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Is birth weight associated with blood pressure among African children and adolescents? A systematic review

  • S. A. Lule (a1) (a2), A. M. Elliott (a1) (a2), L. Smeeth (a1) and E. L. Webb (a1)

There is substantial evidence of an inverse association between birth weight and later blood pressure (BP) in populations from high-income countries, but whether this applies in low-income countries, where causes of low birth weight are different, is not certain. Objective: We conducted a review of the evidence on the relationship between birth weight and BP among African children and adolescents. Medline, EMBASE, Global Health and Web of Science databases were searched for publications to October 2016. Papers reporting the relationship between birth weight and BP among African children and adolescents were assessed. Bibliographies were searched for further relevant publications. Selected papers were summarized following the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. In total, 16 papers from 13 studies conducted in nine African countries (Nigeria, Republic of Seychelles, Gambia, Democratic Republic of Congo, Cameroon, South Africa, Algeria, Zimbabwe and Angola) were reviewed. Eight studies were cohorts, while five were cross-sectional. The relationship between birth weight and later BP varied with age of the participants. Studies in neonates showed a consistently positive association, while predominantly inverse associations were seen among children, and studies in adolescents were inconsistent. Based on the limited number of studies identified, the relationship between birth weight and later BP may vary with age in African children and adolescents. Not all studies adequately controlled for confounding, notably gender or age. Whether the inverse relationship between birth weight and BP in later life observed in Western settings is also seen in Africa remains unclear.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
*Address for correspondence: S. A. Lule, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. (Email
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1. Barker, DJ, Osmond, C. Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet. 1986; 1, 10771081.
2. Barker, DJ, Bull, AR, Osmond, C, Simmonds, SJ. Fetal and placental size and risk of hypertension in adult life. BMJ. 1990; 301, 259262.
3. Schack-Nielsen, L, Holst, C, Sorensen, TI. Blood pressure in relation to relative weight at birth through childhood and youth in obese and non-obese adult men. Int J Obes Relat Metab Disord. 2002; 26, 15391546.
4. Adair, LS, Martorell, R, Stein, AD, et al. Size at birth, weight gain in infancy and childhood, and adult blood pressure in 5 low- and middle-income-country cohorts: when does weight gain matter? Am J Clin Nutr. 2009; 89, 13831392.
5. Law, CM, de Swiet, M, Osmond, C, et al. Initiation of hypertension in utero and its amplification throughout life. BMJ. 1993; 306, 2427.
6. Blake, KV, Gurrin, LC, Evans, SF, et al. Adjustment for current weight and the relationship between birth weight and blood pressure in childhood. J Hypertens. 2000; 18, 10071012.
7. Pharoah, PO, Stevenson, CJ, West, CR. Association of blood pressure in adolescence with birthweight. Arch Dis Child Fetal Neonatal Ed. 1998; 79, F114F118.
8. O’Sullivan, MJ, Kearney, PJ, Crowley, MJ. The influence of some perinatal variables on neonatal blood pressure. Acta Paediatr. 1996; 85, 849853.
9. Perng, W, Rifas-Shiman, SL, Kramer, MS, et al. Early weight gain, linear growth, and mid-childhood blood pressure: a prospective study in project viva. Hypertension. 2016; 67, 301308.
10. Falkner, B, Hulman, S, Kushner, H. Effect of birth weight on blood pressure and body size in early adolescence. Hypertension. 2004; 43, 203207.
11. Macintyre, S, Watt, G, West, P, Ecob, R. Correlates of blood pressure in 15 year olds in the west of Scotland. J Epidemiol Community Health. 1991; 45, 143147.
12. Law, CM, Shiell, AW. Is blood pressure inversely related to birth weight? The strength of evidence from a systematic review of the literature. J Hypertens. 1996; 14, 935941.
13. Huxley, RR, Shiell, AW, Law, CM. The role of size at birth and postnatal catch-up growth in determining systolic blood pressure: a systematic review of the literature. J Hypertens. 2000; 18, 815831.
14. Kim, D, Saada, A. The social determinants of infant mortality and birth outcomes in Western developed nations: a cross-country systematic review. Int J Environ Res Public Health. 2013; 10, 22962335.
15. Dahlui, M, Azahar, N, Oche, OM, Aziz, NA. Risk factors for low birth weight in Nigeria: evidence from the 2013 Nigeria Demographic and Health Survey. Glob Health Action. 2016; 9, 28822.
16. Ndibazza, J, Muhangi, L, Akishule, D, et al. Effects of deworming during pregnancy on maternal and perinatal outcomes in Entebbe, Uganda: a randomized controlled trial. Clin Infect Dis. 2010; 50, 531540.
17. Chibwesha, CJ, Zanolini, A, Smid, M, et al. Predictors and outcomes of low birth weight in Lusaka, Zambia. Int J Gynaecol Obstet. 2016; 134, 309314.
18. Assefa, N, Berhane, Y, Worku, A. Wealth status, mid upper arm circumference (MUAC) and antenatal care (ANC) are determinants for low birth weight in Kersa, Ethiopia. PloS One. 2012; 7, e39957.
19. Denoeud, L, Fievet, N, Aubouy, A, et al. Is chloroquine chemoprophylaxis still effective to prevent low birth weight? Results of a study in Benin. Malar J. 2007; 6, 27.
20. Shiono, PH, Klebanoff, MA, Graubard, BI, Berendes, HW, Rhoads, GG. Birth weight among women of different ethnic groups. JAMA. 1986; 255, 4852.
21. Delnord, M, Blondel, B, Zeitlin, J. What contributes to disparities in the preterm birth rate in European countries? Curr Opin Obstet Gynecol. 2015; 27, 133142.
22. Garner, P, Kramer, MS, Chalmers, I. Might efforts to increase birthweight in undernourished women do more harm than good? Lancet. 1992; 340, 10211023.
23. Shulman, CE, Dorman, EK. Importance and prevention of malaria in pregnancy. Trans R Soc Trop Med Hyg. 2003; 97, 3035.
24. Muanda, FT, Chaabane, S, Boukhris, T, et al. Antimalarial drugs for preventing malaria during pregnancy and the risk of low birth weight: a systematic review and meta-analysis of randomized and quasi-randomized trials. BMC Med. 2015; 13, 193.
25. Cot, M, Le Hesran, JY, Miailhes, P, et al. Increase of birth weight following chloroquine chemoprophylaxis during the first pregnancy: results of a randomized trial in Cameroon. Am J Trop Med Hyg. 1995; 53, 581585.
26. Akombi, BJ, Agho, KE, Merom, D, Renzaho, AM, Hall, JJ. Child malnutrition in sub-Saharan Africa: a meta-analysis of demographic and health surveys (2006-2016). PloS One. 2017; 12, e0177338.
27. Vorster, HH, Kruger, A. Poverty, malnutrition, underdevelopment and cardiovascular disease: a South African perspective. Cardiovasc J Afr. 2007; 18, 321324.
28. Benzekri, NA, Sambou, J, Diaw, B, et al. High prevalence of severe food insecurity and malnutrition among HIV-infected adults in Senegal, West Africa. PloS One. 2015; 10, e0141819.
29. Guwatudde, D, Mutungi, G, Wesonga, R, et al. The epidemiology of hypertension in Uganda: findings from the national non-communicable diseases risk factor survey. PloS One. 2015; 10, e0138991.
30. Kavishe, B, Biraro, S, Baisley, K, et al. High prevalence of hypertension and of risk factors for non-communicable diseases (NCDs): a population based cross-sectional survey of NCDS and HIV infection in Northwestern Tanzania and Southern Uganda. BMC Med. 2015; 13, 126.
31. Ataklte, F, Erqou, S, Kaptoge, S, et al. Burden of undiagnosed hypertension in sub-Saharan Africa: a systematic review and meta-analysis. Hypertension. 2015; 65, 291298.
32. Reddy, SP, Mbewu, AD. The Implications of the Developmental Origins of Health and Disease on Public Health Policy and Health Promotion in South Africa. Parthasarathy S, ed. Healthcare. 2016; 4, 83.
33. Lule, SA, Webb, EL, Ndibazza, J, et al. Maternal recall of birthweight and birth size in Entebbe, Uganda. Trop Med Int Health. 2012; 17, 14651469.
34. Kagura, J, Adair, LS, Musa, MG, Pettifor, JM, Norris, SA. Blood pressure tracking in urban black South African children: Birth to Twenty cohort. BMC Pediatr. 2015; 15, 78.
35. Hao, G, Wang, X, Treiber, FA, et al. Blood pressure trajectories from childhood to young adulthood associated with cardiovascular risk: results from the 23-year longitudinal Georgia stress and heart study. Hypertension. 2017; 69, 435442.
36. Moher, D, Shamseer, L, Clarke, M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015; 4, 1.
37. Steyn, K, de Wet, T, Richter, L, et al. Cardiovascular disease risk factors in 5-year-old urban South African children – the birth to ten study. S Afr Med J. 2000; 90, 719726.
38. Sadoh, WE, Ibhanesebhor, SE. Oscillometric blood pressure reference values of African full-term neonates in their first days postpartum. Cardiovasc J Afr. 2009; 20, 344347.
39. Law, CM, Egger, P, Dada, O, et al. Body size at birth and blood pressure among children in developing countries. Int J Epidemiol. 2000; 30, 5257.
40. Margetts, BM, Rowland, MG, Foord, FA, et al. The relation of maternal weight to the blood pressures of Gambian children. Int J Epidemiol. 1991; 20, 938943.
41. Ayoola, OO, Gemmell, I, Omotade, OO, et al. Maternal malaria, birth size and blood pressure in Nigerian newborns: insights into the developmental origins of hypertension from the Ibadan growth cohort. PloS One. 2011; 6, e24548.
42. Hawkesworth, S, Prentice, AM, Fulford, AJ, Moore, SE. Maternal protein-energy supplementation does not affect adolescent blood pressure in the Gambia. Int J Epidemiol. 2009; 38, 119127.
43. Sadoh, WE, Ibhanesehbor, SE, Monguno, AM, Gubler, DJ. Predictors of newborn systolic blood pressure. West Afr J Med. 2010; 29, 8690.
44. Nwokoye, I, Uleanya, N, Ibeziako, N, et al. Blood pressure values in healthy term newborns at a tertiary health facility in Enugu, Nigeria. Niger J Clin Pract. 2015; 18, 584588.
45. Silva, ABT, Capingana, DP, Magalhaes, P, et al. Predictors and reference values of pulse wave velocity in prepubertal Angolan children. J Clin Hypertens. 2016; 18, 725732.
46. Kagura, J, Adair, LS, Munthali, RJ, Pettifor, JM, Norris, SA. Association between early life growth and blood pressure trajectories in black South African children. Hypertension. 2016; 68, 11231131.
47. Adair, LS, Fall, CH, Osmond, C, et al. Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet. 2013; 382, 525534.
48. Griffiths, PL, Sheppard, ZA, Johnson, W, et al. Associations between household and neighbourhood socioeconomic status and systolic blood pressure among urban South African adolescents. J Biosoc Sci. 2012; 44, 433458.
49. Levitt, NS, Steyn, K, De Wet, T, et al. An inverse relation between blood pressure and birth weight among 5 year old children from Soweto, South Africa. J Epidemiol Community Health. 1999; 53, 264268.
50. Woelk, G, Emanuel, I, Weiss, NS, Psaty, BM. Birthweight and blood pressure among children in Harare, Zimbabwe. Arch Dis Child Fetal Neonatal Ed. 1998; 79, F119F122.
51. Youmbissi, TJ, Oudou, N, Mbede, J, Nasah, BT. Blood pressure profiles of a group of African children in the first year of life. J Trop Pediatr. 1989; 35, 245246.
52. Longo-Mbenza, B, Ngiyulu, R, Bayekula, M, et al. Low birth weight and risk of hypertension in African school children. J Cardiovasc Risk. 1999; 6, 311314.
53. Chiolero, A, Paradis, G, Madeleine, G, et al. Birth weight, weight change, and blood pressure during childhood and adolescence: a school-based multiple cohort study. J Hypertens. 2011; 29, 18711879.
54. Salvi, P, Meriem, C, Temmar, M, et al. Association of current weight and birth weight with blood pressure levels in Saharan and European teenager populations. Am J Hypertens. 2010; 23, 379386.
55. Woelk, GB. Is low birth weight a risk factor for adult hypertension? A literature review with particular reference to Africa. S Afr Med J. 1995; 85(Pt 2), 13481349, 1352–1353.
56. Levitt, NS, Lambert, EV, Woods, D, et al. Impaired glucose tolerance and elevated blood pressure in low birth weight, nonobese, young South African adults: early programming of cortisol axis. J Clin Endocrinol Metabol. 2000; 85, 46114618.
57. Berlin, JA, Begg, CB, Louis, TA. An assessment of publication bias using a sample of published clinical trials. J Am Stat Assoc. 1989; 84, 381392.
58. Ewald, DR, Haldeman, DL. Risk factors in adolescent hypertension. Glob Pediatr Health. 2016; 3, 2333794X15625159.
59. Hardy, R, Sovio, U, King, VJ, et al. Birthweight and blood pressure in five European birth cohort studies: an investigation of confounding factors. Eur J Public Health. 2006; 16, 2130.
60. Huxley, R, Neil, A, Collins, R. Unravelling the fetal origins hypothesis: is there really an inverse association between birthweight and subsequent blood pressure? Lancet. 2002; 360, 659665.
61. Curhan, GC, Willett, WC, Rimm, EB, et al. Birth weight and adult hypertension, diabetes mellitus, and obesity in US men. Circulation. 1996; 94, 32463250.
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