–36 months were each associated with repeated measures of BP at 36–72 months of age. We sequentially conditioned on zBMI at birth and zBMI gain in each period prior to each period tested, as covariates, and adjusted for important socio-demographic, familial, and study design covariates. We examined whether these associations were modified by birthweight or maternal obesity, by including interaction terms.

Results

After adjusting for all covariates and conditioning on prior zBMI gains, a 1 standard deviation unit faster rate of zBMI gain during 0–3 months, (β = 0.59 mmHg; 95% CI 0.31, 0.86) and 3–18 months (β = 0.74 mmHg; 95% CI 0.46, 1.03) were each associated with higher systolic BP at 36–72 months. No significant associations were observed, however, for zBMI at birth or zBMI gain in the 18–36 month growth period. zBMI gains from 0–3 and 3–18 months were also associated with diastolic BP. Birthweight significantly modified the relationship during the 3–18 month period (p = 0.02), with the low birthweight group exhibiting the strongest association for faster rate of zBMI gain with higher systolic BP (β = 1.31 mmHg; 95% CI 0.14, 2.48).

Conclusions

Given that long-term exposure to small elevations in BP are associated with subclinical cardiovascular disease, promoting interventions targeting healthy growth in infancy may be important.

Maternal Factors and Utilization of the Antenatal Care Services during Pregnancy Associated with Low Birth Weight in Rural Nepal: Analyses of the Antenatal Care and Birth Weight Records of the MATRI-SUMAN Trial

Low birth weight (LBW) remains a major public health problem in developing countries, including Nepal. This study was undertaken to examine the association between LBW and maternal factors and antenatal care service utilization, in rural Nepal, using data obtained for a capacity-building and text-messaging intervention, designed to enhance maternal and child health service utilization among pregnant women, in rural Nepal ("MATRI-SUMAN"). The study used a clustered randomized controlled design and was conducted during 2015⁻2016. We investigated maternal and antenatal care service utilization determinants of LBW, using a logistic regression model. Of the four hundred and two singleton babies, included in the present study, seventy-eight (19.4%) had an LBW (mean (SD), 2210.64 (212.47)) grams. It was found that Dalit caste/ethnicity, illiteracy, manual labor, a female baby, and having more than four family members were significantly positively associated with LBW. In addition, mothers who did not visit an antenatal care (ANC) unit, visited an ANC < 4 times, did not take iron and folic acid (IFA), de-worming tablets, and mothers that did not consume additional food, during pregnancy, were more likely to have an LBW baby, than their counterparts. The MATRI-SUMAN intervention and availability of a kitchen garden at home, were found to reduce the risk of LBW. Nepalese child survival policies and programs should pay attention to these maternal and antenatal care service utilization factors, while designating preventive strategies to improve child health outcomes.

Appetite during the second and third trimesters mediates the impact of prenatal environmental tobacco smoke exposure on symmetric full-term low birth weight

Objective: To examine the relationship of prenatal environmental tobacco smoke (ETS) exposure and full-term low birth weight (FT-LBW) when taking anthropometric proportionality into consideration, and explore whether appetite mediates their association.Study design: We conducted a case-control study among pregnant women at two Women and Children's Hospitals in Guangdong, China. Information was collected through interview and medical records review. A series of logistic and linear regressions were used to examine the relationships of prenatal ETS exposure, appetite, and FT-LBW.Results: After adjusting for the potential confounders, prenatal ETS exposure was significantly negatively associated with FT-LBW (OR: 1.83, 95%CI: 1.35-2.48) and negatively correlated with maternal appetite in second and third trimester during pregnancy (β: -0.11, standard error: 0.03). Moreover, mediation analysis illustrated that maternal appetite partially mediated 12.00% of their relationship. However, subgroup analysis showed that prenatal ETS exposure was linked to higher risk of symmetric FT-LBW (OR: 2.26, 95%CI: 1.56-3.26) but not asymmetric FT-LBW. And maternal appetite explained only 6.45% of their relationship.Conclusions: Maternal prenatal ETS exposure increased risk of having symmetric FT-LBW infant, and appetite might mediate their relationship partially. This study emphasizes the importance of sample homogeneity and stresses the needs to improve the public awareness of the harmful effects of ETS.

Both maternal and paternal risk factors for term singleton low birthweight infants in rural Chinese population: a population-based, retrospective cohort study

No large population-based study has focused on both maternal paternal risk factors for low birthweight (LBW) in China. We aimed to identify parental risk factors associated with LBW.A population-based, retrospective cohort study was conducted on 202,725 singleton infants at 37–42 weeks. These term singleton newborns were classified as LBW with birthweight ≤2500 g(TLBW) and normal birthweight between 50^th to 97^th percentile (TNBW 50^th–97^th) according to Chinese singleton norms. Multiple logistic regression analyses were used to find those parental risk factors of LBW by comparing two groups. TLBW and TNBW(50^th–97^th) occupied 4.8% and 70.8% of the study population, respectively. Logistic regression showed a significant association with positive maternal hepatitis B surface antigen (RR = 1.979, P = 0.047), irregular folic acid intake (RR = 1.152, P = 0.003), paternal history of varicocele (RR = 2.404, P = 0.003) and female babies (RR = 1.072, P = 0.046). Maternal smoking, hypertension and history of stillbirth were found related to LBW but no statistically significant. Positive maternal hepatitis B surface antigen, irregular folic acid intake, paternal history of varicocele had a negative effect on birth weight. Measures are necessarily taken to avoid them to improve pregnancy outcomes. Further studies should be done to investigate each detailed risk factors on LBW.

High birth weight modifies association between adolescent physical activity and cardiometabolic health in women and not men

Recent evidence suggests that adverse prenatal development alters physiological response to physical activity, but longitudinal epidemiologic evidence is scant. This study tested the hypothesis that lower physical activity during adolescence and young adulthood is more strongly associated with later cardiovascular disease (CVD) risk and diabetes or prediabetes (DM/PDM) in women and men who were born with high or low birth weight (HBW, LBW), compared to normal birth weight (NBW). We analyzed data from the National Longitudinal Study of Adolescent to Adult Health, a cohort study of US adolescents followed into adulthood (1994-2009). Using sex-stratified multivariable regression, 30-year CVD risk score (calculated using objective measures; n=12,775) and prevalent DM/PDM (n=15,138) at 24-32years of age were each modeled as a function of birth weight category, self-reported moderate-to-vigorous physical activity frequency in adolescence (MVPA1) and young adulthood (MVPA3), and MVPA-birth weight interactions. Greater MVPA1 was associated with lower 30-year CVD risk score and DM/PDM risk in HBW women but not NBW or LBW women. Associations between MVPA1 and 30-year CVD risk or DM/PDM were not modified by HBW in men; or by LBW in women or men. Additionally, birth weight did not modify estimated effects of MVPA3. Findings suggest that frequent MVPA in adolescence may be a particularly important cardiometabolic risk reduction strategy in girls born HBW; however, we found no evidence that birth weight and MVPA interact in cardiometabolic disease risk in men, for MVPA in adulthood, or for LBW.

Fetal Origins of Hypertension

Hypertension is a common noncommunicable disease. According to the World Health Organization, 1.13 billion people were suffering from hypertension in the year 2015. High blood pressure, hypertension, has a multifactorial etiology. Arterial atherosclerotic changes, systolic or diastolic dysfunction of the heart, and other noncardiac factors are involved. Epidemiological evidence has revealed that perinatal growth disturbance elevates the prevalence of hypertension. However, the specific effects of developmental disturbances on the pathological process of hypertension are poorly understood. Recently, it has become apparent that the perinatal period plays many essential roles in cardiovascular development. In this chapter, we focus on the perinatal development of the cardiovascular system, especially in murine models. Individual organs, blood, blood vessels, and the heart show unique growth characteristics during this period. We also introduce evidence from related clinical studies regarding the developmental origins of hypertension. Finally, evidence from several animal models is presented to reveal the effects of developmental disturbance or stress on arterial pathology. Improving our understanding of both developmental events and the results of clinical studies will give fresh insight into the fetal origins of hypertension.

Maternal socioeconomic factors and adverse perinatal outcomes in two birth cohorts, 1997/98 and 2010, in São Luís, Brazil

ABSTRACT: Several studies have identified social inequalities in low birth weight (LBW), preterm birth (PTB), and intrauterine growth restriction (IUGR), which, in recent years, have diminished or disappeared in certain locations. Objectives: Estimate the LBW, PTB, and IUGR rates in São Luís, Maranhão, Brazil, in 2010, and check for associations between socioeconomic factors and these indicators. Methods: This study is based on a birth cohort performed in São Luís. It included 5,051 singleton hospital births in 2010. The chi-square test was used for proportion comparisons, while simple and multiple Poisson regression models with robust error variance were used to estimate relative risks. Results: LBW, PTB and IUGR rates were 7.5, 12.2, and 10.3% respectively. LBW was higher in low-income families, while PTB and IUGR were not associated with socioeconomic factors. Conclusion: The absence or weak association of these indicators with social inequality point to improvements in health care and/or in social conditions in São Luís.

Clinical review of 24-35 year olds conceived with and without in vitro fertilization: study protocol

Background

Children conceived by assisted reproductive technologies (ART) currently comprise 4% of Australian births. The manipulation of biological parameters related to fertilization and implantation are integral to successful ART but potentially pose a risk to the longer-term health of the offspring. There is consensus that many common adult health problems (particularly cardiovascular, metabolic and respiratory conditions) have their origins in early life, possibly before birth, and that risk trajectories track through childhood until clinical disease manifests in adulthood. Early life epigenetic variation may play a role in this process. However little is known about the long-term health of individuals conceived by ART. In a previous study, based on telephone-interviews, we found that young adults conceived by in vitro fertilization (IVF) had significantly more maternal reported atopic respiratory, endocrine, nutritional, and metabolic conditions than non-IVF conceived matched controls. Here we outline the protocol for a follow-up biomedical assessment of this cohort and a questionnaire to obtain information on potential confounders.

Methods

We are conducting a clinical review of an existing, well characterised cohort comprising 547 IVF-conceived adults and 549 matched controls. We are measuring cardiovascular intermediate phenotypes, metabolic parameters and respiratory function, complemented by epigenome-wide DNA methylation analysis. A pilot study demonstrated the feasibility of our proposed protocol and its acceptability to participants. Participants attend a 2–3 h clinical assessment and complete a study-specific online questionnaire. Measurements include: 1) cardiovascular phenotypes: carotid artery intima-media thickness and distensibility, retinal vascular calibre, resting blood pressure, pulse wave velocity and pulse wave analysis; 2) respiratory function: spirometry, plethysmography, multiple breath washout; 3) auxology: height, weight, waist circumference, bio-impedance. Blood is collected for 4) biomarkers of cardiometabolic profile including inflammatory markers and 5) epigenetic analysis.

Discussion

Recruitment for this clinical review is challenging as many of the participants have moved to regional, interstate or international locations. Additionally, many female participants are pregnant or breastfeeding, and are therefore ineligible. Nevertheless, comprehensive strategies have been developed to optimize recruitment. Given the increasing use of IVF and related technologies, the potential long-term consequences for risk of common adult diseases is an important clinical and public health issue.

Relationship Between Birth Weight and the Double Product in Childhood, Adolescence, and Adulthood (from the Bogalusa Heart Study)

Low birth weight is associated with cardiovascular disease and its risk factors, including heart rate and blood pressure. Therefore, we examined the hypothesis that birth weight is related to blood pressure-heart rate product (double product, DP), an index of oxygen consumption and workload of the heart, at different ages. Heart rate at rest, blood pressure at rest, and birth weight data were available in 2,340 children (4 to 11 years), 1,621 adolescents (12 to 19 years), and 2,315 adults (20 to 52 years) from the Bogalusa Heart Study (total n = 6,276). After adjustment for age, sex, race, and body mass index, gestational age-adjusted birth weight was inversely associated with DP, with per 100-g decrease in birth weight associated with an increase of 12.8, 22.9, and 23.2 beats/min × mmHg in DP in children (p = 0.016), adolescents (p = 0.0007), and adults (p = 0.0006), respectively. An amplifying trend of the association with age was observed in the total sample (p = 0.002). In conclusion, birth weight is associated with increased DP beginning in childhood, which may partly mediate the association between low birth weight and increased cardiovascular risk later in life.

Association of long-term blood pressure variability and brachial-ankle pulse wave velocity: a retrospective study from the APAC cohort

We investigated associations between long-term blood pressure variability (BPV) and brachial-ankle pulse wave velocity (baPWV). Within the Asymptomatic Polyvascular Abnormalities Community (APAC) study, we retrospectively collected long-term BPV and baPWV measures. Long-term BPV was calculated using the mean and standard deviation of systolic blood pressure (SBP) across 4 years based on annual values of SBP. In total, 3,994 subjects (2,284 men) were eligible for inclusion in this study. We stratified the study population into four SBP quartiles. Left and right baPWV was higher in participants with long-term SBPV in the fourth quartile compared with the first quartile (left: 1,725 ± 488 vs. 1,461 ± 340 [p < 0.001]; right: 1,722 ± 471 vs. 1,455 ± 341 [p < 0.001], respectively). We obtained the same result for total baPWV (fourth vs. first quartile: 1,772 ± 429 vs. 1,492 ± 350 [p < 0.001]). Furthermore, there was a trend for gradually increased baPWV (≥1,400 cm/s) with increased SBPV (p < 0.001). After multivariable adjustment, baPWV was positively correlated with long-term BPV (p < 0.001). In conclusion, long-term BPV is significantly associated with arterial stiffness as assessed by baPWV.

White-Coat and Reverse White-Coat Effects Correlate with 24-h Pulse Pressure and Systolic Blood Pressure Variability in Children and Young Adults

Masked hypertension (MH) and white-coat hypertension (WCH) are associated with organ damage. In the present study, we examined the correlation between the magnitude of white-coat effect (WCE) or reverse WCE (RWCE) and 24-h pulse pressure (PP), an indicator of target organ damage and arterial stiffness, in children and young adults. We also examined the relationship of WCE or RWCE and blood pressure (BP) variability, another predictor of clinical outcomes. One hundred and ninety-eight subjects were studied. According to the office BP and ambulatory BP, they were divided into normotension, WCH, MH, and hypertension. The magnitude of WCE or RWCE, along with male gender and 24-h systolic BP, was the determinant of 24-h PP. In subjects with 24-h PP ≥ 61 mmHg, the magnitude of WCE or RWCE, age, male ratio, height, weight, BMI, the percentage of secondary hypertension, that of MH, office systolic BP, and 24-h systolic BP were significantly greater. There was a progressive increase in 24-h PP from normotension, WCH, MH, to hypertension. BP variability in subjects with MH was numerically highest in both systolic and diastolic. Diastolic BP variability of WCH, MH, and hypertension was significantly higher than that of normotension. Finally, the magnitude of WCE or RWCE in systolic showed a significant correlation with systolic BP variability. In conclusion, the magnitude of WCE or RWCE correlates with 24-h PP and systolic BP variability, which may suggest increased arterial stiffness in WCH and MH.

Delivery modes and pregnancy outcomes of low birth weight infants in China

OBJECTIVE

To investigate and analyze the perinatal outcomes of low birth weight (LBW) infants, thereby selecting the appropriate mode and suitable time of delivery to improve the adverse pregnancy outcomes.

STUDY DESIGN

A retrospective analysis of 112,441 deliveries (from 39 hospitals of different levels in 14 provinces and autonomous regions in China throughout 2011) were performed in this study to further evaluate the modes of delivery and pregnancy outcomes of LBW infants.

RESULTS

The rate of cesarean section, stillbirth, neonatal asphyxia and mortality of LBW were significantly higher than those of normal birth weight (NBW) infants (odds ratio, 1.24, 56.56, 57.27 and 10.40 times higher, respectively). Stratified analysis showed that adverse events were reduced with the increase in gestational weeks, especially at 34 to 36(+6) weeks. However, LBW infants still had higher risks of adverse events as compared with NBW infants. In particular, full-term LBW babies had a 23.81- and 26.06-fold higher risk of stillbirth and neonatal death as compared with term babies with NBW. In addition, the cesarean delivery rate was 1.24-fold higher for LBW babies than for NBW babies. With an increase in gestational age in LBW infants, the rate of cesarean section was also increased. The rates of stillbirth and neonatal mortality of full-term LBW infants who were delivered via cesarean section (0.5% and 1.0%, respectively) were significantly lower than in the vaginal-delivery group (5.2% and 6.9%, respectively).

CONCLUSION

LBW is one of the causes of perinatal death and other adverse pregnancy outcomes and increases the rate of cesarean section. Individualized analysis according to gestational age and intrauterine fetal condition should be performed to extend the gestational age to at least 34 weeks before delivery, cesarean section is a relatively safe mode of delivery, but cannot completely eliminate complications. The key to improving mother and child outcomes is to strengthen pregnancy care and reduce low birth weight infants and premature birth. LBW is one of the causes of adverse pregnancy outcomes in both premature and full-term infants and increases the rate of cesarean section. Individualized analysis of the mode of delivery should be performed to extend the gestational age to 34 weeks and so improve the survival rate.

Effects of Maternal Cortisol during Pregnancy on Children's Blood Pressure Responses

BACKGROUND

It is well established that birth weight has an effect on subsequent blood pressure. Predominantly experimental studies have also reported effects of altered corticosteroid levels on subsequent cardiovascular responses. In the current study, we have examined the effects of both birth weight and maternal cortisol levels in a cohort of mothers and their pre-adolescent children.

PROCEDURE

A total of 216 women and their 7- to 9-year-old children comprised the cohort. The women had been assessed for plasma cortisol during the first (n = 71), second (n = 72) and third (n = 73) trimester. Maternal cortisol had been measured on a fasting sample taken between 9 and 11 a.m. The children's blood pressure and heart rate were recorded in the resting state, in response to a 10-min video game stress challenge and during recovery. Resting values, incremental responses to stress and recovery were evaluated.

OBSERVATION

Maternal cortisol levels increased with duration of pregnancy. There were inverse correlations between birth weight and all haemodynamic measures. The positive associations between maternal cortisol and children's haemodynamic measures were most evident in the first and second trimesters. Birth weight was inversely related to maternal cortisol. In multiple regression analyses, the effects of maternal cortisol were more consistent than those of birth weight.

CONCLUSION

Both birth weight and maternal cortisol are predictive of children's resting and stress-modulated haemodynamic measures. The effects of birth weight may partly mediate the effects of maternal cortisol.

Birth weight and childhood obesity: a 12-country study

OBJECTIVES

Few studies have investigated the association between the full range of birth weight and the risk of childhood obesity in high-, middle- and low-income countries. The aim of the present study is to assess the association between different levels of birth weight and the risk of obesity among children aged 9-11 years in 12 countries.

METHODS

A multinational, cross-sectional study of 5141 children aged 9-11 years was conducted in 12 countries. Height and weight were obtained using standardized methods. Time spent in moderate-to-vigorous physical activity (MVPA), sedentary and sleeping were objectively measured using 24-h, waist-worn accelerometer (Actigraph GT3X+) monitored for 7 days. Birth weight and other factors (regions, parental education, maternal history of gestational diabetes, children age, gender, breast feeding, gestational age, unhealthy diet scores and healthy diet scores) were collected by parental and children's questionnaires. Multilevel modeling was used to account for the nested nature of the data.

RESULTS

The overall prevalence of obesity (BMI z-score>+2 s.d.) was 15.4% for boys and 10.0% for girls. There was a positive association between birth weight and BMI z-scores. The multivariable-adjusted odds ratios (ORs) of childhood obesity were significantly higher among children whose birth weights were 3500-3999 g (OR 1.45; 95% confidence interval (CI): 1.10-1.92), and >4000 g (OR 2.08; 95% CI: 1.47-2.93), compared with the reference group (2500-2999 g). The positive association between birth weight and the odds of childhood obesity was seen in girls, whereas a U-shaped association appeared in boys.

CONCLUSIONS

High levels of birth weight, defined as birth weight ⩾3500 g, were associated with increased odds of obesity among 9-11-year-old children in 12 countries. However, sex differences in the association between birth weight and the risk of obesity need to be considered when planning interventions to reduce childhood obesity.

Relationship between cardiovascular health score and year-to-year blood pressure variability in China: a prospective cohort study

OBJECTIVES

On the basis of cardiovascular health factors and behaviours, the American Heart Association proposed the Cardiovascular Health Score (CHS). It has been widely used to estimate the cardiovascular health status of individuals. The aim of this study was to investigate the relationship between CHS and year-to-year blood pressure variability (BPV).

DESIGN

Prospective cohort study.

SETTINGS

We stratified participants into two groups by gender: first group, female group; second group, male group. The relationship between CHS and year-to-year blood pressure variability were analysed.

PARTICIPANTS

A total of 41,613 individuals met the inclusion criteria (no history of stroke, transient ischaemic attack, myocardial infarction, malignant tumour or atrial fibrillation) and had complete blood pressure data.

RESULTS

The coefficient of the variation of systolic blood pressure (SCV) was 8.33% in the total population and 8.68% and 8.22% in female and male groups, respectively (p<0.05). Multivariable linear regression analysis revealed that higher CHS was inversely associated with increasing year-to-year BPV, which persisted after adjusting for baseline systolic blood pressure and other risk factors. Each SD increase in CHS could lead to a 0.016SD decrease in SCV (p<0.05).

CONCLUSIONS

In summary, CHS was inversely related to year-to-year BPV, which suggested that a healthy lifestyle may contribute to better blood pressure management.

Effects of maternal anxiety and depression during pregnancy in Chinese women on children's heart rate and blood pressure response to stress

Psychological disturbances, including anxiety and depression, are common during human pregnancy. Our objective was to determine whether these maternal disturbances influence cardiovascular responses of the offspring. The psychological status of 231 pregnant women was determined. Offspring (216) of these women were subsequently exposed to a video challenge stress when aged 7-9 years. Heart rate (HR) and blood pressure (BP) of the children were determined at rest, in response to video stress and during subsequent recovery. Children's resting and stress-induced increases in HR (bpm), systolic (SBP, mm Hg) and diastolic (DBP, mm Hg) BP were all greater in children whose mothers reported anxiety during pregnancy. Values (mean±s.d.) for resting HR, SBP and DBP were 75.15±5.87, 95.37±2.72 and 66.39±4.74 for children whose mothers reported no anxiety and an average of 81.62±6.71, 97.26±2.90 and 68.86±2.82 for children whose mothers reported anxiety at any level. Respective values for stress-induced increments in HR, SBP and DBP were 14.83.±2.14, 16.41±1.97 and 12.72±2.69 for children whose mothers reported no anxiety and 17.95±3.46, 18.74±2.46 and 14.86±2.02 for children whose mothers reported any level of anxiety. Effects of maternal depression were less consistent. The effects of maternal anxiety remained in multivariate analyses, which also included children's birth weight. The results indicate a long-term influence of maternal psychological status during pregnancy on the cardiovascular responses to stress among offspring. These effects may contribute to prenatal influences on subsequent health of the offspring.

Long-Term Blood Pressure Variability, New-Onset Diabetes Mellitus, and New-Onset Chronic Kidney Disease in the Japanese General Population

Whether long-term blood pressure (BP) variability among individuals without diabetes mellitus is associated with new-onset chronic kidney disease (CKD) risk, independently of other BP parameters (eg, mean BP, cumulative exposure to BP) and metabolic profile changes during follow-up, remains uncertain. We used data from a nationwide study of 48 587 Japanese adults aged 40 to 74 years (mean age, 61.7 years; 39% men) without diabetes mellitus or CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2 or proteinuria by dipstick). BP was measured at baseline and during 3 annual follow-up visits (4 visits). BP variability was defined as standard deviation (SD) and average real variability during the 4 visits. At the year 3 follow-up visit, 6.3% of the population had developed CKD. In multivariable-adjusted logistic regression models, 1 SD increases in SDSBP (per 5 mmHg), SDDBP (per 3 mmHg), average real variabilitySBP (per 6 mmHg), and average real variabilityDBP (per 4 mmHg) were associated with new-onset CKD (odds ratios [ORs] and 95% confidence intervals, 1.15 [1.11-1.20], 1.08 [1.04-1.12], 1.13 [1.09-1.17], 1.06 [1.02-1.10], respectively; all P<0.01) after adjustment for clinical characteristics, and with mean BP from year 0 to year 3. The associations of SDBP and average real variabilityBP with CKD remained significant after additional adjustments for metabolic parameter changes during follow-up (ORs, 1.06-1.15; all P<0.01). Sensitivity analyses by sex, antihypertensive medication use, and the presence of hypertension showed similar conclusions. Among those in the middle-aged and elderly general population without diabetes mellitus, long-term BP variability during 3 years was associated with new-onset CKD risk, independently of mean or cumulative exposure to BP and metabolic profile changes during follow-up.

Relation between birth weight, growth, and subclinical atherosclerosis in adulthood

Background and Objectives. Adverse conditions in the prenatal environment and in the first years of life are independently associated with increased risk for cardiovascular disease. This paper aims to study the relation between birthweight, growth in the first year of life, and subclinical atherosclerosis in adults. Methods. 88 adults aged between 20 and 31 were submitted to sociodemographic qualities, anthropometric data, blood pressure measurements, metabolic profile, and evaluation of subclinical atherosclerosis. Results. Birthweight <2,500 grams (g) was negatively correlated with (a) increased waist-to-hip ratio (WHR), according to regression coefficient (RC) equal to −0.323, 95% CI [−0.571, −0.075] P < 0.05; (b) diastolic blood pressure (RC = −4.744, 95% CI [−9.017, −0.470] P < 0.05); (c) low HDL-cholesterol (RC = −0.272, 95% CI [−0.516, −0.029] P < 0.05); (d) frequency of intima-media thickness (IMT) of left carotid >75th percentile (RC = −0.242, 95% CI [−0.476, −0.008] P < 0.05). Birthweight >3,500 g was associated with (a) BMI >25.0 kg/m², (RC = 0.317, 95% CI [0.782, 0.557] P < 0.05); (b) increased waist circumference (RC = 0.284, 95% CI [0.054, 0.513] P < 0.05); (c) elevated WHR (RC = 0.280, 95% CI [0.054, 0.505] P < 0.05); (d) minimum subcutaneous adipose tissue (SAT) (RC = 4.354, 95% CI [0.821, 7.888] P < 0.05); (e) maximum SAT (RC = 7.095, 95% CI [0.608, 13.583] P < 0.05); (f) right lobe of the liver side (RC = 6.896, 95% CI [1.946, 11.847] P < 0.001); (g) frequency's right lobe of the liver >75th percentile (RC = 0.361, 95% CI [0.169, 0.552] P < 0.001). Weight gain in the first year of life was inversely correlated with (a) mean IMT of left carotid (RC = −0.046, 95% CI [−0.086, −0.006] P < 0.05; (b) frequency IMT of left carotid >75th percentile (RC = −0.253, 95% CI [−0.487, −0.018] P < 0.05); (c) mean IMT (RC = −0.038, 95% CI [0.073, −0.002] P < 0.05); (d) the frequency of the mean IMT >75th percentile (RC = −0.241, 95% CI [−0.442, −0.041] P < 0.05). Conclusions. Adults birthweight <2,500 g and >3,500 g and with insufficient weight gain in the first year of life have showed different metabolic phenotypes, but all of them were related to subclinical atherosclerosis.

Birth weight and eating behaviors of young children

OBJECTIVE

To evaluate the relationships prospectively between birth weight (standardized for gestational age) and problematic eating behaviors, as reported by the parents, at different ages in 3 birth cohorts: Generation XXI (Portugal), Avon Longitudinal Study of Parents and Children (United Kingdom), and Etude des Déterminants pre et postnatals précoces du développement et de la santé de l'ENfant study (France) - HabEat project. We also aimed to explore the effect of child's current body mass index (BMI) in these relationships.

STUDY DESIGN

Problematic eating behaviors were assessed at 4-6, 12-15, 24, and 48-54 months, based on caregiver's perception. Children born small, appropriate, and large for gestational age were defined based on sex-specific Kramer growth references. Associations were tested by logistic regression (OR, 95% CI) adjusted for maternal age, education, BMI, smoking, breastfeeding duration, older siblings, birth type and, in a second step, for child's current BMI World Health Organization z-score.

RESULTS

Parents of children born small for gestational age (compared with appropriate gestational age) reported more often feeding difficulties and poor eating patterns (eating small quantities or needing stimulation to eat) at 4-6 months (Generation XXI: OR 2.02, 95% CI 1.40-2.94; Avon Longitudinal Study of Parents and Children: OR 1.36, 95% CI 1.14-1.62; Etude des Déterminants pre et postnatals précoces du développement et de la santé de l'ENfant OR 3.24, 95% CI 1.50-6.96), but this effect was weaker at older ages. Overall, the effects decreased, after adjustment for child's BMI, but remained significant.

CONCLUSIONS

Low birth weight for gestational age was related to later difficulty in eating behaviors, primarily in the first 4-6 months.

Autonomic nervous system dysregulation in pediatric hypertension

Historically, primary hypertension (HTN) has been prevalent typically in adults. Recent data however, suggests an increasing number of children diagnosed with primary HTN, mainly in the setting of obesity. One of the factors considered in the etiology of HTN is the autonomous nervous system, namely its dysregulation. In the past, the sympathetic nervous system (SNS) was regarded as a system engaged mostly in buffering major acute changes in blood pressure (BP), in response to physical and emotional stressors. Recent evidence suggests that the SNS plays a much broader role in the regulation of BP, including the development and maintenance of sustained HTN by a chronically elevated central sympathetic tone in adults and children with central/visceral obesity. Consequently, attempts have been made to reduce the SNS hyperactivity, in order to intervene early in the course of the disease and prevent HTN-related complications later in life.

Long-term blood pressure variability throughout young adulthood and cognitive function in midlife: the Coronary Artery Risk Development in Young Adults (CARDIA) study

Whether long-term blood pressure (BP) variability throughout young adulthood is associated with cognitive function in midlife remains uncertain. Using data from the Coronary Artery Risk Development in Young Adults (CARDIA), which recruited healthy young adults aged 18 to 30 years (mean age, 25 years) at baseline (Y(0)), we assessed BP variability by SD and average real variability (ARV) for 25 years (8 visits). Cognitive function was assessed with the Digit Symbol Substitution Test (psychomotor speed test), the Rey Auditory Verbal Learning Test (verbal memory test), and the modified Stroop test (executive function test) at follow-up (Y(25)). At the Y(25) examination, participants (n=2326) had a mean age of 50.4 years, 43% were men, and 40% were black. In multivariable-adjusted linear regression models, higher ARV(SBP), ARV(DBP), and SD(DBP) were significantly associated with lower scores of Digit Symbol Substitution Test (β [SE]: -0.025 [0.006], -0.029 [0.007], and -0.029 [0.007], respectively; all P<0.001) and Rey Auditory Verbal Learning Test (β [SE]: -0.016 [0.006], -0.021 [0.007], and -0.019 [0.007], respectively; all P<0.05) after adjustment for demographic and clinical characteristics and with cumulative exposure to BP through Y(0) to Y(25). Neither SDBP nor ARV(BP) was associated with the Stroop score. The associations between ARV(BP) or SD(BP) and each cognitive function test were similar between blacks and whites except for 1 significant interaction between race and SDS(BP) on the Digit Symbol Substitution Test (P<0.05). Long-term BP variability for 25 years beginning in young adulthood was associated with worse psychomotor speed and verbal memory tests in midlife, independent of cumulative exposure to BP during follow-up.

Maternal parity, fetal and childhood growth, and cardiometabolic risk factors

We examined the associations of maternal parity with fetal and childhood growth characteristics and childhood cardiometabolic risk factors in a population-based prospective cohort study among 9031 mothers and their children. Fetal and childhood growth were repeatedly measured. We measured childhood anthropometrics, body fat distribution, left ventricular mass, blood pressure, blood lipids, and insulin levels at the age of 6 years. Compared with nulliparous mothers, multiparous mothers had children with higher third trimester fetal head circumference, length and weight growth, and lower risks of preterm birth and small-size-for-gestational-age at birth but a higher risk of large-size-for-gestational-age at birth (P<0.05). Children from multiparous mothers had lower rates of accelerated infant growth and lower levels of childhood body mass index, total fat mass percentage, and total and low-density lipoprotein cholesterol than children of nulliparous mothers (P<0.05). They also had a lower risk of childhood overweight (odds ratio, 0.75 [95% confidence interval, 0.63–0.88]). The risk of childhood clustering of cardiometabolic risk factors was not statistically significantly different (odds ratio, 0.82; 95% confidence interval, 0.64–1.05). Among children from multiparous mothers only, we observed consistent trends toward a lower risk of childhood overweight and lower cholesterol levels with increasing parity (P<0.05). In conclusion, offspring from nulliparous mothers have lower fetal but higher infant growth rates and higher risks of childhood overweight and adverse metabolic profile. Maternal nulliparity may have persistent cardiometabolic consequences for the offspring.

Birth weight and blood pressure: 'J' shape or linear shape? Findings from a cross-sectional study in Hong Kong Chinese women

OBJECTIVES

To investigate the association between birth weight and blood pressure (BP) and to determine the effect of body size change from birth to adulthood on BP.

DESIGN

A cross-sectional design to collect retrospective data.

PARTICIPANTS

1253 female nurses aged 35-65 years in Hong Kong.

MAIN OUTCOME MEASURES

Birth weight, height, weight, BP, waist circumference, demographics and lifestyle factors were collected by a self-administered questionnaire through mail survey. These self-reported variables have been validated in a pilot study. The conditional relative weight (CRW), which was calculated as a residual of current weight regressed on birth weight, was used to express higher or lower relative weight gain from birth to adulthood.

RESULTS

No significant linear association between overall range of birth weight and BP was found. The curve estimation showed a significant quadratic curvilinear association ('J' shape). In the piecewise-linear analysis, a significant inverse association between birth weight z-scores and BP was observed in the birth weight ≤3.1 kg group (systolic BP (SBP): coefficient B=-1.73, 95% CI -3.17 to -0.30; diastolic BP (DBP): B=-1.12, 95% CI -2.19 to -0.06). A positive but non-significant association occurred in the birth weight >3.1 kg group. Participants who belonged to the lowest 10% birth weight category but at the current top 10% BMI group had higher BP than participants in other BMI groups. The CRW z-score was positively associated with BP (coefficient B: 4.18 for SBP and 2.87 for DBP).

CONCLUSIONS

Unlike most previous studies, we found a 'J' shape association rather than a linear association between birth weight and BP. Women with large percentile crossing of body size from birth to adulthood were more likely to have elevated BP. A higher weight gain from birth to adulthood than expected led to higher BP.

The effect of abnormal birth history on ambulatory blood pressure and disease progression in children with chronic kidney disease

OBJECTIVE

To examine the associations between abnormal birth history (birth weight <2500 g, gestational age <36 weeks, or small for gestational age), blood pressure (BP), and renal function among 332 participants (97 with abnormal and 235 with normal birth history) in the Chronic Kidney Disease in Children Study, a cohort of children with chronic kidney disease (CKD).

STUDY DESIGN

Casual and 24-hour ambulatory BP were obtained. Glomerular filtration rate (GFR) was determined by iohexol disappearance. Confounders (birth and maternal characteristics, socioeconomic status) were used to generate predicted probabilities of abnormal birth history for propensity score matching. Weighted linear and logistic regression models with adjustment for quintiles of propensity scores and CKD diagnosis were used to assess the impact of birth history on BP and GFR.

RESULTS

Age at enrollment, percent with glomerular disease, and baseline GFR were similar between the groups. Those with abnormal birth history were more likely to be female, of Black race or Hispanic ethnicity, to have low household income, or part of a multiple birth. Unadjusted BP measurements, baseline GFR, and change in GFR did not differ significantly between the groups; no differences were seen after adjusting for confounders by propensity score matching.

CONCLUSIONS

Abnormal birth history does not appear to have exerted a significant influence on BP or GFR in this cohort of children with CKD. The absence of an observed association is likely secondary to the dominant effects of underlying CKD and its treatment.

Heart rate and blood pressure variability in children with chronic kidney disease: a report from the CKiD study

BACKGROUND

Autonomic nervous system dysfunction and sympathetic nervous system over-activity play important roles in the development of hypertension associated with chronic kidney disease (CKD). In adults, increased blood pressure variability (BPV) appears to be directly related to sympathetic over-activity with increased risk of end-organ damage and cardiovascular events. Decreased heart rate variability (HRV) has been observed in adults with CKD, and is an independent predictor of mortality.

METHODS

The purpose of this study was to evaluate BPV and HRV in pediatric patients enrolled in the Chronic Kidney Disease in Children Study. Ambulatory blood pressure monitoring data were available for analysis of 215 person-visits from 144 children that were not receiving antihypertensive medications.

RESULTS

BPV and HRV were determined by standard deviation and coefficient of variation for heart rate and systolic and diastolic blood pressure for each patient averaged for wake/sleep periods during 24-h monitoring. Uniformly lower values were displayed during sleep versus wake periods: BPV was 20 % lower during sleep (p < 0.001) and HRV was 30 % lower during sleep (p < 0.001). A significant increase in systolic BPV was observed in hypertensive children compared to children with normal blood pressure (6.9 %, p = 0.009). Increased diastolic BPV was detected among hypertensive children during sleep period compared to children with normal blood pressure (11.5 %, p = 0.008). There was a significant decrease in HRV in hypertensive compared to normotensive children (-8.2 %, p = 0.006).

CONCLUSIONS

These findings are similar to those in adult patients and may underscore childhood origin and natural progression of adverse cardiovascular outcomes in adults with CKD.

Comparing indicators of health and development of singleton young adults conceived with and without assisted reproductive technology

OBJECTIVE

To compare outcomes for young adults conceived by assisted reproductive technology (ART) with non-ART-conceived young adults.

DESIGN

Cohort study.

SETTING

Not applicable.

PARTICIPANT(S)

Mothers and their offspring (aged 18-28 years) conceived by ART; mothers and their non-ART-conceived offspring, randomly selected from the same source population.

INTERVENTION(S)

Structured telephone interviews, one with mothers and another with their young adult offspring.

MAIN OUTCOME MEASURE(S)

Maternal report on young adult offspring hospitalizations and chronic illness accumulated over the first 18 years of their lives; young adult self-report on perceived current quality of life, body mass index, pubertal development, and educational achievement.

RESULT(S)

Of 1,480 eligible ART mothers, 80% were traced and contacted. Of those, 656 (55%) participated, reporting on 705 ART-conceived offspring; 269 (23%) declined participation and 262 (22%) did not respond. Of the participants, 84% consented to contact with their young adult offspring, of whom 547 (92%) participated. Random-digit dialing recruited 868 non-ART mothers and 549 offspring. Compared with non-ART young adults, the ART group had significant increases in three maternally reported outcomes: 1) hospital admissions, including those in the secondary school years; 2) atopic respiratory conditions; and 3) combined endocrine, nutritional, and metabolic disease ICD-10 category. Young adult reported outcomes were similar for both groups.

CONCLUSION(S)

This study addresses gaps in knowledge of outcomes beyond adolescence for those conceived by ART. Results show few adverse outcomes in this large cohort of young adults, but additional assessment through clinical review is required to address issues unable to be examined in this study.

Developmental Origins of Cardiovascular Disease

Although cardiovascular disease has traditionally been viewed as a condition of aging individuals, increasing focus has turned to its developmental origins. Since birthweight has been related to cardiovascular disease risk, research into factors such as gravid conditions that affect fetal growth have grown. Associations between maternal diabetes and childhood obesity from sibling studies suggest a causal role but prospective studies of gestational diabetes remain mixed. Preeclampsia and increased offspring blood pressure has been consistently observed but evidence for other cardiovascular outcomes is lacking. While maternal obesity is associated with childhood obesity, causality remains unclear and paternal obesity should be investigated as an independent risk factor. Environmental chemical exposures in utero, particularly obesogens, are now emerging as another concern, as is conception by infertility treatment. Few studies have investigated subclinical measures of endothelial function or atherosclerosis and more research in these areas may help reveal the underlying pathogenesis.

An epidemiological survey on low birth weight infants in China and analysis of outcomes of full-term low birth weight infants

BACKGROUND

Low birth weight (LBW) is one of the leading causes of adverse perinatal outcomes and is closely related to neonatal disease and death. The incidence of LBW has been increasing. The aim of this study was to investigate the current incidence rate and factors affecting low birth weight infants and perinatal outcomes of full-term low birth weight infants in mainland China.

METHODS

This paper describes a retrospective analysis of children born in 39 hospitals of different types in 14 different provinces, municipalities, and autonomous regions in seven districts within China throughout 2011. The data were first collected in hardcopy format and then entered into computer network databases. Data covering a total of 112,441 cases were collected. Cases were excluded if data were incomplete and in the case of miscarriage before 24 weeks of gestation, multiple pregnancies, or induction of labor due to fetal malformation, intrauterine death, and other reasons, leaving a total of 101,163 cases. SPSS 18.0 and SAS 9.2 statistical packages were used to analyze the collected data.

RESULTS

According to this research, the incidence of LBW in mainland China was 6.1%, which is higher than the 5.87% reported in 2000, and it varied across different areas. The incidence of LBW was significantly higher in tertiary care hospitals than in secondary care hospitals. LBW was found to be associated with maternal age of less than 20 years, low level of maternal education, previous histories of adverse pregnancies, and with pregnancy comorbidities and complications, such as hypertensive disorders during pregnancy, anemia, oligohydramnios, premature rupture of membranes, and gestational diabetes. The rates of stillbirths, severe neonatal asphyxia, and deaths among full-term LBW infants were 2.42%, 0.83%, and 3.49%, respectively. The rates of stillbirths and neonatal deaths among full-term LBW infants born by caesarean section were 0.5% and 1.0%, respectively, which was lower than vaginal delivery.

CONCLUSIONS

The incidence of LBW has increased in China. LBW is a leading cause of adverse pregnancy outcomes. Health care during pregnancy and management of high-risk factors for LBW may reduce the incidence of LWB and the death rate of LBW infants.

The association of birth weight with cardiovascular risk factors and mental problems among Iranian school-aged children: the CASPIAN-III study

OBJECTIVE

Both high and low birth weights (HBW and LBW) are risk factors for adulthood diseases. The aim of this study was to investigate the association of birth weight with cardiovascular disease (CVD) risk factors and mental problems among Iranian school-aged children.

METHODS

This national multicenter study of school-aged children entitled CASPIAN III was conducted among 5528 students in ranging from ages 10 to 18 y. Biochemical indices and anthropometric measurements were collected. Mental health was assessed by questionnaire. To investigate the association between birth weight categories and CVD risk factors and mental problems, multivariate logistic regression was used.

RESULTS

HBW adolescents were at higher risk for elevated diastolic blood pressure (DBP) (Ptrend < 0.05), low levels of high-density lipoprotein cholesterol (HDL-C) (Ptrend < 0.05), and lower risk for general obesity (Ptrend < 0.05) compared with the LBW category. HBW had no significant association with mental problems (Ptrend > 0.05) compared with LBW adolescents. The results of regression analysis, which considered normal birth weight as the reference group, showed that LBW students had lower risk for overweight and obesity (P < 0.01), as well as higher DBP (P < 0.05) but they were at higher risk for lower levels of HDL-C (P < 0.01). Furthermore, birth-weight categories had a U-shaped relationship with mental problems and sleep disorders (P < 0.05). Risk for confusion was higher among the LBW group (P < 0.05).

CONCLUSION

Findings from this population-based study revealed a positive relation between birth weight categories and CVD risk factors. Compared with students born with normal weight, those born with HBW and LBW were at higher risk for mental problems, sleep disorders, and confusion.

Nutritional programming of insulin resistance: causes and consequences

Strong evidence indicates that adverse prenatal and early postnatal environments have a significant long-term influence on risk factors that result in insulin resistance, type 2 diabetes (T2D), and cardiovascular disease later in life. Here we discuss current knowledge of how maternal and neonatal nutrition influence early growth and the long-term risk of developing insulin resistance in different organs and at the whole-body level. Accumulating evidence supports a role for epigenetic mechanisms underlying this nutritional programming, consisting of heritable changes that regulate gene expression which in turn shapes the phenotype across generations. Deciphering these molecular mechanisms in key tissues and discovering key biological markers may provide valuable insight towards the development of effective intervention strategies.