Objectives-To examine the relation between disproportionate fetal growth and adult blood pressure and to investigate whether arterial compliance in adult life is related to early development. Design-A follow up study of a group of men and women whose birth weights and other measurements of body size had been recorded at birth. Setting-Home and outpatient study. Subjects-337 men and women born in the Jessop Hospital, Sheffield, between 1939 and 1940. Main outcome-Adult systolic and diastolic blood pressures and arterial compliance as measured by pulse wave velocity in two arterial segments. Results-Both systolic and diastolic blood pressures were higher in people whose birth weight was low, who were short or who had small abdominal or head circumferences at birth. Systolic blood pressure decreased by 2f7 mm Hg (95% CI 0f8 to 4.6) for each pound (454 g) gain in birth weight and by 3'4 mm Hg (95% CI 1P4 to 5.4) for each inch (2.54 cm) increase in crown-heel length. Diastolic pressure fell by 1 9 mm Hg (95% CI 0 9 to 2.9) for each pound (454 g) gain in birth weight and by 2-4 mm Hg (95% CI 1.4 to 3.5) for each inch (2.54 cm) increase in length. Systolic blood pressure was also higher in individuals whose mother's intercristal pelvic diameter was small or whose mother's blood pressure had been raised during pregnancy but these effects were statistically independent ofthe effects of low birth weight and other measurements that indicate fetal growth retardation. Arterial compliance was lower in those who had been small at birth. Conclusion-Impairment of fetal growthis associated with raised blood pressure in adult life and decreased compliance in the conduit arteries of the trunk and legs. (Br Heart J 1995;73:116-121)

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To explore the relation between reduced fetal growth and impaired glucose tolerance in adult life, an oral glucose tolerance test (75 g glucose) was carried out on 218 men and women, now aged around 50 years, who had been measured in detail at birth. Measurements of plasma concentrations of glucose and insulin were made at 0, 30, and 120 min. Fasting plasma concentrations of proinsulin and 32-33 split proinsulin were also measured. People in the highest category of birthweight tended to have the lowest plasma concentrations of insulin as adults at both 0 and 120 min, though both these relations were weak. Plasma insulin concentrations in adult life were more strongly related to abdominal circumference at birth than to birthweight. After adjusting for sex and body mass index, mean insulin concentrations at 0 min fell from 50 pmol l-1 to 46 pmol l-1 (p = 0.04) and at 120 min from 235 pmol l-1 to 144 pmol l-1 (p = 0.003) between people whose abdominal circumference at birth had been less than 11.5 in and those who abdominal circumference had been greater than 13 in. Plasma glucose concentrations at 120 min also fell with increasing abdominal circumference at birth. Because abdominal circumference at birth is an indicator of the growth of the liver in fetal life, one interpretation of these findings is that the sensitivity of the liver to insulin is permanently reduced if the intrauterine development of this organ is impaired.

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