International Journal of Epidemiology 2002;31:294-299
© International Epidemiological Association 2002
Review |
Epidemiological challenges in studying the fetal origins of adult chronic disease
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, and the Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
Keywords Fetal origins of adult disease, lifecourse, socioeconomic status, fetal growth, gene-environment interaction, nutrition, epidemiological study design, fetal programming
Accepted 23 October 2001
The relatively new research field of the fetal origins of adult disease has matured greatly in the past decade. Recent systematic overviews provide strong evidence that robust inverse epidemiological associations exist between birthweight and later blood pressure/hypertension1 and glucose intolerance/type 2 diabetes.2 Consistent associations are also evident for the inverse associations of birthweight with coronary heart disease incidence and mortality.3,4 Studies with high follow-up rates and adjustment for social and economic variables have to a large extent mitigated earlier criticisms that observed associations were highly subject to confounding and selection bias.5 Many questions remain, however, about the contributing roles of postnatal growth and development, underlying biological mechanisms, and the importance of the epidemiological findings to public health. This review outlines current challenges—stated in the form of propositions—that epidemiologists in this field currently face.
1. The Lifecourse Approach Helps Put Fetal Influences into Perspective
The lifecourse approach to chronic disease posits that fetal life is one important period of development, but
2. Adjustment for Achieved Body Mass Index, Despite Being Controversial, Is Often Helpful
3. Social and Economic Factors Are Not Just Confounders
4. Fetal Growth and Size at Birth Are Not Synonymous
5. Some Determinants of Fetal Growth Will Be Red Herrings
6. Both Genes and Environment Are Important. Even Distinction Between the Two Is Difficult
7. Maternal Nutrition Does Not Equal Fetal Nutrition
8. New Epidemiological Study Designs Will Help
9. To Make Policy Recommendations Now Regarding Fetal Programming Is Dangerous
Acknowledgments
References
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