title: Delivery of a small for gestational age infant and greater maternal risk of ischemic heart disease.
abstract: BACKGROUND
  Delivery of a small for gestational age (SGA) infant has been associated with increased maternal risk of ischemic heart disease (IHD). It is uncertain whether giving birth to SGA infant is a specific determinant of later IHD, independent of other risk factors, or a marker of general poor health. The purpose of this study was to investigate the association between delivery of a SGA infant and maternal risk for IHD in relation to traditional IHD risk factors.
  
  
  RESULTS
  Risk of maternal IHD was evaluated in a population based cross-sectional study of 6,608 women with a prior live term birth who participated in the National Health and Nutrition Examination Survey (1999-2006), a probability sample of the U.S. population. Sequence of events was determined from age at last live birth and at diagnosis of IHD. Delivery of a SGA infant is strongly associated with greater maternal risk for IHD (age adjusted OR; 95% CI: 1.8; 1.2, 2.9; p = 0.012). The association was independent of the family history of IHD, stroke, hypertension and diabetes (family history-adjusted OR; 95% CI: 1.9; 1.2, 3.0; p = 0.011) as well as other risk factors for IHD (risk factor-adjusted OR; 95% CI: 1.7; 1.1, 2.7; p = 0.025). Delivery of a SGA infant was associated with earlier onset of IHD and preceded it by a median of 30 (interquartile range: 20, 36) years.
  
  
  CONCLUSIONS
  Giving birth to a SGA infant is strongly and independently associated with IHD and a potential risk factor that precedes IHD by decades. A pregnancy that produces a SGA infant may induce long-term cardiovascular changes that increase risk for IHD.
authors.affiliation: Medical Branch, Department of Obstetrics and Gynecology, University of Texas, Galveston, Texas, United States of America. rkbukows@utmb.edu
authors.forename: Radek
authors.initials: R
authors.lastname: Bukowski
authors.forename: Karen E
authors.initials: KE
authors.lastname: Davis
authors.forename: Peter W F
authors.initials: PW
authors.lastname: Wilson
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D053208:Kaplan-Meier Estimate; D009035:Mothers; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology*; D016017:Odds Ratio; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology