Background: Previous studies have reported an association between low birthweight and elevated blood pressure (BP) in adulthood, but few have examined the relationship between foetal growth and adult BP. Method:The study examined the association between intrauterine growth trajectories determined by serial ultrasound and BP of the adult offspring in the Raine Study. Foetal growth trajectories for abdominal circumference, femur length and head circumference zscores were developed using group-based trajectory modelling from 1440 women with serial ultrasounds from 15-weeks pregnancy to birth. Seven abdominal circumference, five femur length and five head circumference trajectory groups were identified. Longitudinal linear mixed modelling examined the association between trajectory groups and offspring BP at 20 (n ¼ 487), 22 (n ¼ 419) and 27 (n ¼ 436) years.Results: Higher SBP in adulthood significantly associated with two abdominal circumference trajectories, one with the most restricted foetal growth [3.52 mmHg, 95% confidence interval (95% CI) ¼ 1.20-5.83] and the other with sustained low-growth (1.92 mmHg, 95% CI ¼ 0.11-3.73) compared with an average growth trajectory, after adjusting for sex, age, alcohol consumption and BMI. Foetal head circumference trajectories with sustained lowgrowth or average-to-falling growth significantly associated with higher adult systolic (3.45 mmHg, 95% CI ¼ 1.77-5.14 and 1.54 mmHg, 95% CI ¼ 0.30-2.78, respectively) and diastolic (2.28 mmHg, 95% CI ¼ 0.77-3.78 and 1.47 mmHg, 95% CI ¼ 0.54-2.39, respectively) BP compared with average growth. Low femur length growth associated with higher adult DBP after adjusting for sex, but not after accounting for adult BMI. Conclusion:Our results show that restricted foetal head and abdominal circumference associated with higher adult SBP over two decades later, reinforcing the importance of the early intrauterine environment and its influence on adult BP.

Context Events during gestation significantly influence the risk of cardiometabolic diseases including diabetes in the offspring during later life. Objective The study aimed to investigate relationships between serial ultrasound derived fetal growth trajectories and markers of insulin resistance in young adults in the Raine Study, an Australian pregnancy cohort. Research Design and Methods Linear mixed modeling examined the relationship between fetal growth trajectory groups, constructed using serial ultrasound-based abdominal circumference (AC), femur length (FL) and head circumference (HC) from 1333 mother-fetal pairs, and offspring Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), as a marker of diabetes risk, at 20 (n = 414), 22 (n = 385) and 27 (n = 431) years. Analyses were adjusted for age, sex, ethnicity, socio-economic status, adult lifestyle factors and maternal factors during pregnancy. Results The study identified seven AC, five FL and five HC growth trajectory groups. Compared to the average-stable (reference) group, a low-falling AC growth trajectory (26%, P = 0.005) and two low HC growth trajectories (20%, P = 0.006 and 8%, P = 0.021) associated with higher adult HOMA-IR. Trajectories representing a high-stable FL and a rising HC associated with 12% (P = 0.002) and 9% (P = 0.021) lower adult HOMA-IR respectively, compared to the reference group. Conclusions Restricted fetal head and abdominal circumference from early pregnancy associate with higher relative insulin resistance in the offspring during adulthood. These data strengthen our understanding of the importance of the intrauterine environment and its effect on the risk of predisposition to adult diabetes and related metabolic disorders.

Background There is now good evidence that events during gestation significantly influence the developmental well-being of an individual in later life. This study aimed to investigate the relationships between intrauterine growth trajectories determined by serial ultrasound and subsequent markers of adiposity and inflammation in the 27-year-old adult offspring from the Raine Study, an Australian longitudinal pregnancy cohort. Methods Ultrasound fetal biometric measurements including abdominal circumference (AC), femur length (FL), and head circumference (HC) from 1333 mother-fetal pairs (Gen1–Gen2) in the Raine Study were used to develop fetal growth trajectories using group-based trajectory modeling. Linear mixed modeling investigated the relationship between adult body mass index (BMI), waist circumference (WC), and high-sensitivity C-reactive protein (hs-CRP) of Gen2 at 20 (n = 485), 22 (n = 421) and 27 (n = 437) years and the fetal growth trajectory groups, adjusting for age, sex, adult lifestyle factors, and maternal factors during pregnancy. Results Seven AC, five FL and five HC growth trajectory groups were identified. Compared to the average-stable (reference) group, a lower adult BMI was observed in two falling AC trajectories: (β = −1.45 kg/m2, 95% CI: −2.43 to −0.46, P = 0.004) and (β = −1.01 kg/m2, 95% CI: −1.96 to −0.05, P = 0.038). Conversely, higher adult BMI (2.58 kg/m2, 95% CI: 0.98 to 4.18, P = 0.002) and hs-CRP (37%, 95% CI: 9–73%, P = 0.008) were observed in a rising FL trajectory compared to the reference group. A high-stable HC trajectory associated with 20% lower adult hs-CRP (95% CI: 5–33%, P = 0.011). Conclusion This study highlights the importance of understanding causes of the unique patterns of intrauterine growth. Different fetal growth trajectories from early pregnancy associate with subsequent adult adiposity and inflammation, which predispose to the risk of diabetes and cardiometabolic disease.