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Substantial evidence implicates both premature birth and low birthweight as risk factors for cardiovascular and other adult-onset diseases such as impaired glucose regulation and hypertension. However, a persistent criticism of such studies is the likelihood of confounding by genetic factors. Shared genetic influences may be behind both low birthweights and increased risks of cardiovascular disease into adulthood, an issue that has not been satisfactorily addressed. It is also unclear whether low birthweight or prematurity is the better marker of early life disadvantage and susceptibility for later-life diseases.
Twin studies are useful in answering the first issue because monozygotic and dizygotic twins provide a genetic “control” …