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Offspring birth weight and cardiovascular mortality among parents: the role of cardiovascular risk factors

  • F. Shaikh (a1), M. K. Kjøllesdal (a1) and Ø. Naess (a1) (a2)


An inverse association between offspring birth weight (BW) and higher risk of parental cardiovascular disease (CVD) mortality and morbidity has been reported. Shared environmental, genetic and intrauterine factors may be responsible for explaining these associations. We studied the role of parental CVD risk factors in the association between offspring BW and CVD mortality among mothers and fathers. All births registered in Medical Birth Registry Norway (1967–2012) were linked to three health surveys, National Educational Registry and Cause of Death Registry. Number of births with information of parental CVD risk factors available for the analyses was 1,006,557 (520,670 for mothers and 485,887 for fathers). Cox proportional hazards regression models were used, following CVD deaths in parents from 1974 to 2012. An inverse association between offspring BW and CVD mortality was observed among both parents: hazard ratio 1.60 (1.44–1.75) for mothers and 1.16 (1.10–1.23) for fathers. Among mothers, adjustment for smoking, triglycerides and diabetes reduced the risk to 1.36 (1.25–1.52), 1.57 (1.43–1.73) and 1.58 (1.43–1.79), respectively. Adjustment for diastolic blood pressure (DBP) and systolic blood pressure (SBP) both reduced the risk to 1.53 (1.37–1.66). Among fathers, adjustments for smoking, DBP, SBP reduced the risk to 1.08 (1.02–1.15), 1.13 (1.06–1.19) and 1.14 (1.08–1.22), respectively. Triglycerides and diabetes both reduced the risk to 1.15 (1.09–1.12). Our results indicate that shared environmental factors might be important in the association. A stronger association in mothers suggest that intrauterine factors also are at play.


Corresponding author

Address for correspondence: Fareeha Shaikh, Institute of Health and Society, Faculty of Medicine, University of Oslo, Post Box: 1130 Blindern, 0318 Oslo, Norway. E-mail:


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1. Osmond, C, Barker, DJ. Fetal, infant, and childhood growth are predictors of coronary heart disease, diabetes, and hypertension in adult men and women. Environ Health Perspect. 2000; 108(Suppl. 3), 545553.
2. Davey Smith, G, Hypponen, E, Power, C, Lawlor, DA. Offspring birth weight and parental mortality: prospective observational study and meta-analysis. Am J Epidemiol. 2007; 166, 160169.
3. Smith, GD, Sterne, J, Tynelius, P, Lawlor, DA, Rasmussen, F. Birth weight of offspring and subsequent cardiovascular mortality of the parents. Epidemiology. 2005; 16, 563569.
4. Davey Smith, G, Hart, C, Ferrell, C, et al. Birth weight of offspring and mortality in the Renfrew and Paisley study: prospective observational study. BMJ. 1997; 315, 11891193.
5. Friedlander, Y, Manor, O, Paltiel, O, et al. Birth weight of offspring, maternal pre-pregnancy characteristics, and mortality of mothers: the Jerusalem perinatal study cohort. Ann Epidemiol. 2009; 19, 112117.
6. Hales, CN, Barker, DJP. The thrifty phenotype hypothesis: type 2 diabetes. Br Med Bull. 2001; 60, 520.
7. Godfrey, KM, Lillycrop, KA, Burdge, GC, Gluckman, PD, Hanson, MA. Epigenetic mechanisms and the mismatch concept of the developmental origins of health and disease. Pediatr Res. 2007; 61(Pt 2), 5r10r.
8. Waterland, RA, Michels, KB. Epigenetic epidemiology of the developmental origins hypothesis. Annu Rev Nutr. 2007; 27, 363388.
9. Wang, G, Walker, SO, Hong, X, Bartell, TR, Wang, X. Epigenetics and early life origins of chronic noncommunicable diseases. J Adolesc Health. 2013; 52(Suppl. 2), S14S21.
10. Hattersley, AT, Tooke, JE. The fetal insulin hypothesis: an alternative explanation of the association of low birthweight with diabetes and vascular disease. Lancet. 1999; 353, 17891792.
11. Bergvall, N, Cnattingius, S. Familial (shared environmental and genetic) factors and the foetal origins of cardiovascular diseases and type 2 diabetes: a review of the literature. J Intern Med. 2008; 264, 205223.
12. Li, CY, Chen, HF, Sung, FC, et al. Offspring birth weight and parental cardiovascular mortality. Int J Epidemiol. 2010; 39, 10821090.
13. Manor, O, Koupil, I. Birth weight of infants and mortality in their parents and grandparents: the Uppsala Birth Cohort Study. Int J Epidemiol. 2010; 39, 12641276.
14. Naess, O, Stoltenberg, C, Hoff, DA, et al. Cardiovascular mortality in relation to birth weight of children and grandchildren in 500,000 Norwegian families. Eur Heart J. 2013; 34, 34273436.
15. Elshibly, EM, Schmalisch, G. The effect of maternal anthropometric characteristics and social factors on gestational age and birth weight in Sudanese newborn infants. BMC Public Health. 2008; 8, 244.
16. Vik, KL, Romundstad, P, Carslake, D, Davey Smith, G, Nilsen, TIL. Comparison of father-offspring and mother-offspring associations of cardiovascular risk factors: family linkage within the population-based HUNT Study, Norway. Int J Epidemiol. 2014; 43, 760771.
17. Dietz, PM, England, LJ, Shapiro-Mendoza, CK, et al. Infant morbidity and mortality attributable to prenatal smoking in the U.S. Am J Prev Med. 2010; 39, 4552.
18. Bonamy, AK, Parikh, NI, Cnattingius, S, Ludvigsson, JF, Ingelsson, E. Birth characteristics and subsequent risks of maternal cardiovascular disease: effects of gestational age and fetal growth. Circulation. 2011; 124, 28392846.
19. Irgens, LM. The Medical Birth Registry of Norway. Epidemiological research and surveillance throughout 30 years. Acta Obstet Gynecol Scand. 2000; 79, 435439.
20. Bjartveit, K, Foss, OP, Gjervig, T, Lund-Larsen, PG. The cardiovascular disease study in Norwegian counties. Background and organization. Acta Med Scand Suppl. 1979; 634, 170.
21. Bjartveit, K, Stensvold, I, Lund-Larsen, PG, et al. [Cardiovascular screenings in Norwegian counties. Background and implementation. Status of risk pattern during the period 1986-90 among persons aged 40-42 years in 14 counties]. Tidsskr Nor Laegeforen. 1991; 111, 20632072.
22. Naess, O, Sogaard, AJ, Arnesen, E, et al. Cohort profile: cohort of Norway (CONOR). Int J Epidemiol. 2008; 37, 481485.
23. Kjollesdal, MK, Ariansen, I, Mortensen, LH, Davey Smith, G, Naess, O. Educational differences in cardiovascular mortality: the role of shared family factors and cardiovascular risk factors. Scand J Public Health. 2016; 44, 744750.
24. Stocks, T, Borena, W, Strohmaier, S, et al. Cohort profile: the metabolic syndrome and cancer project (Me-Can). Int J Epidemiol. 2010; 39, 660667.
25. Lund-Larsen, P. Blood pressure measured with a sphygmomanometer and with Dinamap under field conditions – a comparison. Nor J Epidemiol. 1997; 7, 235241.
26. Norwegian Institute of Public Health. Retrieved 3 March 2017 from
27. Lawlor, DA, Davey Smith, G, Whincup, P, et al. Association between offspring birth weight and atherosclerosis in middle aged men and women: British Regional Heart Study. J Epidemiol Community Health. 2003; 57, 462463.
28. Adams, J, Pearce, MS, White, M, Unwin, NC, Parker, L. No consistent association between birthweight and parental risk of diabetes and cardiovascular disease. Diabet Med. 2005; 22, 950953.
29. Catov, JM, Newman, AB, Roberts, JM, et al. Association between infant birth weight and maternal cardiovascular risk factors in the health, aging, and body composition study. Ann Epidemiol. 2007; 17, 3643.
30. Vik, KL, Romundstad, P, Nilsen, TI. Tracking of cardiovascular risk factors across generations: family linkage within the population-based HUNT study, Norway. J Epidemiol Community Health. 2013; 67, 564570.
31. Davey Smith, G, Sterne, JAC, Tynelius, P, Rasmussen, F. Birth characteristics of offspring and parental diabetes: evidence for the fetal insulin hypothesis. J Epidemiol Community Health. 2004; 58, 126128.
32. Walker, BR, McConnachie, A, Noon, JP, Webb, DJ, Watt, GC. Contribution of parental blood pressures to association between low birth weight and adult high blood pressure: cross sectional study. BMJ. 1998; 316, 834837.
33. Lawlor, DA, Smith, GD, Ebrahim, S. Birth weight of offspring and insulin resistance in late adulthood: cross sectional survey. BMJ.. 2002; 325, 359.
34. Dior, UP, Lawrence, GM, Sitlani, C, et al. Parental smoking during pregnancy and offspring cardio-metabolic risk factors at ages 17 and 32. Atherosclerosis. 2014; 235, 430437.
35. Horta, BL, Victora, CG, Menezes, AM, Halpern, R, Barros, FC. Low birthweight, preterm births and intrauterine growth retardation in relation to maternal smoking. Paediatr Perinat Epidemiol. 1997; 11, 140151.
36. Havlik, RJ, Garrison, RJ, Feinleib, M, et al. Blood pressure aggregation in families. Am J Epidemiol. 1979; 110, 304312.
37. Garrison, RJ, Castelli, WP, Feinleib, M, et al. The association of total cholesterol, triglycerides and plasma lipoprotein cholesterol levels in first degree relatives and spouse pairs. Am J Epidemiol. 1979; 110, 313321.
38. Thomas, F, Balkau, B, Vauzelle-Kervroedan, F, Papoz, L. Maternal effect and familial aggregation in NIDDM. The CODIAB Study. CODIAB-INSERM-ZENECA Study Group. Diabetes. 1994; 43, 6367.
39. Barker, DJ. Fetal origins of coronary heart disease. BMJ. 1995; 311, 171174.
40. Langsted, A, Freiberg, JJ, Nordestgaard, BG. Fasting verses non-fasting lipid levels – influence of normal food intake on lipids, lipoproteins, and apolipoproteins. Atheroscler Suppl. 2008; 9, 174.
41. SSB. Smoking habits, 2017. Retrieved 5 November 2017 from



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