Blog entry by mohammad katout
Two decades ago, Hales and Barker reported the association between hypertension (HTN) in adult life and birth weight. They suggested that intrauterine environmental factors, mainly nutrition, could lead to permanent metabolic and structural changes in the fetus, influencing BP in adult life and increasing the risk of CVD in adulthood.
An inverse association exists between low birth weight (LBW) and higher blood pressures in infancy and childhood, and overt HTN in adulthood.
Impaired kidney development in an adverse intrauterine environment results in a low nephron number, which predisposes individuals to hypertension and kidney disease in adulthood. The main factors that predispose individuals to impaired kidney development are protein and calorie malnutrition, placental malfunction and maternal hyperglycemia. Complex processes with yet to be identified cellular and molecular mechanisms presumably contribute to impaired nephrogenesis. Growing evidence suggests that epigenetic modifications might explain many of the changes noted in perinatal programming.
What can we do then to ameliorate the effect of adverse fetal programming?
Prenatal care is transitioning to incorporate goals of optimizing maternal, fetal, and neonatal health to prevent or reduce adult-onset diseases including HTN and CVD morbidities.