Mother's weight in pregnancy and coronary heart disease in a cohort of finnish men: follow up study

Abstract Objective: To determine whether restricted growth in utero is associated with an increased risk of coronary heart disease among men in Finland, where rates of the disease are among the highest in the world. Design: Follow up study. Setting: Helsinki, Finland. Subjects: 3302 men born in Helsinki University Central Hospital during 1924–33 who went to school in the city of Helsinki and were resident in Finland in 1971. Main outcome measures: Standardised mortality ratios for coronary heart disease. Results: Men who were thin at birth, with low placental weight, had high death rates from coronary heart disease. Men whose mothers had a high body mass index in pregnancy also had high death rates. In a multivariate analysis the hazard ratio for coronary heart disease was 1.37 (95% confidence interval 1.20 to 1.57) (P<0.0001) for every standard deviation decrease in ponderal index at birth and 1.24 (1.10 to 1.39) (P=0.0004) for every standard deviation increase in mother's body mass index. The effect of mother's body mass index was restricted to mothers of below average stature. Conclusion: These findings suggest a new explanation for the epidemics of coronary heart disease that accompany Westernisation. Chronically malnourished women are short and light and their babies tend to be thin. The immediate effect of improved nutrition is that women become fat, which seems to increase the risk of coronary heart disease in the next generation. With continued improvements in nutrition, women become taller and heavier; their babies are adequately nourished; and maternal fatness no longer increases the risk of coronary heart disease, which therefore declines. Key messages Men who were thin at birth have high death rates from coronary heart disease If, in addition, their mothers were short and heavy they have evenhigher rates Women tend to be short and heavy in populations at an intermediatestage between chronic malnutrition and adequate nutrition This may explain why rates of coronary heart disease rise as nutrition improves in a population; rates then decline with continuing nutritional improvement