Prenatal undernutrition, postnatal environments, and antibody response to vaccination in adolescence

Background: Recently, researchers have considered the fetal and infant orig ins of several adult cardiovascular and metabolic diseases, but the implica tions of early events for immune function and infectious disease are unclea r. Objective: We investigated the association between prenatal undernutrition and immunocompetence in adolescence and hypothesized that intrauterine grow th retardation is associated with a lower likelihood of mounting an adequat e antibody response later in life. Design: A subsample of one hundred three 14-15-y-olds was recruited from an ongoing longitudinal study in which data collection began while participan ts were in utero. A typhoid vaccine was given, and anti-typhoid antibodies were measured 2 wk and 3 mo later as a functional marker of immunocompetenc e. The likelihood of mounting an adequate antibody response was compared fo r adolescents who were small for gestational age or appropriate for gestati onal age at birth while controlling for a range of postnatal exposures. Results: The predicted probability of mounting a positive antibody response for adolescents who were prenatally and currently undernourished was 0.32, compared with probabilities of 0.49-0.70 for adequately nourished adolesce nts (P=0.023). Diarrhea in the first year of life (P=0.009) and fast weight gain during the first 6 mo (P=0.003) were also associated with a higher pr obability of response. Conclusions: These findings extend the concept of fetal and early infant pr ogramming of adult diseases to the immune system and suggest that early env ironments may have long-term implications for immunocompetence and infectio us disease risk, particularly in developing countries.