Cardiovascular Health Starts in the Womb

Abstract

Hypertension has largely been viewed as a disorder of adulthood. Historically, blood pressure (BP) was not routinely measured in children because hypertension was considered uncommon in childhood. It was not until the 1970s that it was apparent that in childhood BP levels were normally lower compared with those in adults, were related to age and growth, and that abnormal BP in children needed different definitions. Based on the distribution of BP levels in available child cohorts, the 95th percentile of BP levels became the definition of hypertension in children and adolescents-an epidemiological definition. Subsequent clinical and epidemiological research identified associated risk factors in childhood that linked abnormal BP in youth with hypertension in adulthood. In the 1980s, the Barker hypothesis, based on observations that low birth weight could be linked to cardiovascular disease in adulthood, promoted further research spanning epidemiological, clinical, and basic science on the childhood origins of hypertension. This review focuses on recent findings from both longitudinal maternal-child cohorts and experimental models that examine both maternal and offspring conditions associated with risks of subsequent cardiovascular disease.

Keywords: adolescent; adult; birth weight; blood pressure; hypertension; pre-eclampsia; risk factors.

Figure 1A: Prenatal Phase: Both maternal and paternal conditions, exposures, and each parent’s genetics and epigenetics contribute Parental Genetics & Epigenetics to the fetus in the prenatal period. During pregnancy, maternal conditions such as HDP can alter the intrauterine environment at the Utero-Placental-Fetal Interface. In response to a suboptimal intrauterine environment the fetus can make adjustments to conserve nutrients for survival termed Prenatal Programming. A consequence of the suboptimal nutrients for fetal growth and organ development can be Fetal Growth Restriction, Small for Gestational Age, or Preterm, all of which is manifest as Low Birth Weight. Figure 1B. Postnatal Period: An offspring with Low Birth Weight at birth, whether due to Fetal Growth Restriction, Small for Gestational Age, or Preterm, begins Childhood Growth and Development that is regulated by its unique Offspring Genetics and Epigenetics, developed from its experience in the Prenatal period. The Offspring childhood growth and development pathway may also be compromised by limitations in Altered Organ Structure and Function in the prenatal period of fetal growth. In addition to the risks related to Low Birth Weight, additional adverse postnatal exposures (sub-optimal health behaviors, obesity, environmental stress) can increase the risk for Hypertension, Vascular Stiffness, and Cardiac Hypertrophy.