Coronary heart disease after prenatal exposure to the Dutch famine, 1944-45.
OBJECTIVE
To assess the effect of prenatal exposure to maternal malnutrition on coronary heart disease in people born around the time of the Dutch famine, 1944-45.


METHODS
Historical cohort study.


METHODS
Community study.


METHODS
Singletons born alive between November 1943 and February 1947 for whom detailed birth records were available.


METHODS
The prevalence of coronary heart disease was compared between those exposed to famine in late gestation (n = 120), in mid-gestation (n = 108), or in early gestation (n = 68), and those born in the year before the famine or those conceived in the year after the famine (non-exposed subjects, n = 440).


METHODS
Prevalence of coronary heart disease, defined as the presence of angina pectoris according to the Rose questionnaire, Q waves on the ECG, or a history of coronary revascularisation.


RESULTS
The prevalence of coronary heart disease was higher in those exposed in early gestation than in non-exposed people (8.8% v 3.2%; odds ratio adjusted for sex 3.0, 95% confidence interval (CI) 1.1 to 8.1). The prevalence was not increased in those exposed in mid gestation (0.9%) or late gestation (2.5%). People with coronary heart disease tended to have lower birth weights (3215 g v 3352 g, p = 0.13), and smaller head circumferences at birth (32.2 cm v 32.8 cm, p = 0.05), but the effect of exposure to famine in early gestation was independent of birth weight (adjusted odds ratio 3.2, 95% CI 1.2 to 8.8).


CONCLUSIONS
Although the numbers are very small, this is the first evidence suggesting that maternal malnutrition during early gestation contributes to the occurrence of coronary heart disease in the offspring.
Roseboom
T J
TJ
Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands. t.j.roseboom@amc.uva.nl
van der Meulen
J H
JH
Osmond
C
C
Barker
D J
DJ
Ravelli
A C
AC
Schroeder-Tanka
J M
JM
van Montfrans
G A
GA
Michels
R P
RP
Bleker
O P
OP
D001724:Birth Weight; D002508:Cephalometry; D015331:Cohort Studies; D003327:Coronary Disease / Q000196:embryology* / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010927:Placental Insufficiency / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications; D011297:Prenatal Exposure Delayed Effects; D015995:Prevalence; D012307:Risk Factors; D013217:Starvation / Q000150:complications*