Delicate beginnings: fetal programming under the microscope

View Large Image | Download PowerPoint SlideOne of Frank Herbert's science fiction novels carries an extremely poignant statement: ‘beginnings are such delicate times.’ If we emerge from the novel's fictional realm and envision the impact of events from early human development on adult health, Herbert's words feel almost oracular.The link between the fetal environment and non-communicable adult diseases was discovered decades ago, in the aftermath of WWII. Years later, the topic has received renewed attention with landmark studies performed by Barker and colleagues [1xInfant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Barker, D.J. and Osmond, C. Lancet. 1986; 8489: 1077–1081Abstract | Scopus (1141)See all References][1], who elaborated the ‘developmental origins of adult disease’ hypothesis or ‘Barker’ hypothesis. At the root of this concept is the observation that geographical regions with the greatest infant mortality rates in early twentieth century England had the greatest coronary heart disease mortality rates decades later. The importance of the link between early developmental events and adult susceptibility to disease is illustrated by the increasing number of publications in the field and by the major meetings revolving around the topic: the first world congress was held in 2001, and the second meeting, organized just two years later, attracted twice as many invited speakers and poster presentations [2xReport on the 2nd World Congress on Fetal Origins of Adult Disease, Brighton, U.K., June 7–10, 2003. Hanson, M. et al. Pediatr. Res. 2004; 55: 894–897Crossref | PubMed | Scopus (26)See all References][2].In Early Life Origins of Health and Disease, a group of internationally reputed contributors explore known and suspected factors that might act during fetal development and examine their link with adult disorders, such as cardiovascular disease, type 2 diabetes mellitus and obesity. The fifteen chapters of the volume cover a variety of topics: studies of twins and details that they can or cannot tell us about developmental origins of disease; disturbances in utero and their impact on the development of the human motor system; the link between maternal diet and epigenetic modifications in the embryo; and animal models and how they can improve our comprehension of early life programming for disorders such as hypertension, cardiovascular diseases, renal problems and obesity. Some of the findings described in the volume refer to humans, whereas other data come from animal experiments and observations.The book concludes with four chapters that address topics of recently increased interest: implications of vitamin D deficiency with regard to the health of offspring; the involvement of fetal hypoxia in the development of adult diseases; and the impact of alcohol exposure on developmental programming. A chapter is dedicated to the exploration of the neurodevelopmental hypothesis, a concept that has gained increasing acceptance and that considers fetal exposure to adverse environmental effects to be at the root of adult mental diseases.Early Life Origins of Health and Disease will benefit students, research scientists and physicians interested in comprehending how the prenatal environment impacts future health as an adult. The volume carries several important teachings. It is widely known that maternal health requires increased attention, both before and during pregnancy; at the same time, the book underscores that the optimal nutritional recommendations for women at different stages of their reproductive cycle are not yet completely understood. Improving fetal and maternal health could help prevent diseases that rank as the leaders in terms of morbidity and mortality. Also, when exploring adult diseases with fetal origins, the real strength will be provided by the combined use of epidemiological and genetic studies.There is another important lesson that emerges from the volume and is very vividly depicted in one of its chapters. With recent advances in science and technology, it has become impossible to think of diseases as being ‘either genetic or environmental’. The absence of such a dichotomy becomes a fundamental concept, particularly in the context of the intricate relationship among genes, organisms and environment that has emerged in recent years. The complex interplay among these three factors is most relevantly explained by Richard Lewontin, in his book The Triple Helix [3xThe Triple Helix. Lewontin, R. See all References][3]: ‘Taken together, the relations of genes, organisms, and environment are reciprocal relations in which all three elements are both causes and effects. Genes and environment are both causes of organisms, which are, in turn, causes of environments, so that genes become causes of environments as mediated by the organisms.’