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Growth in utero and blood pressure levels in the next generation

Barker, David J.P.1,2; Shiell, Alistair W.1; Barker, Mary E.1; Law, Catherine M.1

Original article

Objective To determine whether blood pressure levels in adult life are related to the mother's fetal growth and size at birth.

Design A follow-up study of men and women whose mothers' or fathers' size at birth was recorded in Preston, Lancashire, UK.

Subjects Two hundred and twenty-eight men and women born in Preston, Lancashire, UK, and still living in Lancashire.

Main outcome measures Blood pressure at 18–40 years of age.

Results Systolic and diastolic pressures fell with increasing mother's birthweight and head circumference. Systolic pressure fell by 2.4 mmHg (95% confidence interval (CI) 0.1–4.7) for each pound increase in mother's birthweight and by 4.0 mmHg (95% CI 0.2–7.8) for each one inch increase in head circumference. These associations were little changed by adjusting for length of gestation or for the subject's age, sex, body mass index or alcohol consumption. They were independent of the mother's blood pressure. As expected, mothers' birthweights were strongly related to their children's birthweights (P = 0.009), but the association between mother's birthweight and offspring's blood pressure was largely independent of this. Father's size at birth was not related to the offspring's blood pressure.

Conclusions If the growth of a female fetus is constrained by lack of nutrients, there are persisting changes in her physiology and metabolism which lead to reduced fetal growth and raised blood pressure in the next generation. Public health policies to improve fetal growth in one generation may therefore benefit succeeding generations as well.

1MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.

2Correspondence and requests for reprints to Professor D.J.P. Barker, MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton S016 6YD, UK. Tel: +44 023 80 777624; fax: +44 023 80 704021; e-mail:

Received 25 November 1999, Revised 29 March 2000, Accepted 4 April 2000

© 2000 Lippincott Williams & Wilkins, Inc.