News - Hypertension Week of June 29, 2003/ Vol. 2 No. 26

Study: Poverty at Birth May Account for Increased Stroke Risk

Poor living standards generations ago may account for the increased stroke risk currently found in certain parts of the United States and Great Britain, according to a study reported in the June 20 rapid access issue of Stroke.

Parts of the southeast United States and northern towns in England and Wales have a higher incidence of stroke deaths.

Researchers from the University of Southampton in England and Medical University of South Carolina compared data on the geographic distribution of stroke in England and Wales between 1968 and 1978 with information on maternal and newborn death rates between 1911 and 1925, which was about the time the stroke patients were born.

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, a time when mothers in these areas tended to be poor and malnourished and in poor general health. Many mothers at this time had poor physiques marked by short stature, while their infants had low birth weights.

The researchers believe that coronary heart disease and stroke originate through responses to malnutrition during fetal life and infancy, and that these responses permanently change the body's structure and function in ways that lead to disease in later life.

Using that hypothesis, the researchers suggest that the U.S. stroke belt is linked to a similar legacy of rural poverty. Malnutrition was common in the southeastern United States between the Civil War and the Great Depression. That, along with other socioeconomic influences, could have impacted mothers and babies.

Researchers also found that children born in areas with high stroke rates continue to have a high risk of stroke regardless of where they live later.

"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," said David Barker, of the University of Southampton. "A person's birthweight predicts his or her stroke risk. People who have strokes tend to have had lower birth weights."

Barker said protecting the growth and nutrition of young women and their babies may reduce future stroke deaths.

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

In an accompanying editorial, Dr. Larry B. Goldstein, professor of medicine at Duke University Medical Center, said the research provides another compelling argument to ensure adequate prenatal care and maternal nutrition.

Other sources: American Stroke Association