Fetal growth and later maternal death, cardiovascular disease and diabetes

Abstract

Objectives: Low birthweight of the offspring has been associated with increased risk of early death and ischemic heart disease in the mother. However, other measurements of fetal growth than the basic birthweight are more accurate. We investigated the relation between the standardized birthweight by gestational age and gender and the ponderal index and the mother's subsequent mortality and cardiovascular morbidity.

Design: Registry-based retrospective cohort study.

Setting: Women with a first singleton delivery in Denmark from 1978 to 2007.

Population: 782 287 women followed for 14.6 years yielding 11 600 945 person-years.

Methods: Cox proportional hazard models.

Main outcome measures: The primary exposures were variation in the standardized birthweight and ponderal index. The endpoints were subsequent maternal death, hypertension, ischemic heart disease, stroke, thrombosis, and diabetes mellitus.

Results: The risk-profile for the standardized birthweight and subsequent maternal death had a nadir between -0.5 and -1 SD (HR 0.91; 95%CI 0.83-1.00) and increased with decreasing fetal growth peaking at <-3 SD (HR 2.75; 95%CI 2.37-3.19) compared to the median. The risk-profile for subsequent diabetes mellitus by standardized ponderal index had a nadir between +0.5 to +1 SD (HR 0.82; 95%CI 0.76-0.89) rising with increasing fetal growth and peaking at >+3 SD (HR 17.8; 95%CI 15.0-21.0). The risk-profiles for standardized ponderal index paralleled those for birthweight, but with smaller risk estimates. Adjusting for other pregnancy complications diminished the estimates.

Conclusion: The fetal growth is a marker of subsequent risk for premature death, cardiovascular disease, and diabetes mellitus in the mother.