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Media Spotlight: Fetal Growth and Adult Heart Disease

The details of Barker’s discoveries are described with literary finesse — a terrific late-night read for pediatricians.

The Barker hypothesis states an association between low birth weight and adult coronary heart disease. The fascinating story behind this discovery was reported recently in the New Yorker. In the 1980s, David Barker, a British epidemiologist, compiled maps showing common causes of death in different regions of England and Wales. Surprised by his initial observation that death rates from heart disease in adults were higher in economically poorer regions, he asked the question: Could early childhood health be important? Through meticulous scavenging of birth records and death certificates of individuals born 50 years earlier, he made the following discoveries:

• The poorest regions had the highest rates of neonatal and infant mortality and adult coronary heart disease, compared with more-affluent regions.
  
• Men who had birth weights of 5.5 pounds or less had the highest rates of death from adult heart disease. The association was even greater in those who remained underweight at 1 year of age. (Premature infants were excluded.)
  

Barker recognized clues in his data that growth rate and the amount of weight gain in early childhood among low birth weight infants also contributed to adult heart disease. Using birth records, early childhood measurements from public health records, and school health data from Finland, Barker and Johan Eriksson observed that among low birth weight children, small size at age 1 year and a rapid gain in BMI after age 2 years were associated with adult mortality from heart disease.

Comment: Since Barker’s discovery linking small for gestational age (SGA) with adult heart disease, other studies have correlated SGA with insulin resistance, obesity, and diabetes. These conditions result from chronic fetal undernourishment. Intrauterine growth restriction might be an adaptive process for short-term survival at the expense of adult disease. Further studies are needed to determine the optimal weight gain for SGA babies early in life to reduce the risk for adult coronary disease.

— Martin T. Stein, MD

Published in Journal Watch Pediatrics and Adolescent Medicine January 9, 2008

Citation(s):

Hall SS. Small and thin: The controversy over the fetal origins of adult health. New Yorker 2007 Nov 19; :52.