Childhood blood pressure : aspects of programming

Clark, Phillipa Margaret (1996) Childhood blood pressure : aspects of programming. University of Southampton, Doctoral Thesis.

Abstract

The two epidemiological studies in this thesis tested hypotheses relating to the programming of childhood blood pressure.

In the first, the urinary excretion of glucocorticoid and adrenal androgen metabolites (expressed as μg/day) was related to the size at birth and current size and blood pressure of 190 healthy 9 year old children. The results were consistent with a hypothesis that factors associated with reduced fetal growth programme hypothalamo-pituitary-adrenal (HPA) axis function, and that programmed alterations in function are related to childhood blood pressure. For example, children who had been light at birth excreted more urinary adrenal androgen and glucocorticoid metabolites, although the latter relationship was best described as U-shaped. Increased urinary adrenal androgen excretion was associated with higher systolic blood pressure. The relationship of blood pressure and glucocorticoid excretion appeared quadratic. The highest mean blood pressure was found in the middle range of excretion. This is the first evidence of fetal programming of the HPA axis in childhood, and could also suggest that the timing of adrenarche is related to size at birth.

In the second study, the children of 298 women who had taken part in a study of nutrition in pregnancy were followed up at a mean age of 11 years. The hypothesis: that increased pregnancy weight gain and thicker early pregnancy triceps skinfold thickness (TST) would be associated with lower childrens' blood pressure. Maternal pregnancy weight gain was associated with lower systolic and diastolic blood pressure, but only in children born to women with thin pregnancy TT measurements. There was no statistical evidence this relationship differed between the two groups when women were divided according to TST at current follow-up. In conclusion, maternal nutrition in early pregnancy may be particularly important when considering children's blood pressure.

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