Henriksen Tore, Clausen Torun
Department of Obstetrics and Gynecology, The National Hospital, University of Oslo, Oslo, Norway.
Acta Obstet Gynecol Scand. 2002 Feb;81(2):112-4. doi: 10.1034/j.1600-0412.2002.810204.x.
The 'Fetal origins hypothesis' states that individuals born small because of malnutrition are predisposed to adult diseases. Fetal malnutrition has two main causes, poor maternal nutrition and placental insufficiency. A distinction between these causes is important because it is likely that maternal nutrition has been sufficient in the majority of populations in which the fetal origins hypothesis has been tested. Thus, placental insufficiency is a more reasonable cause of reduced fetal growth in adequately nourished populations. Placental insufficiency is mainly due to inadequate vascular adaptation at the uteroplacental interface ('poor placentation'). Among women with placental insufficiency syndromes such as pre-eclampsia and 'idiopathic' intrauterine growth retardation, there is an increased prevalence of risk factors for cardiovascular diseases. Maternal cardiovascular risk factors may therefore increase the risk of adult diseases in the offspring both through direct inheritance and by interfering with uteroplacental vascular adaptation. The latter may result in placental insufficiency and fetal growth retardation that by itself could cause adult disease (as the Fetal origins hypothesis states). Alternatively, the association between low birth weight for gestational and adult disease could be an epiphenomenon, leaving inheritance as the main explanation for the fetal origins hypothesis, in adequately nourished populations.
“胎儿起源假说”指出，因营养不良出生时体重较轻的个体易患成人疾病。胎儿营养不良主要有两个原因，即母亲营养不足和胎盘功能不全。区分这两个原因很重要，因为在大多数检验胎儿起源假说的人群中，母亲营养状况可能是充足的。因此，在营养充足的人群中，胎盘功能不全是胎儿生长受限更合理的原因。胎盘功能不全主要是由于子宫胎盘界面血管适应性不足（“胎盘形成不良”）。在患有先兆子痫和“特发性”宫内生长受限等胎盘功能不全综合征的女性中，心血管疾病风险因素的患病率增加。因此，母亲的心血管风险因素可能通过直接遗传以及干扰子宫胎盘血管适应性，增加后代患成人疾病的风险。后者可能导致胎盘功能不全和胎儿生长受限，而这本身就可能引发成人疾病（如胎儿起源假说所述）。或者，孕周低出生体重与成人疾病之间的关联可能是一种附带现象，在营养充足的人群中，遗传是胎儿起源假说的主要解释。
