Programming of endocrine mechanisms of cardiovascular control and growth

Several epidemiologic studies have linked size at birth to health in adult life. One school of thought centres on the part that periconceptual or intr auterine events play in this relationship. The idea is that an event, or se veral events, during critical periods of development can program, or perman ently alter, fetal physiology resulting in altered size at birth and subseq uent adult disease, including that of the cardiovascular system. Maternal d iet or body composition at the time of conception can influence placental d evelopment and subsequent transfer of nutrients and substrates to the fetus . Alteration to the maternal diet or body composition throughout gestation are then seen as challenges that are superimposed on this backdrop of peric onceptual events. One task is to find an animal model that replicates the m ajor features of the epidemiologic data: for adult cardiovascular disease t his would be altered fetal size and the development of postnatal hypertensi on. In addition, a critical issue is to investigate the mechanisms underlyi ng this Fetal Origins of Adult Disease hypothesis. The multiple mechanisms that constitute fetal cardiovascular responses to hypoxia in late gestation at neuronal, endocrine and local tissue levels have been studied extensive ly, and there is evidence from several different experimental paradigms tha t these control mechanisms can be programmed by intrauterine challenges. Th is review synthesized the current knowledge in this area and considers how the programming of cardiovascular control relates to fetal growth. Copyrigh t (C) 2001 by the Society for Gynecologic Investigation.