Coronary heart disease and its biological risk factors hypertension, non-insulin-dependent diabetes mellitus, and abnormalities in lipid metabolism and blood coagulation are associated with low birth weight. 3-7 In studies in which body length at birth was also available the associations with thinness and stunting at birth are stronger than with low birth weight alone. These associations are independent of adult obesity and social class and of lifestyle influences, including smoking and alcohol consumption. The early observations have been replicated in different populations, although there remain some inconsistencies—for example, the absence of an association between birth weight and blood pressure during
adolescence.4 The findings have led to the hypothesis that coronary heart disease is programmed in utero.
The fetal origins hypothesis proposes that adaptations
made by the fetus in response to undernutrition result
in persisting changes in metabolism and organ
structure that lead to disease.3 This hypothesis is
supported by experimental evidence in which offspring
of undernourished pregnant animals show permanent
changes, including raised blood pressure and
abnormal glucose-insulin and lipid metabolism