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Racial Disparities in the Association between Birth Weight in the Term Infant and Blood Pressure at Age 7 Years: Results from the Collaborative Perinatal Project

Anusha H. Hemachandra^*,, Mark A. Klebanoff and Susan L. Furth^,

^* Division of Neonatology, Department of Pediatrics and Division of Pediatric Nephrology, Department of Pediatrics, The Johns Hopkins University School of Medicine and The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Medical Institutions, Baltimore, and Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland

Address correspondence to: Dr. Anusha H. Hemachandra, Division of Neonatology, 600 N. Wolfe Street, NH 2-133, Baltimore, MD 21287, Phone: 410-955-5259; Fax: 410-955-0298; E-mail: ahemach2{at}jhmi.edu

Received for publication September 1, 2005. Accepted for publication July 2, 2006.

BP has been inversely associated with birth weight in studies worldwide, but few studies have included black individuals. The US National Collaborative Perinatal Project followed 58,960 pregnant women and their resultant offspring for 7 yr. In this post hoc analysis, all term white or black children without kidney or heart disease were included (n = 29,710). The effect of birth weight and other risk factors on systolic (SBP) and diastolic BP (DBP) was evaluated at 7 yr. Mean birth weight and body mass index at 7 yr were slightly lower for black compared with white children (birth weight 3.14 ± 0.48 versus 3.32 ± 0.46 kg [P < 0.001]; body mass index 15.8 ± 2.0 versus 16.3 ± 2.0 [P < 0.001]). Compared with white mothers, black mothers were less likely to smoke (41 versus 52%), were more anemic (23 versus 7%), and were more likely to live in poverty (72 versus 39%). In linear regression, there was significant interaction between race and birth weight in predicting SBP (P = 0.002). In bivariate analysis, birth weight was positively associated with SBP ( = 0.87) and DBP ( = 1.14) in black children (P < 0.001) but not associated with either in white children. With maternal poverty, educational level, and anemia during pregnancy added to the model, birth weight remained a significant positive predictor of SBP ( = 0.89, P < 0.001) in black but not in white children ( = 0.02, P = 0.17). The association between birth weight and SBP differs between black and white children. The cause of intrauterine growth restriction–associated hypertension seems to be race sensitive; therefore, future studies of racial disparities in the "Barker hypothesis" may help in the understanding of the mechanism of fetal programming of hypertension.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673