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The European Journal of Public Health Advance Access published online on September 1, 2005
The European Journal of Public Health, doi:10.1093/eurpub/cki171
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© The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Received November 6, 2003
Accepted November 3, 2004

Article

Birthweight and blood pressure in five European birth cohort studies: an investigation of confounding factors

Rebecca Hardy 1*, Ulla Sovio 2, Vanessa J. King 2, Paula M. L. Skidmore 1, Gunnhild Helmsdal 3, Sjurdur F. Olsen 3, Pauline M. Emmett 4, Michael E. J. Wadsworth 1, Marjo-Riitta Järvelin 5, and the EURO-BLCS Study Group

1 Medical Research Council National Survey of Health and Development, Department of Epidemiology and Public Health, Royal Free and University College Medical School, London, UK
2 Department of Epidemiology and Public Health, Imperial College London, UK
3 Maternal Nutrition Group, Danish Epidemiology Science Centre, Statens Serum Institute, Copenhagen, Denmark
4 Unit of Paediatric and Perinatal Epidemiology, Division of Community Medicine, University of Bristol, Bristol, UK
5 Department of Epidemiology and Public Health, Imperial College London, UK; Department of Public Health Science and General Practice, University of Oulu, Finland

* To whom correspondence should be addressed.
Rebecca Hardy, E-mail: r.hardy{at}nshd.mrc.ac.uk


  Abstract

Background: It has been suggested that the association between birthweight and blood pressure has been overstated as a result of publication bias and, within studies, a lack of adjustment for potentially important maternal and socioeconomic confounding factors and ‘overadjustment’ for current body size. This study investigates the impact of potential confounding variables on the birthweight-blood pressure association in birth cohort studies from different time periods and geographical locations in Europe. Methods: Data from five European birth cohort studies (from Finland, the UK, and the Faroe Islands) taking part in the European Birth-Lifecourse-Studies (EURO-BLCS) project were analysed. Birthweight was measured at birth in all cohorts and confounding variable information was collected prospectively at subsequent follow-ups in all cohorts. Regression models were used to assess the unadjusted association between birthweight and blood pressure and then to assess the impact of potential maternal and socioeconomic confounding variables and adjustment for later body size. Analyses were carried out in the same way across all five cohorts. Results: Birthweight was consistently negatively associated with systolic blood pressure (SBP) across all cohorts. Gestational age and possibly maternal pre-pregnancy weight, but not socioeconomic status, may be important confounding factors of the relationship between birthweight and SBP. The size of the birthweight-SBP association in adulthood may be larger than in childhood before adjustment for current body size, although a cohort effect cannot be ruled out. Conclusion: This study highlights the value of future cross-cohort comparisons in the investigation of the foetal origins of adult disease.

Keywords: birthweight; blood pressure; cohort studies; confounding.
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