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Objective Being born small for gestational age (SGA) is associated with insulin resistance, hypertension and increased cardiovascular morbidity/mortality in adulthood. Sympathetic nerve hyperactivity is a well-known risk factor for cardiovascular disease mortality and is proposed to link insulin resistance with hypertension. The objective of this study was to test the hypothesis that sympathetic nerve activity is altered in individuals born SGA.Design A cross-sectional, comparative study of 20 healthy adults (21–25 years old) born SGA (birth weight <−2SD score for healthy newborns) with normal and short stature, and 12 age, gender and body mass index matched individuals, born appropriate for gestational age (AGA) with normal stature.Methods Direct recordings of resting sympathetic nerve activity to the muscle vascular bed (MSA) were obtained from the peroneal nerve posterior to the fibular head. Heart rate, respiration and blood pressure were recorded during the microneurographic session.Results MSA was increased in both groups of young adults born SGA as compared to those born AGA (P< 0.05 and P< 0.005, respectively). In the combined study group MSA was inversely correlated to birth weight, length (r = −0.59, P< 0.001 and r = −0.69, P< 0.0005, respectively) and final adult height (r = −0.58; P< 0.001). Conclusions Being born SGA and achieving a short final height is associated with increased sympathetic nerve traffic. We suggest that the increase in sympathetic nerve traffic in young adults born SGA with normal and short stature may be the link between low birth size, hypertension and cardiovascular morbidity later in life.