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Study: Changes in Womb Influence Later Health Risks

By Emma Ross
Associated Press.

LONDON - New research adds to a growing body of evidence that adult health is set to a significant degree by conditions in the womb and suggests the programming may start earlier in pregnancy than previously believed.

A study published this week n the Journal of Epidemiology and Community Health found that fetuses with shorter thighbones at 24 weeks had higher blood pressure at the age of 6 than those with longer, thighbones.

Understanding how life in the womb influences later health has become a hot area of medical research.

It has focused mostly on the effect of birth weight on health and the subsequent development of illnesses such as heart disease, high blood pressure, diabetes and osteoporosis. But the latest study is among the first to find evidence earlier in human life.

Scientists believe that when a, fetus is undernourished, it diverts resources to areas it really needs at the time, such as the brain, at the expense of organs it will need, later in life.

That may permanently change the baby's structure, functioning and metabolism, experts believe.

"There's a lot of work about the size at birth," said Dr David Barker, an epidemiologist who pioneered fetal programming research but was not involved in the latest study.
"Birth weight is a crude measurement. It tells you very little because babies can reach the same birth weight by many different paths of growth.

"Now, because of technology advances, people are able to study children who have had serial measurements of size in (the uterus) that follow their growth, and these observations take us back into early pregnancy" said Barker, director of the epidemiology unit at the University of Southampton in England.

"It looks as though blood pressure may be set fairly early."

The study, led by Dr. Kevin Blake at the University of Western Australia, involved ultrasounds done at 18, 24, 28, 34 and 38 weeks of pregnancy on 707 women with normal pregnancies.

During each scan, doctors measured the circumference of the head and abdomen and the length of the babies' thighbones.

Blood pressure was measured in about 300 of, the resulting children at age 6.

The researchers found that for every one-tenth of an inch deviation from the typical thighbone length at key stages in the womb, systolic blood pressure – the higher of the two numbers was changed by about 2 points. Shorter thighs meant higher blood pressure.

That effect was first seen at 24 weeks of pregnancy.

Neither head nor abdomen circumference was linked to later blood pressure.

"We don't know whether a very small change in blood pressure, at age 6 has any value in predictability of disease, but it's still a move forward in understanding what kind of factors we can Ioo4 at before birth and use as predictors for potential signs of disease," said Kent Thornburg, a fetal physiologist and director of the Heart Research Center at Oregon Health Sciences University who was unconnected with the research.

The thighbone is easy to measure and skeletal growth is a good measure of the rate a fetus is growing, said Mark Hanson, director of the Center for the Fetal Origins of Adult Disease at England's University of Southampton.

"Skeletal growth is not just determined by how tall the parents are. There's a complex interaction between the fetal, genetic drive to grow - inherited from the parents - and the environment in the womb, in early gestation," said Hanson, a fetal physiologist who was not involved in the study.”

"This study is focusing our attention on early gestation. It's making it clear that it really is fetal growth we're talking about here, not just some funny thing linked to birth weight itself. And it's pointing a finger very clearly that in the fetal growth process, there’s an interaction between the (genes) and the environment, he said.

Rat studies have previously indicated the womb environment, influenced by the mother's nutrition, is important for later disease.

One study showed that pregnant rats given a low-protein diet for the first four days of pregnancy-before the embryo even implants in the womb and before the placenta is formed - produced offspring with high blood pressure.

"There are extensive, experiments in animals which show that fetal programming is a universal biological phenomenon," Hanson said.

The risk of disease in adulthood builds up over a lifetime and experts don't know to what degree fetal programming influ ences the eventual likelihood of disease, but they believe it is considerable.

"The sort of calculations that have been done would suggest that it's certainly a bigger effect than smoking. It's certainly an effect at least of the magnitude of obesity and lack of exercise," Hanson said.