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Last Updated: Friday, 20 June, 2003, 00:01 GMT 01:01 UK
Stroke risk 'determined in womb'
Stroke patient
The researchers looked at stroke incidence across the UK
A person's risk of having a stroke as an adult could be determined when they are in the womb, researchers have suggested.

US scientists say malnourished mothers may be to blame.

They were looking for an explanation as to why people living in some areas, such as the north of England and Wales or the south-east of America have a higher stroke risk.

The difference between those and other areas cannot be explained by lifestyle habits, such as smoking.

Poor growth

Doctors from the University of Southampton in the UK and the Medical University of South Carolina looked at the geographic distribution of stroke in England and Wales between 1968 and 1978.

They then looked at the rates of maternal and newborn deaths more than 50 years earlier, between 1911 and 1925, which was about the time the stroke patients were born.

The evidence is that the biological features of stroke originate in the world stroke patients came from rather than the world they entered when they were born
Dr David Barker, University of Southampton
The researchers also calculated average height in different parts of the country, and estimated the risk of stroke according to birth place.

If adults are short, it can be a marker of poor growth in the womb and poor living standards in childhood.

The researchers found that areas with high death rates from stroke in the 1960s and 1970s also had high maternal and newborn death rates around the turn of the century.

Mothers in those areas at that time tended to be poor, malnourished and in poor general health in general, and often had "poor physiques" marked by short stature. Their infants also had low birth weights.

They say the same pattern is true for the American south-east, which had a similar legacy of rural poverty.

Birthweight

The researchers suggest coronary heart disease and stroke are triggered by responses to malnutrition during foetal life and infancy which cause permanent changes to the body's structure and function in ways that lead to disease in later life.

They also found that children born in areas with high stroke rates continue to have a high risk of stroke even if they move away from the area.

Dr David Barker, from the University of Southampton, said: "Although there is nothing today that characterises places in England and Wales with high rates of stroke, they were characterised by poor living standards in the past."

He added: "The evidence is that the biological features of stroke originate in the world stroke patients came from rather than the world they entered when they were born.

"A person's birthweight predicts his or her stroke risk. People who have strokes tend to have had lower birth weights."

But he said the fact women were eating better and were generally healthier should mean the trend could be halted.

"It is going to take several generations for this effect to wash out.

"The lesson here is that if you prejudice the health of a girl or woman, you prejudice the health of her offspring.

"Stroke risk is not just in the genes. It is about the environment in the womb."

The research is published in Stroke: Journal of the American Heart Association.

In an editorial in the journal, Professor Larry Goldstein, from Duke University Medical Center in Durham, North Carolina, cautioned the data showed an association between maternal nutrition and stroke, but not necessarily a cause.

But he added proactive action would do no harm: "Investment in programmes aimed at optimising maternal health and nutrition may pay dividends in reducing the incidence of stroke in their unborn babies when they reach adulthood."

The research is published in Stroke: Journal of the American Heart Association.


SEE ALSO:
Chiropractic linked to stroke
12 May 03  |  Health


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