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Fetal Programming of Adult Disease: Implications for Prenatal Care
Citation:
LAU, C., J. M. ROGERS, AND M. G. Ross. Fetal Programming of Adult Disease: Implications for Prenatal Care. American Journal of Obstetrics and Gynecology. Mosby Year Book Incorporated, Orlando, FL, 117(4):978-985, (2011).
Impact/Purpose:
This is a brief review of the implications of suboptimal prenatal environment of the adult health of offspring, and what might be done to minimize such impact
Description:
The obesity epidemic, including a marked increase in the prevalence of obesity among pregnant women, represents a critical public health problem in the United States and throughout the world. Over the past two decades, it has been increasingly recognized that the risk of adult health disorders, particularly metabolic syndrome, can be markedly influenced by prenatal and infant environmental exposures (i.e., developmental programming). Low birth weight together with infant catch-up growth is associated with a significant risk of adult obesity and cardiovascular disease, as well as associated adverse effects on pulmonary, renal and cerebral function. Conversely, exposure to maternal obesity or high birth weight also represents an increased risk for childhood and adult obesity. In addition, fetal exposure to select chemicals (e.g., phytoestrogens) or environmental pollutants (e.g., tobacco smoke) may affect the predisposition to adult disease. Animal models have confirmed human epidemiologic findings and provided insight into putative programming mechanisms, including altered organ development, cellular signaling responses, and epigenetic modifications. Prenatal care is transitioning to incorporate goals of optimizing fetal and neonatal health, so as to prevent or reduce adult-onset diseases. Guidelines regarding optimal pregnancy nutrition and weight gain, management of low and high fetal weight pregnancies, use of maternal glucocorticoids, and newborn feeding strategies, among others, have yet to fully integrate long term consequences on adult health. In the interim, we should strive for preconceptional normalization of maternal weight and balanced maternal nutrition during pregnancy. Clearly, prenatal management decisions will await additional studies exploring the mechanisms and consequences of the fetal/neonatal environment on offspring health and disease. This document has been reviewed in accordance with the U.S. Environmental Protection Agency policy and approved for publication. Approval does not signify that the contents reflect the views of the Agency, nor does mention of trade names or commercial products constitute endorsement or recommendation for use.
