Can birth weight predict offspring’s lung function in adult age? Evidence from two Swedish birth cohorts

Abstract

Background Associations between birth weight (BW) and adult lung function have been inconsistent and limited to early adulthood. We aimed to study this association in two population-based cohorts and explore if BW, adjusted for gestational age, predicts adult lung function. We also tested adult lung function impairment according to the mis-match hypothesis—small babies growing big as adults. Methods We included 3495 individuals (aged 46.4 ± 5.4 years) from the Malmo Preventive Project (MPP), Sweden, born between 1921 and 1949, and 1401 young to middle-aged individuals (aged 28.6 ± 6.7 years) from the Malmo Offspring Study (MOS) with complete data on BW and gestational age. Adult lung function (forced vital capacity [FVC], forced expiratory volume in one second [FEV1] and the FEV1/FVC-ratio) were analysed as level of impairment (z-score), using multiple linear and logistic regressions. Results BW (z-score) did not predict adult lung function in MPP, whereas BW was a significant (p = 0.003) predictor of FEV1 following full adjustment in MOS. For every additional unit increase in BW, children were 0.77 (95% CI 0.65–0.92) times less likely to have impaired adult lung function (FEV1). Moreover, adults born with lower BW (< 3510 g) showed improved lung function (FEV1 and FEV1/FVC in MOS and MPP, respectively) if they achieved higher adult body weight. Conclusions Adults born with lower birth weight, adjusted for gestational age, are more likely to have impaired lung function, seen in a younger birth cohort. Postnatal growth pattern may, however, compensate for low birth weight and contribute to better adult lung function.

The Influence of Birthweight on Adult Lung Function: Insights from the UK Biobank

“…It is probable that during this range, the fetal environment facilitates optimal lung development, characterized by adequate alveolar multiplication, sufficient surfactant production, and optimal growth of the pulmonary vascular system. 22,23 The presence of a nonlinear association beyond this range may indicate the presence of distinct physiological challenges, such as an elevated susceptibility to obesity and associated comorbidities, which could counterbalance the advantages of a higher birthweight in terms of lung function 15,24 . This discovery implies the existence of a threshold effect in the correlation between birthweight and lung function.…”

“…21 A comprehensive review of existing literature underscores the consistent finding that individuals with low birthweight consistently exhibit lower lung function, which aligns with our own findings. 22 This implies that the influence of birthweight on lung development is not temporary but rather persists into later stages of life, potentially impacting the susceptibility to respiratory diseases and the decline in lung function observed between the ages of 40 and 70.…”

Comparison of the lower limit of normal to the fixed ratio method for the diagnosis of airflow obstruction at high altitudes: a large cross-sectional survey of subjects living between 3000–4700 m above sea level

“…They found that both FVC and FEV 1 were significantly lower at higher altitude and that the FEV 1 /FVC ratio decreased because FEV 1 decreased proportionally more than FVC, thus impacting on the ability of a FR to identify the population with AO at a high altitude [ 17 ]. Potential mechanisms behind these changes in lung function include harsh living environment, poverty, low birth weight, exposure to HAP [ 18 – 20 ]; adapting to chronic hypoxia and the related increase in ventilation [ 17 ]. However, to the best of our knowledge, no study has focused on comparing spirometry criteria for AO at high altitudes.…”

Seeing pulmonary hypertension through a paediatric lens: a viewpoint

“…Low birth weight is a surrogate marker of poor fetal growth (intrauterine growth restriction; IUGR) and a risk for preterm birth. Initial evidence also indicates that children with IUGR are also at risk for lung function trajectories below average and at risk for chronic lung disease later in life [ 16 , 17 ]. Studies conducted in rodents also suggest that perinatal insults predispose to pulmonary vascular dysfunction in adulthood.…”