As for prenatal exposure, the possibility that
intrauterine growth of the fetus might be
related to health in childhood and adult life has
attracted considerable attention. Most
studies concern ischaemic heart disease but a
link between prenatal exposure and respiratory
disease has also been suggested.33 36 37 Low
birth weight has been associated with reduced
lung function, respiratory infections, and
asthma in children and adults regardless of
length of gestation41 and whether the child had
respiratory complications at birth.42 43 This gap
may continue to widen into adult life as
suggested by Barker and co-workers34 who
reported that, among men born 60–70 years
ago in Hertfordshire, UK, those who had a
lower birth weight had a lower FEV1 adjusted
for age and height. The standardised mortality
rate for COPD was also associated with birth
weight in these men. This was corroborated by
a study on Indian men and women in which mean FEV1 fell by 0.09 litres with each pound
decrease in birth weight in men and by 0.06
litres in women, independent of smoking.28
These results are supported by animal experiments
which show that lung structure may be
permanently altered by calorie or protein deprivation
in utero. Changes include reduction
of elastin or collagen in the lung, enlargement
of air spaces, and a reduction in elastic
recoil compared with that seen in human
emphysema