The relationship between intrauterine foetal growth trajectories and blood pressure in young adults

Abstract

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.

Relationships between intrauterine fetal growth trajectories and markers of adiposity and inflammation in young adults

“…The associations between fetal growth and adult adiposity and hs-CRP, largely persisted after adjustment for postnatal lifestyle factors as well as maternal and pregnancy covariates, with effects more pronounced in females compared to males. These findings support the evidence linking different patterns of fetal growth and markers of adult cardiovascular disease, including our finding of such relationships with adult blood pressure in the same cohort [ 30 ].…”

“…1 ). Details relating to trajectory construction have been published [ 30 ]. In brief, standard deviation scores (SDS) were calculated for ultrasound-based fetal anthropometric markers using linear regression, adjusting for physiological factors influencing fetal growth (maternal height and parity, sex, and ethnicity of the fetus).…”

“… Reproduced from Yadav et al [ 30 ]. DOI:10.1097/HJH.0000000000003035 with permission from Wolters Kluwer Health, Inc. …”

“…Although our birthweight findings are reflective of this, the use of serial ultrasound measures in this study shows that birthweight does not accurately represent different trajectories of early-mid fetal growth. We have previously shown that offspring with similar birthweight can have substantially different fetal growth patterns, and fetuses with similar growth at 15 weeks gestation can have a significantly different birthweight [ 30 ]. Such differences may play an important role in determining adiposity and cardiometabolic health in adolescence and adulthood.…”

“…We have recently reported different intrauterine growth trajectories derived from ultrasounds from 15 weeks gestation to birth in the Raine Study, an Australian longitudinal pregnancy cohort [ 30 ]. In particular, restricted fetal head and abdominal circumference associated with higher adult blood pressure independent of a range of confounders, including adult adiposity.…”