Birth weight in relation to health and disease in later life: an umbrella review of systematic reviews and meta-analyses
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Birth weight, a marker of the intrauterine environment, has been extensively studied in epidemiological research in relation to subsequent health and disease. Although numerous meta-analyses have been published examining the association between birth weight and subsequent health-related outcomes, the epidemiological credibility of these associations has not been thoroughly assessed. The objective of this study is to map the diverse health outcomes associated with birth weight and evaluate the credibility and presence of biases in the reported associations. An umbrella review was performed to identify systematic reviews and meta-analyses of observational studies investigating the association between birth weight and subsequent health outcomes and traits. For each association, we estimated the summary effect size by random-effects and fixed-effects models, the 95 % confidence interval, and the 95 % prediction interval. We also assessed the between-study heterogeneity, evidence for small-study effects and excess significance bias. We further applied standardized methodological criteria to evaluate the epidemiological credibility of the statistically significant associations. Thirty-nine articles including 78 associations between birth weight and diverse outcomes met the eligibility criteria. A wide range of health outcomes has been studied, ranging from anthropometry and metabolic diseases, cardiovascular diseases and cardiovascular risk factors, various cancers, respiratory diseases and allergies, musculoskeletal traits and perinatal outcomes. Forty-seven of 78 associations presented a nominally significant summary effect and 21 associations remained statistically significant at P < 1 × 10 −6 . Thirty associations presented large or very large between-study heterogeneity. Evidence for small-study effects and excess significance bias was present in 13 and 16 associations, respectively. One association with low birth weight (increased risk for all-cause mortality), two dose-response associations with birth weight (higher bone mineral concentration in hip and lower risk for mortality from cardiovascular diseases per 1 kg increase in birth weight) and one association with small-for-gestational age infants with normal birth weight (increased risk for childhood stunting) presented convincing evidence. Eleven additional associations had highly suggestive evidence. The range of outcomes convincingly associated with birth weight might be narrower than originally described under the “fetal origin hypothesis” of disease. There is weak evidence that birth weight constitutes an effective public health intervention marker.
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In an umbrella review, an inverse association between birth weight and future maternal cardiovascular disease was reported (hazard ratio 0.75, 95% CI 0.67 to 0.84, for every one standard deviation increase from the mean weight).
“In an umbrella review,136 an inverse association between birth weight and future maternal cardiovascular disease was reported (hazard ratio 0.75, 95% confidence interval 0.67 to 0.84, for every one standard deviation increase from the mean weight)”
From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [136]
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Adiposity and cancer at major anatomical sites: umbrella review of the literature
Kyrgiou, M., Kalliala, I., Markozannes, G., Gunter, M. J., Paraskevaidis, E., Gabra, H., Martin-Hirsch, P., & Tsilidis, K. K. (2017) · BMJ · doi:10.1136/bmj.j477 · Cited by 803 · see citing works
Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses
Bellou, V., Belbasis, L., Tzoulaki, I., & Evangelou, E. (2018) · PLOS ONE · doi:10.1371/journal.pone.0194127 · Cited by 713 · see citing works
Self-citationWhat causes psychosis? An umbrella review of risk and protective factors
Radua, J., Ramella‐Cravaro, V., Ioannidis, J. P. A., Reichenberg, A., Phiphopthatsanee, N., Amir, T., Yenn Thoo, H., Oliver, D., Davies, C., Morgan, C., et al. (2018) · World Psychiatry · doi:10.1002/wps.20490 · Cited by 553 · see citing works
Dietary fiber and health outcomes: an umbrella review of systematic reviews and meta-analyses
Veronese, N., Solmi, M., Caruso, M. G., Giannelli, G., Osella, A. R., Evangelou, E., Maggi, S., Fontana, L., Stubbs, B., & Tzoulaki, I. (2018) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqx082 · Cited by 536 · see citing works
Self-citationOkoth, K., Chandan, J. S., Marshall, T., Thangaratinam, S., Thomas, G. N., Nirantharakumar, K., & Adderley, N. J. (2020) · BMJ · doi:10.1136/bmj.m3502 · Cited by 416 · see citing works
Szilagyi, J. T., Avula, V., & Fry, R. C. (2020) · Current Environmental Health Reports · doi:10.1007/s40572-020-00279-0 · Cited by 328 · see citing works
Belbasis, L., Bellou, V., & Ioannidis, J. P. A. (2022) · BMJ Medicine · doi:10.1136/bmjmed-2021-000071 · Cited by 325 · see citing works
Self-citationHanem, L. G. E., Stridsklev, S., Júlíusson, P. B., Salvesen, Ø., Roelants, M., Carlsen, S. M., Ødegård, R., & Vanky, E. (2018) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2017-02419 · Cited by 199 · see citing works
Perera, S., Maung, C., Hla, S., Moo Moo, H., Than Lwin, S., Bruck, C., Smith, T., Bakker, M., Akhoon, C., & Sarkar, I. N. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-052571 · Cited by 8 · see citing works
- Authors
- Belbasis, L., Savvidou, M. D., Kanu, C., Evangelou, E., & Tzoulaki, I.
- Affiliations
- University of Ioannina (GR)
- Chelsea and Westminster Hospital (GB)
- Corresponding author
- Tzoulaki, Ioanna
- Venue
- BMC Medicine
- Published
- 2016-09-28
- Volume
- 14
- Issue
- 1
- Pages
- 147-147
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC5039803
- OpenAlex
- W2523853873
- Cited by
- 237
- References
- 93
- Citations by year
- 2026: 15 · 2025: 20 · 2024: 16 · 2023: 28 · 2022: 34 · 2021: 46 · 2020: 30 · 2019: 21 · 2018: 19 · 2017: 7 · 2015: 1
- FWCI
- 2.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Spiral (Imperial College London) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- birth weight, low birth weight, intrauterine environment, cardiovascular disease, all-cause mortality, child stunting, small for gestational age, small-study effects, study heterogeneity, prediction intervals
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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