Published online June 1, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. e1264-e1270 (doi:10.1542/peds.2005-2486)
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ARTICLE

Birth Weight, Postnatal Growth, and Risk for High Blood Pressure at 7 Years of Age: Results From the Collaborative Perinatal Project

Anusha H. Hemachandra, MD, MPHa,b, Penelope P. Howards, PhDa, Susan L. Furth, MD, PhDc,d and Mark A. Klebanoff, MD, MPHa

a Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
b Divisions of Neonatology
c Pediatric Nephrology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
d Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland

OBJECTIVE. A physiologic predisposition toward hypertension is theorized to result from the combination of intrauterine growth restriction followed by rapid catch-up growth. The objective of this study was to evaluate the effects of birth weight and weight gain during childhood on the risk for high blood pressure in childhood and to identify discrete periods of catch-up growth that put children with intrauterine growth restriction at increased risk for the development of high blood pressure later in life.

METHODS. The US Collaborative Perinatal Project (1959–1974) studied 55908 pregnancies in an observational cohort at 12 medical centers in the United States and followed the offspring through 7 years of age. All white or black children who were born at term and completed the follow-up without kidney or heart disease were included in this posthoc analysis. z scores were calculated for weight at birth, 4 months, 1 year, 4 years, and 7 years on the basis of study means and SD. Changes in z scores were calculated for each interval.

RESULTS. Each 1-kg increase in birth weight increased the odds for high systolic blood pressure by 2.19 and high diastolic blood pressure by 1.82 when race and change in weight z scores were also included in the regression model. An increase in weight z score of 1 SD above the previous weight z score increased the odds for high systolic blood pressure at 7 years by 1.65 (birth to 4 months), 1.79 (4 months to 1 year), 1.71 (1–4 years), and 1.94 (4–7 years) in the full model. White race increased the odds for high systolic blood pressure by 1.51.

CONCLUSIONS. In this large biracial US cohort, infants who were small for gestational age were not at increased risk for high blood pressure at 7 years of age. However, children who crossed weight percentiles upward during early childhood did demonstrate an increased risk.

Key Words: hypertension • Barker hypothesis • catch-up growth • intrauterine growth restriction

Abbreviations: IUGR—intrauterine growth restriction • BP—blood pressure • CPP—Collaborative Perinatal Project • DBP—diastolic blood pressure • SBP—systolic blood pressure • SGA—small for gestational age • LGA—large for gestational age • AGA—appropriate for gestational age • PP—pulse pressure • OR—odds ratio • CI—confidence interval

Accepted Dec 12, 2006.


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