Risk of hypertension following perinatal adversity: IUGR and prematurity

Abstract

Consistent with the paradigm shifting observations of David Bar ker and colleagues that revealed a powerful relationship between decreased weight throu gh 2 years of age and adult disease, intrauterine growth restriction (IUGR) and prete rm birth are independent risk factors for the development of subsequent hypertension. An imal models have been indispensable in defining the mechanisms responsible for th ese associations and the potential targets for therapeutic intervention. Among the m odifiable risk factors, micronutrient deficiency, physical immobility, exaggerated stress hormone exposure and deficient trophic hormone production are leading candidates for targeted therapies. With the strong inverse relationship seen between gestational age at delivery and the risk of hypertension in adulthood trumping all other major card iovascular risk factors, improvements in neonatal care are required. Unfortunately, ther apeutic breakthroughs have not kept pace with rapidly improving perinatal survival, a nd groundbreaking bench-to-bedside studies are urgently needed to mitigate and ultimate ly prevent the tsunami of prematurity-related adult cardiovascular disease that may be on the horizon. This review highlights our current understanding of the developmental origi ns of hypertension and draws attention to the importance of increasing the availabilit y of lactation consultants, nutritionists, pharmacists and physical therapists as critical allies in the battle that IUGR or premature infants are waging not just for survival but also for their future cardiometabolic health.