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Fetal origins of adult disease

Fetal origins of adult disease. Anne Wallis MCH – Cluj 27 October 2010. Development of an idea. Early geographic associations showed that contemporary mortality rates from CVD were associated with IMRs >50 years prior, by area, in England and Wales

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Fetal origins of adult disease

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  1. Fetal origins of adult disease Anne Wallis MCH – Cluj 27 October 2010

  2. Development of an idea • Early geographic associations showed that contemporary mortality rates from CVD were associated with IMRs >50 years prior, by area, in England and Wales • Was this evidence of fetal disease origins, or confounding of socioeconomic variables?

  3. BP and birthweight • Law & Shiell conducted a meta-analysis that showed persistent relationship between increased BP at all ages and lower birthweight • Koupilova, et al, showed in a Swedish study that socioeconomic factors did not account for this association • Similar evidence for non-insulin dependent diabetes

  4. Hertfordshire study (Osmond, et al., 1993)

  5. Possible mechanisms • Genetic factors • Maternal nutrition, including placental function in transfer of nutrients • “Programming” (Lucas, 1991) • Induction, deletion, or impaired development of a permanent somatic structure as a result of a stimulus or insult operating at a critical period • Physiological 'setting' by cm early stimulus or insult at a 'sensitive' period, resulting in long-term consequences for function.

  6. What does this mean? • Forces us to reorient how we think about fetal growth and fetal growth restriction • Perinatal epi has been mostly concerned with studying the immediate or short-term pathologic consequences of variations in fetal growth • This hypothesis suggests that insults to fetal growth carry lifetime implications

  7. Implications for theory? • Socioeconomic origins? • Place of residence? • Birth health of parents? • Global health • Implications for research

  8. warming hygiene cord care trained birth attendants food antibiotics antimalarial Rx community health centers breastfeeding education of women improved standard of living social medicine in-hospital births equality emergency transport surfactant NICU tech

  9. Proposed decision-making matrix for antenatal, OB, and neonatal care

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