Birth Weight and Lung Function in Adulthood: A Systematic Review and Meta-analysis

Abstract

At a Glance CommentaryScientific knowledge on the subject: Increasing evidence supports the influence of early life factors on later lung function, which might prevent individuals from attaining maximum lung function and predispose them to increased risk of lung disease in later life.What this study adds to the field: This is the first systematic review and meta-analysis on the association of birth weight, weight at one year and weight gain in the first year of life with lung function measures of both restrictive and obstructive patterns in adulthood. We convincingly show a positive association between birth weight and restrictive impairment (low FVC), with findings consistent across studies. The meta-analysis for birth weight and airflow obstruction (low FEV1/FVC) might suggest a positive association but the evidence is much weaker. We identified gaps and limitations in the current evidence that should be addressed in future research.This article has an online data supplement, which is accessible from this issue's table of content online at www.atsjournals.org. 3 AbstractRationale: There is evidence suggesting that birth weight may influence lung function in adulthood, but it is unclear whether it might differentially affect restrictive (FVC) and obstructive (FEV1/FVC) patterns.Objectives: To summarize evidence available on the association of birth weight, weight at one year and weight gain in the first year of life with FVC and FEV1/FVC in adulthood. Methods:We performed a systematic review of the literature by searching MEDLINE, EMBASE and Web of Science through January 2015. Data were combined using inversevariance weighted meta-analysis with random effects models, and between-study heterogeneity evaluated. We conducted a priori subgroup or sensitivity analyses by age, country wealth, ethnicity, sex and smoking. Risk of bias was evaluated using the Newcastle-Ottawa Scale, and reporting bias using funnel plots. Measurements and Main Results:Eighteen articles were included in the review, and 13 in the meta-analyses. Most studies were from high-income countries, and all showed low risk of bias.We found strong evidence of association of birth weight with adult FVC, a 59.4mL higher FVC in adulthood per kg increase in birth weight (95%CI: 43.3 to 75.5), with no evidence of heterogeneity. Evidence of an association of birth weight with FEV1/FVC was weaker and showed some inconsistency across studies. Only one study investigated weight at one year, and another one weight gain in the first year. Conclusions:Our meta-analyses show strong and consistent evidence of an association of birth weight with adult FVC, a measure of restrictive impairment, with much weaker evidence for airflow obstruction.

Birth weight and prematurity with lung function at ~17.5 years: “Children of 1997” birth cohort

“…Similar to previous findings 4 , these associations remained after adjusting for height, suggesting that the association of birth weight with lung function is independent of height. Inconsistent association of birth weight with FEV 1 /FVC were observed in several previous studies 5 , while our study showed no association. Prematurity was inversely associated lower FEV 1 /FVC and FEF 25-75% and our previous study in this cohort showed preterm infants more prone to asthma 49 , these findings suggests impaired airway development in preterm births, which is consistent with other findings in late adolescence 19,20,22 .…”

“…The developmental origins of health and diseases (DOHaD) hypothesis emphasizes the role of poorer early growth, particularly in the first 1000 days, in non-communicable diseases (NCDs) 1 . Observationally poorer intrauterine experiences, proxied by birth weight or premature birth, are adversely associated with many aspects of adult health, including poorer lung function [2][3][4][5][6] . Lung function contributes both directly to chronic diseases via lung diseases and indirectly as a cardiovascular-related risk factor 7,8 , with potentially a causal role of forced expiratory volume 9 .…”

“…Lung function tracks throughout life 21 . Observationally, birth weight is inversely associated with indicators of restrictive lung function (forced vital capacity (FVC)) but evidence is weaker for the association of indicators of obstructive patterns (lower FEV 1 /FVC) in adults 5 . Previous studies have shown airway obstruction (lower FEV 1 , FEV 1 /FVC and forced expiratory flow between 25% and 75% of the pulmonary volume (FEF 25-Data source.…”

Maternal Birth Weight and BMI Mediate the Transgenerational Effect of Grandmaternal BMI on Grandchild’s Birth Weight

“…Grandmaternal SES was measured by a composite variable using cluster analysis as described before . Three indicators were used in the cluster analysis: the British socioeconomic classes derived from parental occupation reported at birth, number of children in the index child’s bedroom (collected at 4 years of age), and family income when the child was 10 years of age. The derived grandmaternal SES variable was grouped into three levels: low, medium, and high.…”

Perinatal Undernutrition, Metabolic Hormones, and Lung Development

“…In the adult lung, there is a suggestive, not fully consistent, association between FGR and pulmonary function in adulthood [127]. There are some evidences that FGR can decrease adult lung function [128], whereas other studies did not find any effect over lung function [129]. Another study shows that prenatal exposure to famine did not modify the lung function, but increased the prevalence of COPD [130].…”