LOW-BIRTH-WEIGHT AND SUBSEQUENT HYPERTENSION

Geographical studies provoke the hypothesis that early environmental d eprivation may be linked to disease in adult life. There is indeed mou nting evidence from longitudinal studies that markers of poor fetal gr owth such as weight at birth are associated with later disorders inclu ding hypertension. The notion that an adverse event at a critical stag e of fetal development could predispose to disease in adulthood is kno wn as the programming hypothesis. In the case of hypertension, possibl e mechanisms include changes in arterial compliance caused by abnormal ities in fetal blood flow, peripheral insulin resistance and disordere d beta cell function with high circulating levels of insulin precursor s, and reduced nephron mass with abnormalities of salt and fluid excre tion. If the programming hypothesis is correct, risk of cardiovascular disease in adulthood could be reduced by improvements in maternal nut rition in pregnancy.