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15 February 2000 | Volume 132 Issue 4 | Pages 253-260
Background: Reduced birthweight is associated with increased risk for the insulin resistance syndrome. Part of this risk is hypothesized to originate from undernutrition in utero. The prevalence of the insulin resistance syndrome increases in countries that undergo the transition from chronic malnutrition to adequate nutrition, when postnatal nutrition improves more rapidly than prenatal nutrition.
Objective: To determine whether the components of the insulin resistance syndrome are associated with reduced fetal growth and maternal undernutrition.
Design: A nonconcurrent, prospective study of men and women whose mothers' heights and weights were recorded during pregnancy.
Setting: Beijing, China.
Participants: 627 men and women (mean age, 45 years) whose mothers' obstetric records were preserved.
Measurements: Adult offspring's blood pressure, plasma glucose levels, insulin levels, and lipid concentrations during an oral glucose tolerance test. The main explanatory measurements were mothers' body mass index during pregnancy and offspring's birthweight and adult size.
Results: After adjustment for sex and current body mass index, low birthweight was associated with elevated plasma glucose levels, insulin levels, triglyceride concentrations, and blood pressure. For every 1-kg increase in birthweight, systolic blood pressure decreased by 2.9 mm Hg (95% CI, 0.3 to 5.4 mm Hg) and the 2-hour plasma glucose level decreased by 5.1% (CI, 0.7% to 9.3%). Low maternal body mass index in early and late pregnancy was associated with elevated levels of plasma glucose, insulin, and triglycerides in adult offspring but was not associated with elevated blood pressure.
Conclusions: Risk for the insulin resistance syndrome may be partially established through low maternal body mass before pregnancy and consequent fetal undernutrition. This risk is independent of that associated with adult obesity. In developing countries such as China, improved nutrition in girls and young women may offer long-term benefits to offspring.
Author and Article Information
From Peking Union Medical College, Beijing, People's Republic of China; and Southampton General Hospital, Southampton, United Kingdom.
Acknowledgments: The authors thank the participants, their mothers, and the staff at the Beijing Municipal Residential Records Office. They also thank the staff of the Peking Union Medical College Hospital for their support, including Ming-Ying Gai, Chao-Zhen Zhao, Yi Shen, Xiao-Ling Zhou, and Wei-Hong Tang; the director of Chao Yang Men Hospital, Wei Wang, and his staff for their assistance; Professors T. Meade and N. Hales for their collaboration in laboratory analysis; and Vanessa Cox and Mary Barker for computing and other assistance. Clinics were staffed by Hong-Jian Xu, Yong-Fang Xu, Jun Liu, and Shan-Ying Liu.
Requests for Single Reprints: Catherine Law, MD, MRC Environmental Epidemiology Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom.
Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
Current Author Addresses: Drs. Mi and Zhang: Department of Epidemiology, Peking Union Medical College, 5 Dong Dan San Tiao, Beijing 100005, People's Republic of China.
Drs. Law, Osmond, and Barker: MRC Environmental Epidemiology Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom.
Dr. Stein: Department of Public Health Medicine, Southampton and South West Hants Health Authority, Oakley Road, Southampton, Hampshire S016 49X, United Kingdom.
Author Contributions: Conception and design: J. Mi, C. Law, K.-L. Zhang, C. Osmond, C. Stein, D. Barker.
Analysis and interpretation of the data: J. Mi, C. Law, K.-L. Zhang, C. Osmond, C. Stein, D. Barker.
Drafting of the article: J. Mi, C. Law, K.-L. Zhang, C. Osmond, C. Stein, D. Barker.
Final approval of the article: J. Mi, C. Law, K.-L. Zhang, C. Osmond, C. Stein, D. Barker.
Statistical expertise: C. Osmond.
Administrative, technical, or logistic support: K.-L. Zhang.
Collection and assembly of data: J. Mi, C. Law, C. Stein. ARTICLE
Effects of Infant Birthweight and Maternal Body Mass Index in Pregnancy on Components of the Insulin Resistance Syndrome in China
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