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 Vol. 5 No. 12, December 2004
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NeoReviews Vol.5 No.12 2004 e511
© 2004 American Academy of Pediatrics

Fetal Origins of Adult Disease

Concepts and Controversies

Rebecca Simmons*

* Assistant Professor of Pediatrics, Department of Pediatrics, Children’s Hospital Philadelphia, University of Pennsylvania, Philadelphia, Pa

The first 300 words of the full text of this article appear below.


   Objectives
 
After completing this article, readers should be able to:

  1. Define programming.
  2. List the adult diseases that have been linked epidemiologically with low birthweight.
  3. Describe the fetal insulin hypothesis.
  4. Delineate the cellular consequences of fetal malnutrition.
  5. Describe the vulnerabilities of beta cells that may occur in the fetal-neonatal period.


   Programming
 
The period from conception to birth is a time of rapid growth, cellular replication and differentiation, and functional maturation of organ systems. These processes are very sensitive to alterations in the intrauterine milieu. Programming describes the mechanisms whereby a stimulus or insult at a critical period of development has lasting or lifelong effects.


   Epidemiology
 
It has been recognized for nearly 70 years that the early environment in which a child grows and develops could have long-term effects on subsequent health and survival. As discussed in the article by Matharu and Ozanne in this issue of NeoReviews, multiple epidemiology studies have linked low birthweight to the later development of a number of adult diseases, including hypertension, coronary artery disease, stroke, diabetes, kidney disease, and breast cancer. Studies controlling for the confounding factors of socioeconomic status and lifestyle factors have strengthened the association further of low birthweight with increased risk of coronary heart disease, stroke, and type 2 diabetes. In 1976, the Nurses’ Health Study was initiated, and a large cohort of United States women born from 1921 to 1946 was established. The associations of low birthweight with increased risk of coronary heart disease, stroke, and type 2 diabetes remained strong in this cohort, even after adjusting for lifestyle factors such as smoking, physical activity, occupation, income, dietary habits, and childhood socioeconomic status.


   The Role of Catch-up Growth
 
Many studies have suggested that the associations of birth size with later disease are modified by body mass index (BMI) in childhood. The highest risk for the development of type 2 . . . [Full Text of this Article]


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