Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-17T17:05:09.276Z Has data issue: false hasContentIssue false

Fetal programming and adult health

Published online by Cambridge University Press:  27 September 2007

Keith M Godfrey*
Affiliation:
MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
David JP Barker
Affiliation:
MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
*
*Corresponding author: Email kmg@mrc.soton.ac.uk
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

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.

Type
Research Article
Copyright
Copyright © CABI Publishing 2001

References

1Barker, DJP. Mothers, babies and health in later life. 2nd ed. Edinburgh: Churchill Livingstone, 1998.Google Scholar
2McCance, RA, Widdowson, EM. The determinants of growth and form. Proc. R. Soc. Lond B 1974; 185: 117.Google ScholarPubMed
3Lucas, A.Role of nutritional programming in determining adult morbidity. Arch Dis. Child 1994; 71: 288–90.Google Scholar
4Langley-Evans, SC, Jackson, AA. Increased systolic blood pressure in adult rats induced by fetal exposure to maternal low protein diets. Clin. Sci. 1994; 86: 217–22.CrossRefGoogle Scholar
5Desai, M, Crowther, NJ, Ozanne, SE, Lucas, A, Hales, CN. Adult glucose and lipid metabolism may be programmed during fetal life. Biochem. Soc. Trans. 1995; 23: 331–5.Google Scholar
6Osmond, C, Barker, DJP, Winter, PD, Fall, CHD, Simmonds, SJ. Early growth and death from cardiovascular disease in women. BMJ 1993; 307: 1519–24.CrossRefGoogle ScholarPubMed
7Barker, DJP, Osmond, C, Simmonds, SJ, Wield, GA. The relation of small head circumference and thinness at birth to death from cardiovascular disease in adult life. BMJ 1993; 306: 422–6.Google Scholar
8Frankel, S, Elwood, P, Sweetnam, P, Yarnell, J, Davey Smith, G.Birthweight, body-mass index in middle age, and incident coronary heart disease. Lancet 1996; 348: 1478–80.CrossRefGoogle ScholarPubMed
9Rich-Edwards, JW, Stampfer, MJ, Manson, JE, Rosner, B, Hankinson, SE, Colditz, GA, Willett, WC, Hennekens, CH. Birth weight and risk of cardiovascular disease in a cohort of women followed up since 1976. BMJ 1997; 315: 396400.CrossRefGoogle Scholar
10Stein, CE, Fall, CHD, Kumaran, K, Osmond, C, Cox, V, Barker, DJP. Fetal growth and coronary heart disease in South India. Lancet 1996; 348: 1269–73.CrossRefGoogle ScholarPubMed
11Martyn, CN, Barker, DJP, Osmond, C.Mothers' pelvic size, fetal growth, and death from stroke and coronary heart disease in men in the UK. Lancet 1996; 348: 1264–8.CrossRefGoogle ScholarPubMed
12Forsen, T, Eriksson, JG, Tuomilehto, J, Teramo, K, Osmond, C, Barker, DJP. Mother's weight in pregnancy and coronary heart disease in a cohort of Finnish men: follow up study. BMJ 1997; 315: 837–40.CrossRefGoogle Scholar
13Leon, DA, Lithell, H, Vagero, D, et al. Biological and social influences on mortality in a cohort of 15 000 Swedes followed from birth to old age. J. Epidemiol. Community Health 1997; 51: 594 [Abstract].Google Scholar
14Hales, CN, Barker, DJP, Clark, PMS, Cox, LJ, Fall, C, Osmond, C, Winter, PD. Fetal and infant growth and impaired glucose tolerance at age 64. BMJ 1991; 303: 1019–22.CrossRefGoogle ScholarPubMed
15Law, CM, Shiell, AW. 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.CrossRefGoogle ScholarPubMed
16Barker, DJP, Godfrey, KM, Osmond, C, Bull, A.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.CrossRefGoogle ScholarPubMed
17Moore, VM, Cockington, RA, Ryan, P, Robinson, JS. The relationship between birth weight and blood pressure amplifies from childhood to adulthood. J. Hypertens 1999; 17: 883–8.Google Scholar
18Law, CM, Barker, DJP, Bull, AR, Osmond, C.Maternal and fetal influences on blood pressure. Arch. Dis. Child 1991; 66: 1291–5.CrossRefGoogle ScholarPubMed
19Campbell, DM, Hall, MH, Barker, DJP, Cross, J, Shiell, AW, Godfrey, KM. Diet in pregnancy and the offspring's blood pressure 40 years later. Br. J. Obstet. Gynaecol. 1996; 103: 273–80.Google Scholar
20Robinson, JS, Owens, JA, de Barro, T, et al. Maternal nutrition and fetal growth. In: Ward, RHT, Smith, SK, Donnai, D, eds. Early fetal growth and development. London: Royal College of Obstetricians and Gynaecologists, 1994; 317–34.Google Scholar
21Martyn, CN, Barker, DJP, Jespersen, S, Greenwald, S, Osmond, C, Berry, C.Growth in utero, adult blood pressure, and arterial compliance. Br. Heart J. 1995; 73: 116–21.CrossRefGoogle ScholarPubMed
22Lever, AF, Harrap, SB. Essential hypertension: a disorder of growth with origins in childhood? J. Hypertens 1992; 10: 101–20.Google Scholar
23Martyn, CN, Lever, AF, Morton, JJ. Plasma concentrations of inactive renin in adult life are related to indicators of foetal growth. J. Hypertens 1996; 14: 881–6.CrossRefGoogle ScholarPubMed
24Mackenzie, HS, Brenner, BM. Fewer nephrons at birth: a missing link in the etiology of essential hypertension? Am. J. Kidney Dis. 1995; 26: 91–8.CrossRefGoogle ScholarPubMed
25Konje, JC, Bell, SC, Morton, JJ, de Chazal, R, Taylor, DJ. 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.CrossRefGoogle Scholar
26Edwards, CRW, Benediktsson, R, Lindsay, RS, Seckl, JR. Dysfunction of placental glucocorticoid barrier: link between fetal environment and adult hypertension? Lancet 1993; 341: 355–7.CrossRefGoogle ScholarPubMed
27Phillips, DI, Barker, DJ, Fall, CH, Seckl, JR, Whorwood, CB, Wood, PJ, Walker, BR. Elevated plasma cortisol concentrations: a link between low birth weight and the insulin resistance syndrome? J. Clin. Endocrinol Metab. 1998; 83: 757–60.Google ScholarPubMed
28Martyn, CN, Greenwald, SE. 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.CrossRefGoogle Scholar
29Al-Ghazali, W, Chita, SK, Chapman, MG, Allan, LD. Evidence of redistribution of cardiac output in asymmetrical growth retardation. Br. J. Obstet Gynaecol 1989; 96: 697704.CrossRefGoogle ScholarPubMed
30Leeson, CPM, Whincup, PH, Cook, DG, Donald, AE, Papacosta, O, Lucas, A, Deanfield, JE. Flow-mediated dilation in 9- to 11-year old children. The influence of intrauterine and childhood factors. Circulation 1997; 96: 2233–8.CrossRefGoogle ScholarPubMed
31Phillips, DIW, Barker, DJP. 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: 673–7.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
32Lithell, HO, McKeigue, PM, Berglund, L, Mohsen, R, Lithell, UB, Leon, DA. Relation of size at birth to non-insulin dependent diabetes and insulin concentrations in men aged 50–60 years. BMJ 1996; 312: 406–10.Google Scholar
33Curhan, GC, Willett, WC, Rimm, EB, et al. Birth weight and adult hypertension and diabetes mellitus in US men. Am. J. Hypertens 1996; 9: 11A [Abstract].CrossRefGoogle Scholar
34McCance, DR, Pettitt, DJ, Hanson, RL, Jacobsson, LTH, Knowler, WC, Bennett, PH. Birth weight and non-insulin dependent diabetes: thrifty genotype, thrifty phenotype, or surviving small baby genotype? BMJ 1994; 308: 942–5.CrossRefGoogle ScholarPubMed
35Barker, DJP, Hales, CN, Fall, CHD, Osmond, C, Phipps, K, Clark, PMS. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia 1993; 36: 62–7.CrossRefGoogle ScholarPubMed
36Phillips, DIW, Hirst, S, Clark, PMS, Hales, CN, Osmond, C.Fetal growth and insulin secretion in adult life. Diabetologia 1994; 37: 592–6.CrossRefGoogle ScholarPubMed
37Valdez, R, Athens, MA, Thompson, GH, Bradshaw, BS, Stern, MP. Birthweight and adult health outcomes in a biethnic population in the USA. Diabetologia 1994; 37: 624–31.CrossRefGoogle Scholar
38Leger, J, Levy-Marchal, C, Bloch, J, Pinet, A, Chevenne, D, Porquet, D, Collin, D, Czernichow, P.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.CrossRefGoogle ScholarPubMed
39Ravelli, ACJ, van der Meulen, JHP, Michels, RPJ, Osmond, C, Barker, DJP, Hales, CN, Bleker, OP. Glucose tolerance in adults after prenatal exposure to famine. Lancet 1998; 351: 173–7.CrossRefGoogle ScholarPubMed
40Law, CM, Gordon, GS, Shiell, AW, Barker, DJP, Hales, CN. Thinness at birth and glucose tolerance in seven year old children. Diabet. Med. 1995; 12: 24–9.Google Scholar
41Whincup, PH, Cook, DG, Adshead, F, Taylor, SJC, Walker, M, Papacosta, O, Alberti, KGMM. 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.CrossRefGoogle ScholarPubMed
42Taylor, DJ, Thompson, CH, Kemp, GJ, Barnes, PRJ, Sanderson, AL, Radda, GK, Phillips, DIW. A relationship between impaired fetal growth and reduced muscle glycolysis revealed by 31P magnetic resonance spectroscopy. Diabetologia 1995; 38: 1205–12.CrossRefGoogle ScholarPubMed
43Bjorntorp, P.Insulin resistance: the consequence of a neuroendocrine disturbance? Int. J. Obesity 1995; 19(suppl 1): S6–10.Google ScholarPubMed
44Hales, CN, Barker, DJP. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia 1992; 35: 595601.Google Scholar
45Phillips, DIW, Barker, DJP, Hales, CN, Hirst, S, Osmond, C.Thinness at birth and insulin resistance in adult life. Diabetologia 1994; 37: 150–4.CrossRefGoogle ScholarPubMed
46Alvarsson, M, Efendic, S, Grill, VE. Insulin responses to glucose in healthy males are associated with adult height but not with birth weight. J. Intern. Med. 1994; 236: 275–9.CrossRefGoogle Scholar
47Robinson, S, Walton, RJ, Clark, PM, Barker, DJP, Hales, CN, Osmond, C.The relation of fetal growth to plasma glucose in young men. Diabetologia 1992; 35: 444–6.Google Scholar
48Wills, J, Watson, JM, Hales, CN, Phillips, DIW. The relation of fetal growth to insulin secretion in young men. Diabet. Med. 1996; 13: 773–4.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
49Leger, J, Levy-Marchal, C, Block, J, et al. Evidence for insulin-resistance developing in young adults with intra-uterine growth retardation. Diabetologia 1997; 40: A53 [Abstract].Google Scholar
50Fall, CHD, Stein, CE, Kumaran, K, Cox, V, Osmond, C, Barker, DJP, Hales, CN. Size at birth, maternal weight, and type 2 diabetes in South India. Diabet. Med. 1998; 15: 220–7.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
51Farmer, G, Russell, G, Hamilton-Nicol, DR, Ogenbede, HO, Ross, IS, Pearson, DWM, Thom, H, Kerridge, DF, Sutherland, HW. The influence of maternal glucose metabolism on fetal growth, development and morbidity in 917 singleton pregnancies in nondiabetic women. Diabetologia 1988; 31: 134–41.CrossRefGoogle ScholarPubMed
52Snow, MHL. Effects of genome on fetal size at birth. In: Sharp, F, Fraser, RB, Milner, RDG, eds. Fetal growth. Proceedings of the 20th Study Group. London: Royal College of Obstetricians and Gynaecologists, 1989; 111.Google Scholar
53Morton, NE. The inheritance of human birth weight. Ann. Hum. Genet. 1955; 20: 123–34.CrossRefGoogle ScholarPubMed
54Brooks, AA, Johnson, MR, Steer, PJ, Pawson, ME, Abdalla, HI. Birth weight: nature or nurture? Early Hum. Dev. 1995; 42: 2935.CrossRefGoogle ScholarPubMed
55Stein, Z, Susser, M, Saenger, G, et al. Famine and human development: The Dutch Hunger Winter of 1944/45.New York: Oxford University Press, 1975.Google Scholar
56Godfrey, KM, Barker, DJP, Robinson, S, Osmond, C.Maternal birthweight and diet in pregnancy in relation to the infant's thinness at birth. Br. J. Obstet. Gynaecol. 1997; 104: 663–7.CrossRefGoogle Scholar
57Kramer, MS. Effects of energy and protein intakes on pregnancy outcome: an overview of the research evidence from controlled clinical trials. Am. J. Clin. Nutr. 1993; 58: 627–35.Google Scholar
58Harding, JE, Liu, L, Evans, P, Oliver, M, Gluckman, P.Intrauterine feeding of the growth-retarded fetus: can we help? Early Hum. Dev. 1992; 29: 193–7.Google Scholar
59Walker, SK, Hartwich, KM, Seamark, RF. The production of unusually large offspring following embryo manipulation: concepts and challenges. Theriogenology 1996; 45: 111–20.CrossRefGoogle Scholar
60Stewart, RJC, Sheppard, H, Preece, R, Waterlow, JC. 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.CrossRefGoogle ScholarPubMed
61Emanuel, I, Filakti, H, Alberman, E, Evans, SJW. Intergenerational studies of human birthweight from the 1958 birth cohort. I. Evidence for a multigenerational effect. Br. J. Obstet. Gynaecol. 1992; 99: 6774.CrossRefGoogle ScholarPubMed
62Godfrey, K, Robinson, S, Barker, DJP, Osmond, C, Cox, V.Maternal nutrition in early and late pregnancy in relation to placental and fetal growth. BMJ 1996; 312: 410–4.Google Scholar
63Lumey, LH. Compensatory placental growth after restricted maternal nutrition in early pregnancy. Placenta 1998; 19: 105–11.Google ScholarPubMed
64Robinson, JS, Chidzanja, S, Kind, K, Lok, F, Owens, P, Owens, JA. Placental control of fetal growth. Reprod. Fertil. Dev. 1995; 7: 333–44.CrossRefGoogle ScholarPubMed
65Kind, KL, Clifton, PM, Katsman, AI, Tsiounis, M, Robinson, JS, Owens, JA. Restricted fetal growth and the response to dietary cholesterol in the guinea pig. Am. J. Physiol. 1999; 277: R1675–82.Google ScholarPubMed
66Belizan, JM, Villar, J, Bergel, E, del Pino, A, Di Fulvio, S, Galliano, SV, Kattan, C.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.CrossRefGoogle ScholarPubMed
67Rush, D. Effects of changes in maternal energy and protein intake during pregnancy, with special reference to fetal growth. In: Sharp, F, Fraser, RB, Milner, RDG, eds. Fetal Growth. London: Royal College of Obstetricians and Gynaecologists, 1989; 203–33.Google Scholar
68Godfrey, KM, Forrester, T, Barker, DJP, Jackson, AA, Landman, JP, Hall, JStE, Cox, V, Osmond, C.Maternal nutritional status in pregnancy and blood pressure in childhood. Br. J. Obstet. Gynaecol. 1994; 101: 398403.Google Scholar
69Clark, PM, Atton, C, Law, CM, Shiell, A, Godfrey, K, Barker, DJP. Weight gain in pregnancy, triceps skinfold thickness and blood pressure in the offspring. Obstet. Gynaecol. 1998; 91: 103–7.CrossRefGoogle Scholar
70Independent Inquiry into Inequalities in Health. Report of the Independent Inquiry into Inequalities in Health. London: The Stationery Office, 1998.Google Scholar