OBJECTIVE To determine whether reduced fetal growth leads to raised blood pressure, reduced arterial compliance, and increased left ventricular mass in an Indian population.

DESIGN A retrospective cohort study of men and women (age range 40–61 years) whose weight, length, and head circumference at birth were recorded.

SETTING The Holdsworth Memorial Hospital, Mysore, South India.

SUBJECTS 435 men and women born in the hospital between 1934 and 1953.

MAIN OUTCOME MEASURES Systolic and diastolic blood pressures; compliance in four arterial segments derived from pulse wave velocity, measured by a non-invasive optical method; and left ventricular mass measured using M mode echocardiography.

RESULTS Small size at birth was not associated with increased adult blood pressure or left ventricular mass, or with reduced arterial compliance. Systolic blood pressure and left ventricular mass were higher in subjects who were greater in length at birth, rising by 1.64 mm Hg (95% confidence interval (CI) −0.08 to +3.37 mm Hg) and 1.63 g/m² (95% CI 0.13 to 3.13 g/m²), respectively, per one inch (2.5 cm) increase in birth length, independently of adult size. Arterial compliance was reduced in people whose mothers were lighter and had smaller pelvic (external conjugate) diameters.

CONCLUSIONS The higher prevalence of coronary heart disease in Indian men and women of lower birth weight, shown in an earlier study of the same cohort, cannot be explained by changes in blood pressure, arterial compliance, and left ventricular mass. The association of raised blood pressure and left ventricular mass with longer birth length suggests that the way in which the intrauterine environment influences coronary heart disease differs between Indian and Western populations.