Offspring size at birth and maternal risk for cardiovascular disease: a systematic review and meta-analysis

Background: Offspring size at birth is known to be associated with maternal cardiovascular disease (CVD) risk. Low birthweight (LBW), small for gestational age (SGA) and intrauterine growth restriction (IUGR) are all used to define infants considered small at birth. Objectives: To determine whether women who give birth to SGA/LBW/IUGR infants have higher levels of cardio-metabolic risk factors compared to women who give birth to average for gestational age infants or women. Search strategy: We performed a systematic literature search using PubMed, Embase and CINAHL. Selection criteria: Studies that compared cardio-metabolic risk factors in women who gave birth to SGA/LBW/IUGR infants compared to a control group. Data collection and analysis: Two independent authors screened and extracted data. Meta-analysis was performed on Review Manager 5.3. Main results: The meta-analysis showed a significantly increased CVD mortality among women who gave birth to SGA infants compared to AGA infants (relative risk 1.45, 95% confidence interval (CI) 1.40 to 1.52; 2,584,533 participants, three studies; heterogeneity: Chi2 P=0.48; I2=0%). Women who gave birth to growth restricted infants had significantly higher mean BMI (1.72kg/m2, 95% CI 0.97 to 2.47; 77 participants, two studies; heterogeneity: Chi2 P=0.35; I2=0%), and higher total mean cholesterol levels (0.32mmol/l, 95% CI 0.13 to 0.50; 77 participants, two studies; heterogeneity: Chi2 P=0.69; I2=0%) compared to women who had uncomplicated pregnancies. Conclusions: Women who give birth to small infants are at increased risk of CVD. Postpartum screening for CVD risk factors will help identify those at risk.