Objective-To assess the effect of prenatal exposure to maternal malnutritio
n on coronary heart disease in people born around the time of the Dutch fam
ine, 1944-45.
Design-Historical cohort study. Setting-Community study.
Patients-Singletons born alive between November 1943 and February 1947 for
whom detailed birth records were available.
Design-The prevalence of coronary heart disease was compared between those
exposed to famine in late gestation (n = 120), in mid-gestation (n = 108),
or in early gestation (n = 68), and those born in the year before the famin
e or those conceived in the year after the famine (non-exposed subjects, n
= 440).
Main outcome measures-Prevalence of coronary heart disease, defined as the
presence of angina pectoris according to the Rose questionnaire, Q waves on
the EGG, or a history of coronary revascularisation.
Results-The prevalence of coronary heart disease was higher in those expose
d in early gestation than in non-exposed people (8.8% v 3.2%; odds ratio ad
justed for sex 3.0, 95% confidence interval (CI) 1.1 to 8.1). The prevalenc
e was not increased in those exposed in mid gestation (0.9%) or late gestat
ion (2.5%). People with coronary heart disease tended to have lower birth w
eights (3215 g v 3352 g, p = 0.13), and smaller head circumferences at birt
h (32.2 cm v 32.8 cm, p = 0.05), but the effect of exposure to famine in ea
rly gestation was independent of birth weight (adjusted odds ratio 3.2, 95%
CI 1.2 to 8.8).
Conclusions-Although the numbers are very small, this is the first evidence
suggesting that maternal malnutrition during early gestation contributes t
o the occurrence of coronary heart disease in the offspring.