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(Hypertension. 2007;50:465.)
© 2007 American Heart Association, Inc.

Editorial Commentaries

Divergent Origins of Slow Fetal Growth

Relevance to Adult Cardiovascular Disease

Barbara T. Alexander

From the Department of Physiology, University of Mississippi Medical Center, Jackson.

Correspondence to Barbara T. Alexander, PhD, Department of Physiology, University of Mississippi Medical Center, 2500 North State St, Jackson, MS 39216-4505. E-mail balexander@physiology.umsmed.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Barker and Osmond hypothesized nearly 20 years ago that fetal undernutrition leads to permanent alterations in the body’s structure and physiology and increases susceptibility to cardiovascular disease in adult life.^1,2 Furthermore, they suggested that high blood pressure may be a link between an adverse intrauterine environment and the risk for cardiovascular disease.² Since then, numerous epidemiologic studies have assessed the inverse relation between birth weight and blood pressure.³ Furthermore, experimental studies have supported this inverse association and have demonstrated that the timing, length, and degree of in utero insult, as well as postnatal influences, determine the adult phenotype.^4–6

In humans, postnatal influences may also have an important impact on later development of cardiovascular disease in babies who are born small.^2,7 Accordingly, Barker and colleagues⁷ recently suggested that 2 different pathways of childhood growth may precede development of hypertension and adult cardiovascular disease. Early development of more severe hypertension associated with obesity and insulin resistance is more common in individuals who are born small but who experience rapid catch-up growth during childhood. Individuals who are born short and maintain slow growth during childhood and therefore remain short and thin before puberty develop hypertension at a later age. However, these individuals also have a greater risk for stroke as adults.^7,8

Interestingly, the increased risk for stroke is more common in individuals with mothers who have a "flat" bony pelvis.⁸ Because a flat pelvis is associated with malnutrition during the first year of life, Barker and colleagues⁸ proposed that malnutrition during infancy increases . . . [Full Text of this Article]

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Maternal and Social Origins of Hypertension

David J.P. Barker, Clive Osmond, Tom J. Forsen, Eero Kajantie, and Johan G. Eriksson
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