Leon David A, Koupil Ilona, Mann Vera, Tuvemo Torsten, Lindmark Gunilla, Mohsen Rawya, Byberg Liisa, Lithell Hans
London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
Circulation. 2005 Nov 29;112(22):3478-85. doi: 10.1161/CIRCULATIONAHA.104.497610. Epub 2005 Nov 14.
Little is known about the contribution of maternal and paternal factors to the inverse association between birth weight and later blood pressure in human offspring. A study of within- and between-family associations of birth weight with blood pressure, which collected data on both parents, would address this gap in our knowledge.
The study examined families composed of mother, father, and 2 full sibs delivered between 38 and 41 weeks' gestation within 36 months of each other. A total of 1967 families meeting our inclusion criteria were contacted and 602 were examined (children 5 to 14 years old, 1998 to 2000). Birth weight and gestational age were available from obstetric records. Systolic blood pressure in childhood was inversely associated with birth weight within families (-2.3 mm Hg/kg, 95% CI -4.4 to -0.3) after adjustment for gestational age, sex, height, and weight at examination. The between-family effect (-1.5 mm Hg/kg, -3.1 to 0.0) was strengthened on adjustment for maternal and paternal height and weight, whereas adjustment for paternal and maternal systolic blood pressure at examination independently attenuated the effect.
The existence of an inverse association of birth weight with systolic blood pressure within families (adjusted for height and weight at examination) demonstrates that factors that vary between pregnancies in the same woman (including fetal genotype) can influence the later blood pressure of offspring. We conclude that this apparent fetal programming effect on blood pressure will not be eliminated solely by interventions aimed at modifying growth and cumulative nutritional status from conception through childhood or other fixed characteristics of future mothers.
关于母体和父体因素对人类后代出生体重与后期血压之间负相关关系的贡献,我们知之甚少。一项关于出生体重与血压的家庭内和家庭间关联的研究,若能收集父母双方的数据,将填补我们在这方面的知识空白。
该研究考察了由母亲、父亲和两个同胞兄弟姐妹组成的家庭,这些家庭的孩子在36个月内于妊娠38至41周出生。共联系了1967个符合纳入标准的家庭,其中602个家庭接受了检查(孩子年龄在5至14岁之间,时间为1998年至2000年)。出生体重和孕周数据来自产科记录。在调整了检查时的孕周、性别、身高和体重后,儿童期收缩压与家庭内出生体重呈负相关(-2.3 mmHg/kg,95%可信区间-4.4至-0.3)。在调整了父母的身高和体重后,家庭间效应(-1.5 mmHg/kg,-3.1至0.0)增强,而调整检查时父母的收缩压则分别减弱了这种效应。
家庭内出生体重与收缩压之间存在负相关(调整了检查时的身高和体重),这表明同一女性不同孕期变化的因素(包括胎儿基因型)可影响后代的后期血压。我们得出结论,这种明显的胎儿编程对血压的影响不会仅通过旨在从受孕到儿童期改变生长和累积营养状况或未来母亲的其他固定特征的干预措施而消除。