Barker DJP
Fetal origins of hypertension
16th Scientific Meeting of the International Society of Hypertension
ISH Abstract Book
(Jun) 16: 1996
The hypothesis that "a baby's nourishment before birth and during
infancy" influences the risk of vascular disease in later life is
very intriguing. Barker gave a brilliant lecture on this issue. Animal
studies have shown that undernutrition before birth programmes
persisting changes in a range of metabolic and physiological
parameters, including BP and influences size and body proportions at
birth. 21 studies in humans have shown that people whose birthweights
were at the lower end of the normal range have raised blood pressure.
This has led to the hypothesis that hypertension may originate before
birth, one aspect of a more general phenomenon whereby coronary heart
disease is programmed in utero.
Body proportions at birth are more
strongly associated with blood pressure than birthweight. Babies who
are thin or short at birth, or proportionately small, have all been
shown to have raised blood pressure. This suggests that blood pressure
maybe programmed at different stages of development, possibly through
differing mechanisms. Possible mechanisms include the effects of
glucocorticoid hormones in utero and persisting changes in vascular
structure. Maternal nutrition may influence the offspring's blood
pressure by influencing placental growth. For example, in a recent study
differences in animal protein and carbohydrate intakes in pregnancy
were associated with differences in placental size and in the
offspring's blood pressure 40 years later (Campbell DM. Br J Obstet
Gynaecol, 1995) (Carmine Zoccali, M.D, Reggio Calabria,
Italy).
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16th Scientific Meeting of the International Society of Hypertension
H: Pathophysiology :
Fetal origins, birth weight
H: Pathophysiology :
Vascular pathology