Maternal regulation of fetal development and health in adult life

Babies who are small or disproportionate at birth, or who have altered placental growth are now known to have increased rates of coronary heart disease, hypertension and non-insulin-dependent diabetes in adult life. These associations are thought to result from fetal 'programming' whereby a stimulus or insult at a critical, sensitive period of early life has permanent effects on the body's structure, physiology and metabolism. Small size at birth and disproportion in head size, length and weight appear to be surrogate markers for the actual influences that programme the fetus. These observations have prompted a re-evaluation of the maternal regulation of human fetal development. Recent studies suggest that the fetus may be considerably more sensitive to the materno-placental supply of nutrients than hitherto imagined. Adult cardiovascular disease may be a consequence of fetal adaptations invoked when the materno-placental nutrient supply fails to match the fetal nutrient demand. Understanding the maternal regulation of human fetal development could lead to public health measures that improve the adult health of future generations. (C) 1998 Elsevier Science Ireland Ltd.