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Fetal programming and adult health

  • Keith M Godfrey (a1) and David JP Barker (a1)
Abstract
Abstract

Low birthweight is now known to be associated with increased rates of coronary heart disease and the related disorders stroke, hypertension and non-insulin dependent diabetes. These associations have been extensively replicated in studies in different countries and are not the result of confounding variables. They extend across the normal range of birthweight and depend on lower birthweights in relation to the duration of gestation rather than the effects of premature birth. The associations are thought to be consequences of ‘programming’, whereby a stimulus or insult at a critical, sensitive period of early life has permanent effects on structure, physiology and metabolism. Programming of the fetus may result from adaptations invoked when the materno-placental nutrient supply fails to match the fetal nutrient demand. Although the influences that impair fetal development and programme adult cardiovascular disease remain to be defined, there are strong pointers to the importance of maternal body composition and dietary balance during pregnancy.

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Corresponding author
*Corresponding author: Email kmg@mrc.soton.ac.uk
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2RA McCance , EM Widdowson . The determinants of growth and form. Proc. R. Soc. Lond B 1974; 185: 117.

3A. Lucas Role of nutritional programming in determining adult morbidity. Arch Dis. Child 1994; 71: 288–90.

4SC Langley-Evans , AA Jackson . Increased systolic blood pressure in adult rats induced by fetal exposure to maternal low protein diets. Clin. Sci. 1994; 86: 217–22.

5M Desai , NJ Crowther , SE Ozanne , A Lucas , CN Hales . Adult glucose and lipid metabolism may be programmed during fetal life. Biochem. Soc. Trans. 1995; 23: 331–5.

6C Osmond , DJP Barker , PD Winter , CHD Fall , SJ Simmonds . Early growth and death from cardiovascular disease in women. BMJ 1993; 307: 1519–24.

7DJP Barker , C Osmond , SJ Simmonds , GA Wield . The relation of small head circumference and thinness at birth to death from cardiovascular disease in adult life. BMJ 1993; 306: 422–6.

8S Frankel , P Elwood , P Sweetnam , J Yarnell , G. Davey Smith Birthweight, body-mass index in middle age, and incident coronary heart disease. Lancet 1996; 348: 1478–80.

9JW Rich-Edwards , MJ Stampfer , JE Manson , B Rosner , SE Hankinson , GA Colditz , WC Willett , CH Hennekens . Birth weight and risk of cardiovascular disease in a cohort of women followed up since 1976. BMJ 1997; 315: 396400.

10CE Stein , CHD Fall , K Kumaran , C Osmond , V Cox , DJP Barker . Fetal growth and coronary heart disease in South India. Lancet 1996; 348: 1269–73.

11CN Martyn , DJP Barker , C. Osmond Mothers' pelvic size, fetal growth, and death from stroke and coronary heart disease in men in the UK. Lancet 1996; 348: 1264–8.

12T Forsen , JG Eriksson , J Tuomilehto , K Teramo , C Osmond , DJP Barker . Mother's weight in pregnancy and coronary heart disease in a cohort of Finnish men: follow up study. BMJ 1997; 315: 837–40.

14CN Hales , DJP Barker , PMS Clark , LJ Cox , C Fall , C Osmond , PD Winter . Fetal and infant growth and impaired glucose tolerance at age 64. BMJ 1991; 303: 1019–22.

15CM Law , AW Shiell . Is blood pressure inversely related to birth weight? The strength of evidence from a systematic review of the literature. J. Hypertens 1996; 14: 935–41.

16DJP Barker , KM Godfrey , C Osmond , A. Bull The relation of fetal length, ponderal index and head circumference to blood pressure and the risk of hypertension in adult life. Paediatr. Perinat. Epidemiol. 1992; 6: 3544.

17VM Moore , RA Cockington , P Ryan , JS Robinson . The relationship between birth weight and blood pressure amplifies from childhood to adulthood. J. Hypertens 1999; 17: 883–8.

18CM Law , DJP Barker , AR Bull , C. Osmond Maternal and fetal influences on blood pressure. Arch. Dis. Child 1991; 66: 1291–5.

19DM Campbell , MH Hall , DJP Barker , J Cross , AW Shiell , KM Godfrey . Diet in pregnancy and the offspring's blood pressure 40 years later. Br. J. Obstet. Gynaecol. 1996; 103: 273–80.

21CN Martyn , DJP Barker , S Jespersen , S Greenwald , C Osmond , C. Berry Growth in utero, adult blood pressure, and arterial compliance. Br. Heart J. 1995; 73: 116–21.

22AF Lever , SB Harrap . Essential hypertension: a disorder of growth with origins in childhood? J. Hypertens 1992; 10: 101–20.

23CN Martyn , AF Lever , JJ Morton . Plasma concentrations of inactive renin in adult life are related to indicators of foetal growth. J. Hypertens 1996; 14: 881–6.

24HS Mackenzie , BM Brenner . Fewer nephrons at birth: a missing link in the etiology of essential hypertension? Am. J. Kidney Dis. 1995; 26: 91–8.

25JC Konje , SC Bell , JJ Morton , R de Chazal , DJ Taylor . Human fetal kidney morphometry during gestation and the relation-ship between weight, kidney morphometry and plasma active renin concentration at birth. Clin. Sci. 1996; 91: 169–75.

26CRW Edwards , R Benediktsson , RS Lindsay , JR Seckl . Dysfunction of placental glucocorticoid barrier: link between fetal environment and adult hypertension? Lancet 1993; 341: 355–7.

27DI Phillips , DJ Barker , CH Fall , JR Seckl , CB Whorwood , PJ Wood , BR Walker . Elevated plasma cortisol concentrations: a link between low birth weight and the insulin resistance syndrome? J. Clin. Endocrinol Metab. 1998; 83: 757–60.

28CN Martyn , SE Greenwald . Impaired synthesis of elastin in walls of aorta and large conduit arteries during early development as an initiating event in pathogenesis of systemic hypertension. Lancet 1997; 350: 953–5.

29W Al-Ghazali , SK Chita , MG Chapman , LD Allan . Evidence of redistribution of cardiac output in asymmetrical growth retardation. Br. J. Obstet Gynaecol 1989; 96: 697704.

30CPM Leeson , PH Whincup , DG Cook , AE Donald , O Papacosta , A Lucas , JE Deanfield . Flow-mediated dilation in 9- to 11-year old children. The influence of intrauterine and childhood factors. Circulation 1997; 96: 2233–8.

31DIW Phillips , DJP Barker . Association between low birthweight and high resting pulse in adult life: is the sympathetic nervous system involved in programming the insulin resistance syndrome?. Diabet. Med. 1997; 14: 673–7.

32HO Lithell , PM McKeigue , L Berglund , R Mohsen , UB Lithell , DA Leon . Relation of size at birth to non-insulin dependent diabetes and insulin concentrations in men aged 50–60 years. BMJ 1996; 312: 406–10.

33GC Curhan , WC Willett , EB Rimm , Birth weight and adult hypertension and diabetes mellitus in US men. Am. J. Hypertens 1996; 9: 11A [Abstract].

34DR McCance , DJ Pettitt , RL Hanson , LTH Jacobsson , WC Knowler , PH Bennett . Birth weight and non-insulin dependent diabetes: thrifty genotype, thrifty phenotype, or surviving small baby genotype? BMJ 1994; 308: 942–5.

35DJP Barker , CN Hales , CHD Fall , C Osmond , K Phipps , PMS Clark . Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia 1993; 36: 62–7.

36DIW Phillips , S Hirst , PMS Clark , CN Hales , C. Osmond Fetal growth and insulin secretion in adult life. Diabetologia 1994; 37: 592–6.

37R Valdez , MA Athens , GH Thompson , BS Bradshaw , MP Stern . Birthweight and adult health outcomes in a biethnic population in the USA. Diabetologia 1994; 37: 624–31.

38J Leger , C Levy-Marchal , J Bloch , A Pinet , D Chevenne , D Porquet , D Collin , P. Czernichow Reduced final height and indications for insulin resistance in 20 year olds born small for gestational age: regional cohort study. BMJ 1997; 315: 341–7.

39ACJ Ravelli , JHP van der Meulen , RPJ Michels , C Osmond , DJP Barker , CN Hales , OP Bleker . Glucose tolerance in adults after prenatal exposure to famine. Lancet 1998; 351: 173–7.

40CM Law , GS Gordon , AW Shiell , DJP Barker , CN Hales . Thinness at birth and glucose tolerance in seven year old children. Diabet. Med. 1995; 12: 24–9.

41PH Whincup , DG Cook , F Adshead , SJC Taylor , M Walker , O Papacosta , KGMM Alberti . Childhood size is more strongly related than size at birth to glucose and insulin levels in 10–11-year-old children. Diabetologia 1997; 40: 319–26.

42DJ Taylor , CH Thompson , GJ Kemp , PRJ Barnes , AL Sanderson , GK Radda , DIW Phillips . A relationship between impaired fetal growth and reduced muscle glycolysis revealed by 31P magnetic resonance spectroscopy. Diabetologia 1995; 38: 1205–12.

44CN Hales , DJP Barker . Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia 1992; 35: 595601.

45DIW Phillips , DJP Barker , CN Hales , S Hirst , C. Osmond Thinness at birth and insulin resistance in adult life. Diabetologia 1994; 37: 150–4.

46M Alvarsson , S Efendic , VE Grill . Insulin responses to glucose in healthy males are associated with adult height but not with birth weight. J. Intern. Med. 1994; 236: 275–9.

47S Robinson , RJ Walton , PM Clark , DJP Barker , CN Hales , C. Osmond The relation of fetal growth to plasma glucose in young men. Diabetologia 1992; 35: 444–6.

48J Wills , JM Watson , CN Hales , DIW Phillips . The relation of fetal growth to insulin secretion in young men. Diabet. Med. 1996; 13: 773–4.

50CHD Fall , CE Stein , K Kumaran , V Cox , C Osmond , DJP Barker , CN Hales . Size at birth, maternal weight, and type 2 diabetes in South India. Diabet. Med. 1998; 15: 220–7.

51G Farmer , G Russell , DR Hamilton-Nicol , HO Ogenbede , IS Ross , DWM Pearson , H Thom , DF Kerridge , HW Sutherland . The influence of maternal glucose metabolism on fetal growth, development and morbidity in 917 singleton pregnancies in nondiabetic women. Diabetologia 1988; 31: 134–41.

53NE Morton . The inheritance of human birth weight. Ann. Hum. Genet. 1955; 20: 123–34.

54AA Brooks , MR Johnson , PJ Steer , ME Pawson , HI Abdalla . Birth weight: nature or nurture? Early Hum. Dev. 1995; 42: 2935.

56KM Godfrey , DJP Barker , S Robinson , C. Osmond Maternal birthweight and diet in pregnancy in relation to the infant's thinness at birth. Br. J. Obstet. Gynaecol. 1997; 104: 663–7.

58JE Harding , L Liu , P Evans , M Oliver , P. Gluckman Intrauterine feeding of the growth-retarded fetus: can we help? Early Hum. Dev. 1992; 29: 193–7.

59SK Walker , KM Hartwich , RF Seamark . The production of unusually large offspring following embryo manipulation: concepts and challenges. Theriogenology 1996; 45: 111–20.

60RJC Stewart , H Sheppard , R Preece , JC Waterlow . The effect of rehabilitation at different stages of development of rats marginally malnourished for ten to twelve generations. Br. J. Nutr. 1980; 43: 403–12.

61I Emanuel , H Filakti , E Alberman , SJW Evans . Intergenerational studies of human birthweight from the 1958 birth cohort. I. Evidence for a multigenerational effect. Br. J. Obstet. Gynaecol. 1992; 99: 6774.

62K Godfrey , S Robinson , DJP Barker , C Osmond , V. Cox Maternal nutrition in early and late pregnancy in relation to placental and fetal growth. BMJ 1996; 312: 410–4.

64JS Robinson , S Chidzanja , K Kind , F Lok , P Owens , JA Owens . Placental control of fetal growth. Reprod. Fertil. Dev. 1995; 7: 333–44.

66JM Belizan , J Villar , E Bergel , A del Pino , S Di Fulvio , SV Galliano , C. Kattan Long term effect of calcium supplementation during pregnancy on the blood pressure of offspring: follow up of a randomised controlled trial. BMJ 1997; 315: 281–5.

67D Rush . Effects of changes in maternal energy and protein intake during pregnancy, with special reference to fetal growth. In: F Sharp , RB Fraser , RDG Milner , eds. Fetal Growth. London: Royal College of Obstetricians and Gynaecologists, 1989; 203–33.

68KM Godfrey , T Forrester , DJP Barker , AA Jackson , JP Landman , JStE Hall , V Cox , C. Osmond Maternal nutritional status in pregnancy and blood pressure in childhood. Br. J. Obstet. Gynaecol. 1994; 101: 398403.

69PM Clark , C Atton , CM Law , A Shiell , K Godfrey , DJP Barker . Weight gain in pregnancy, triceps skinfold thickness and blood pressure in the offspring. Obstet. Gynaecol. 1998; 91: 103–7.

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