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Published on: October 25, 2015
[Fetal programming--the intrauterine origin of adult morbidity]
1Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mt. Scopus, Jerusalem, Israel. rkochman@itsa.ucsf.edu
Insights
Low birth weight is linked to adult diseases like hypertension and diabetes, independent of lifestyle factors. Fetal programming, where the intrauterine environment alters development, explains this connection.
Area of Science:
- Epidemiology
- Developmental Biology
- Public Health
Context:
- Epidemiological studies consistently show a link between low birth weight and increased risk of adult chronic diseases.
- This association persists across the entire birth weight spectrum and is independent of common lifestyle risk factors.
- Rapid postnatal growth may also contribute to later cardiovascular disease risk.
Purpose:
- To review the epidemiological and physiological evidence supporting the fetal programming hypothesis.
- To elucidate the role of the intrauterine environment in shaping adult health outcomes.
- To highlight the long-term public health implications of fetal development.
Summary:
- Low birth weight and rapid postnatal catch-up growth are associated with higher risks of hypertension, insulin resistance, type 2 diabetes, and cardiovascular disease.
- The 'fetal programming' hypothesis posits that the intrauterine environment permanently alters organ structure and function epigenetically during critical developmental periods.
- Evidence from human and animal studies supports the concept that adult diseases can be initiated by the fetal environment.
Impact:
- Fetal programming is a significant factor in the etiology of adult chronic diseases.
- Improved prenatal care and management can have substantial long-term, wide-scale benefits for societal health.
- Understanding fetal programming offers a novel perspective on disease prevention and public health strategies.
Abstract:
Many epidemiological studies have demonstrated an association between low birth weight and the subsequent development of hypertension, insulin resistance, type 2 diabetes and cardiovascular disease. This association appears to be independent of classic lifestyle risk factors such as smoking, overweight, social class, alcohol consumption and lack of exercise, which are additive to the effect. The association holds for the full range of birth weights, including those within the normal range. In addition, it was suggested that faster postnatal catch-up growth may also predict later risk of cardiovascular disease. 'Fetal programming' has been proposed as a mechanism underlying the link related to low birth weight, rapid neonatal growth and adult disease. The fetal programming hypothesis suggests that the intrauterine environment during critical periods of organogenesis and tissue growth may permanently alter organ structure and function in an epigenetic manner. Indeed, evidence from both human and animal studies suggests that diseases of adult life are induced by the fetal environment. This review describes epidemiological and physiological evidence that the programming phenomenon is a major factor in determining later life diseases. Better management of pregnancy in the present will have long term wide-scale effects on the health of our society.
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