Lapillonne Alexandre
Université Paris Descartes, APHP-Hôpital Necker-Enfants Malades 149 rue de Sèvres, 75015 Paris.
Bull Acad Natl Med. 2011 Mar;195(3):477-84; discussion 484-5.
The epidemiologist David Barker was among the first to develop the concept that some adult diseases might have their origins during fetal life, based notably on a strong association between low birth weight and the risk of chronic diseases in adulthood (coronary artery disease, hypertension and stroke, type 2 diabetes, and osteoporosis). Several other groups replicated these results in other populations, thus confirming that birth weight is a determining factor of adult health. Intra-uterine growth retardation (IUGR) has been widely used as a marker of poor fetal nutrition and health, but some antenatal nutritional disturbances can increase the risk of diseases later in life without affecting fetal growth. The risk of diseases in adulthood appears to be further increased when IUGR is associated with rapid postnatal catch-up growth. This suggests that fetal malnutrition induces adaptations necessary for fetal survival and health, but that it also undermines future health if the postnatal environment is unfavorable. The fetal origins of adult diseases has major public health implications and calls for reinforced pre- and post-natal prevention strategies.
流行病学家大卫·巴克是最早提出某些成人疾病可能起源于胎儿期这一概念的人之一，这一观点主要基于低出生体重与成年期慢性病（冠状动脉疾病、高血压和中风、2型糖尿病以及骨质疏松症）风险之间的紧密关联。其他几个研究团队在其他人群中重复了这些结果，从而证实出生体重是成人健康的一个决定性因素。宫内生长迟缓（IUGR）已被广泛用作胎儿营养和健康状况不佳的一个标志，但一些产前营养紊乱会增加日后患疾病的风险，而不影响胎儿生长。当宫内生长迟缓与出生后快速追赶生长相关联时，成年期疾病的风险似乎会进一步增加。这表明胎儿营养不良会引发胎儿生存和健康所需的适应性变化，但如果产后环境不利，也会损害未来的健康。成人疾病的胎儿起源具有重大的公共卫生意义，需要加强产前和产后预防策略。
