Body size at birth and bleed pressure among children in developing countries

Background Studies in developed countries have shown that reduced fetal gro wth is related to raised blood pressure in childhood and adult Life. Little is known about this association in developing countries, where fetal growt h retardation is common. Methods In 1994-1995, we measured blood pressure in 1570 3-6-year-old child ren living in China, Guatemala, Chile, Nigeria and Sweden. We related their blood pressure to patterns of fetal growth, as measured by body proportion s at birth. The children were all born after 37 weeks gestation and weighed more than 2.5 kg at birth. Results In each country, blood pressure was positively related to the child 's current weight. After adjusting for this and gender, systolic pressure w as inversely related to size at birth in all countries except Nigeria. In C hile, China and Guatemala, children who were proportionately small at birth had raised systolic pressure. For example, in Chile, systolic pressure adj usted for current weight increased by 4.9 mmHg (95% CI 2.1, 7.7) for every kilogram decrease in birthweight, by 1 mmHg (95% CI : 0.4, 1.6) for every c entimetre decrease in birth length, and by 1.3 mmHg (95% CI:0.4, 2.2) for e very centimetre decrease in head circumference at birth. In Sweden, systoli c pressure was higher in children who were disproportionately small, that i s thin, at birth. Systolic pressure increased by 0.3 mmHg (95% Cf : 0.0, 0. 6) for every unit (kg/m(3)) decrease in ponderal index at birth. These asso ciations were independent of the duration of gestation. Conclusions Raised blood pressure among children in three samples from Chin a, Central and South America is related to proportionate reduction in body size at birth, which results from reduced growth throughout gestation. The relation between fetal growth and blood pressure may be different in Africa n populations. Proportionately reduced fetal growth is the prevalent patter n of fetal growth retardation in developing countries, and is associated Wi th chronic undernutrition among women. Improvement in the nutrition and hea lth of girls and young women may be important in preventing cardiovascular disease in developing countries.