title: The sex-specific effects of famine on the association between placental size and later hypertension.
abstract: BACKGROUND
  People who had low birth weight are at increased risk of hypertension. This may reflect fetal programming by undernutrition. Placental size is also associated with hypertension. Maternal undernutrition during the Dutch famine reduced placental surface area. We examined whether maternal undernutrition altered the relationship between placental size and later hypertension.
  
  
  METHODS
  Retrospective cohort study among 860 subjects born in Amsterdam during 1943-47. 216 subjects were taking anti-hypertensive medication. Birth records included placental length and breadth from which we calculated its area.
  
  
  RESULTS
  Among men who were not in utero during the famine hypertension was associated with a small placental surface area due to a small placental breadth, and with an oval-shaped surface. The OR for hypertension was 0.83 (95% CI 0.70 to 1.00) for a 40 cm(2) increase in surface area. Among men who were in utero during the famine hypertension was associated with a large placental surface area due to a large placental breadth, and with a round-shaped surface. The OR for hypertension was 1.34 (95% CI 0.99 to 1.80) for a 40 cm(2) increase in surface area. The associations between placental size and hypertension in men who were and were not in utero during the famine were significantly different (p values for interaction = 0.008 for placental surface area, 0.001 for the breadth and 0.01 for the difference in the two diameters). Among women hypertension was not associated with placental size.
  
  
  CONCLUSIONS
  Our study provides the first direct evidence that changes in maternal diet during pregnancy alter the relationship between placental size and later hypertension among men but not women. We suggest that among men who were not in utero during the famine, hypertension was related to impaired implantation, whereas among men who were in utero during the famine it was related to compensatory expansion of the placental surface.
authors: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Electronic address: a.f.vanabeelen@amc.uva.nl.
authors: A F M
authors: AFM
authors: van Abeelen
authors: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors: S R
authors: SR
authors: de Rooij
authors: MRC Lifecourse Epidemiology Unit (University of Southampton), Southampton General Hospital, Southampton SO16 6YD, UK.
authors: C
authors: C
authors: Osmond
authors: Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors: R C
authors: RC
authors: Painter
authors: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors: M V E
authors: MVE
authors: Veenendaal
authors: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors: P M M
authors: PMM
authors: Bossuyt
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors: S G
authors: SG
authors: Elias
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors: D E
authors: DE
authors: Grobbee
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors: Y T
authors: YT
authors: van der Schouw
authors: MRC Lifecourse Epidemiology Unit (University of Southampton), Southampton General Hospital, Southampton SO16 6YD, UK; Fetal Programming of Diseases Research Chair, College of Medicine, King Saud University, PO Box 245, Riyadh 11411, Saudi Arabia.
authors: D J P
authors: DJP
authors: Barker
authors: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors: T J
authors: TJ
authors: Roseboom
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition / Q000150:complications; D009426:Netherlands; D009929:Organ Size; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000503:physiopathology*; D012189:Retrospective Studies; D012727:Sex Characteristics; D013217:Starvation / Q000150:complications* / Q000503:physiopathology