Growth in utero and during childhood among women who develop coronary heart disease:: longitudinal study

Objective To examine whether women who develop coronary heart disease have different patterns of fetal and childhood growth from men in the same cohort who develop the disease. Design Follow up study of women whose body size at birth was recorded and who had an average of 10 measurements of height and weight during childhood. Setting Helsinki, Finland. Subjects 3447 women who were born in Helsinki University Central Hospital during 1924-33 and who went to school in Helsinki. Main outcome measures Hazard ratios for hospital admission for or death from coronary heart disease. Results Coronary heart disease among women was associated with low birth weight (P = 0.08 after adjustment for gestation, P = 0.007 after adjustment for placental weight) and was more strongly associated with short body length at birth (P = 0.001 and P < 0.0001, respectively). The hazard ratio for women developing coronary heart disease increased by 10.2% (95% confidence interval 4.3 to 15.7) for each rm decrease in length at birth. The effect of short length at birth was greatest in women whose height "caught up" after birth so that as girls they were tall. Such girls tended to have tall mothers. In contrast, men in the same cohort who developed the disease were thin at birth rather than short, showed "catch up" growth in weight rather than height, and their mothers tended to be overweight rather than tall. Conclusion Coronary heart disease among both women and men reflects poor prenatal nutrition and consequent small body size at birth combined with improved postnatal nutrition and "catch up" growth in childhood. The disease is associated with reductions in those aspects of body proportions at birth that distinguish die two sexes-short body length in women and thinness in men.