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Fetal Programming and the Risk of Noncommunicable Disease

  • Symposium on Chronic Noncommunicable Diseases and Children
  • Published:
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Abstract

The “developmental origins of health and disease” (DOHaD) hypothesis proposes that environmental conditions during fetal and early post-natal development influence lifelong health and capacity through permanent effects on growth, structure and metabolism. This has been called ‘programming’. The hypothesis is supported by epidemiological evidence in humans linking newborn size, and infant growth and nutrition, to adult health outcomes, and by experiments in animals showing that maternal under- and over-nutrition and other interventions (e.g., glucocorticoid exposure) during pregnancy lead to abnormal metabolism and body composition in the adult offspring. Early life programming is now thought to be important in the etiology of obesity, type 2 diabetes, and cardiovascular disease, opening up the possibility that these common diseases could be prevented by achieving optimal fetal and infant development. This is likely to have additional benefits for infant survival and human capital (e.g., improved cognitive performance and physical work capacity). Fetal nutrition is influenced by the mother’s diet and body size and composition, but hard evidence that the nutrition of the human mother programmes chronic disease risk in her offspring is currently limited. Recent findings from follow-up of children born after randomised nutritional interventions in pregnancy are mixed, but show some evidence of beneficial effects on vascular function, lipid concentrations, glucose tolerance and insulin resistance. Work in experimental animals suggests that epigenetic phenomena, whereby gene expression is modified by DNA methylation, and which are sensitive to the nutritional environment in early life, may be one mechanism underlying programming.

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Abbreviations

CHD:

Coronary Heart Disease

CVD:

Cardiovascular Disease

GDM:

Gestational Diabetes Mellitus

LMIC:

Low and Middle Income Countries

PMNS:

Pune Maternal Nutrition Study

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Acknowledgements

The author would like to thank the Indian scientists with whom she work, including those at the KEM Hospital, Pune; Holdsworth Memorial Hospital, Mysore; New Delhi Birth Cohort Study, New Delhi; Christian Medical College, Vellore; and Centre for the Study of Social Change, Mumbai; and also the Indian society for research into the developmental origins of health and disease, Sneha-India. The research described is funded by the Indian Council of Medical Research; Medical Research Council, UK; Wellcome Trust, UK; Parthenon Trust, Switzerland; and ICICI Foundation, India. The manuscript was produced with the assistance of Jane Pearce.

Conflict of Interest

None.

Role of Funding Source

The work was funded by the Medical Research Council, UK, the Wellcome Trust, UK and the Parthenon Trust (Switzerland). The funders played no role in the data analysis and interpretation.

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  1. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, Hampshire, SO16 6YD, UK

    Caroline H. D. Fall

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  1. Caroline H. D. Fall
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Correspondence to Caroline H. D. Fall.

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Fall, C.H.D. Fetal Programming and the Risk of Noncommunicable Disease. Indian J Pediatr 80 (Suppl 1), 13–20 (2013). https://doi.org/10.1007/s12098-012-0834-5

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  • DOI: https://doi.org/10.1007/s12098-012-0834-5

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