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Birth weight, physical morbidity, and mortality: a population-based sibling-comparison study

Quetzal A Class, Martin E Rickert, Paul Lichtenstein

    American Journal of Epidemiology
    |December 21, 2013
    PubMed

    Insights

    Low birth weight increases the risk of mortality and morbidity, even after accounting for shared family factors. This highlights birth weight as a critical predictor of long-term health outcomes.

    Area of Science:

    • Epidemiology
    • Public Health
    • Genetics

    Background:

    • The developmental origins of health and disease (DOHaD) hypothesis links low birth weight (LBW) to later life health issues.
    • Previous studies could not fully account for unmeasured familial confounders.

    Purpose of the Study:

    • To investigate the association between birth weight and subsequent mortality and morbidity.
    • To control for unmeasured familial factors by comparing differentially exposed siblings.

    Main Methods:

    • A large Swedish population cohort (3,291,773 individuals, 1973-2008) was analyzed.
    • Fixed-effects models compared siblings with different birth weights, controlling for covariates like gestational age.
    • Sensitivity analyses addressed potential alternative explanations.

    Main Results:

    • Lower birth weight was significantly associated with increased risks of mortality (e.g., cardiac-related death) and morbidity (e.g., type 2 diabetes mellitus).
    • These associations remained robust and independent of shared familial confounders and measured covariates.
    • Hazard ratios for cardiac-related death and type 2 diabetes mellitus demonstrated a clear dose-response relationship with decreasing birth weight.

    Conclusions:

    • Birth weight is an independent risk factor for subsequent mortality and morbidity.
    • The findings support the DOHaD hypothesis, emphasizing the importance of fetal growth for long-term health.
    • Sibling comparison strengthens the evidence for a causal link between low birth weight and adverse health outcomes.

    Keywords:
    birth weightcardiovascular diseasesdiabetes mellitusfetal developmentstroke

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