Skip to main content
Log in

Fetale Wachstumsrestriktion und Herz-Kreislauf-Erkrankungen im Erwachsenenalter

Fetal growth restriction and adult cardiovascular diseases

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Epidemiologische Untersuchungen weisen auf einen Zusammenhang von intrauteriner Wachstumsrestriktion und arterieller Hypertonie beim Menschen hin. Tierversuche bestätigen, dass eine von der genetischen Grundausstattung unabhängige inverse Relation zwischen Geburtsgewicht und arteriellem Blutdruck besteht. Der Fet adaptiert sich an ein gestörtes intrauterines Milieu mit metabolischen, endokrinen und hämodynamischen Veränderungen, die in ihrer Gesamtheit zu einer Blutdruckerhöhung führen und über die Neugeborenenzeit bis in die Erwachsenenzeit persistieren könnten. Falls die intrauterine Wachstumsrestriktion als unabhängiger Risikofaktor für Herz-Kreislauf-Erkrankungen bestätigt wird, könnten sich in der Zukunft mannigfaltige Ansätze zur primären und früh einsetzenden Prophylaxe dieser Erkrankungen bei entsprechend exponierten Neugeborenen ergeben.

Abstract

Epidemiological studies in different populations have revealed an association between low birth weight and cardiovascular disease later in life. Animal studies confirm that placental insufficiency results in low birth weight offspring destined to develop hypertension, the main risk factor for atherosclerosis and cardiovascular disease in later life. The fetus adapts towards an adverse intrauterine environment with metabolic, endocrine and hemodynamic changes. It is hypothesized that these changes persist after delivery and predispose the individual to hypertension and atherosclerosis. Cardiovascular disease is by far the most relevant factor in overall mortality in Germany. If intrauterine growth restriction is confirmed to be an independent risk factor for cardiovascular disease, this knowledge will have a great impact on health care systems and on the primary prophylaxis of cardiovascular diseases in persons born with intrauterine growth restriction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1

Literatur

  1. Alexander BT (2003) Placental insufficiency leads to development of hypertension in growth-restricted offspring. Hypertension 41: 457–462

    Article  PubMed  Google Scholar 

  2. Alexander BT (2006) Fetal programming of hypertension. Am J Physiol Regul Integr Comp Physiol 290: R1–R10

    PubMed  Google Scholar 

  3. Baird J, Osmond C, MacGregor A et al. (2001) Testing the fetal origins hypothesis in twins: the Birmingham twin study. Diabetologia 44: 33–39

    Article  PubMed  Google Scholar 

  4. Barker DJ, Osmond C, Simmonds SJ, Wield G (1993) The relation of small head circumference and thinness at birth to death from cardiovascular disease in adult life. Br Med J 306: 422–426

    Google Scholar 

  5. Benediktsson R, Lindsay RS, Noble J et al. (1993) Glucocorticoid exposure in utero: a new model for adult hypertension. Lancet 341: 339–341

    Article  PubMed  Google Scholar 

  6. Christensen K, Stovring H, McGue M (2001) Do genetic factors contribute to the association between birth weight and blood pressure? J Epidemiol Community Health 55: 583–587

    Article  PubMed  Google Scholar 

  7. Curhan GC, Willett WC, Rimm EB et al. (1996) Birth weight and adult hypertension, diabetes mellitus, and obesity in US men. Circulation 94: 3246–3250

    PubMed  Google Scholar 

  8. Economides DL, Nicolaides KH, Linton EA et al. (1988) Plasma cortisol and adrenocorticotropin in appropriate and small for gestational age fetuses. Fetal Therapy 3: 158–164

    PubMed  Google Scholar 

  9. Forsén T, Eriksson JG,Tuomilehto J et al. (1997) Mother’s weight in pregnancy and coronary heart disease in a cohort of finnish men: follow up study. BMJ 315: 837–840

    PubMed  Google Scholar 

  10. Hübinette A, Cnattingius S, Ekbom A et al. (2001) Birthweight, early environment, and genetics: a study of twins discordant for acute myocardial infarction. Lancet 357: 1997–2001

    Article  PubMed  Google Scholar 

  11. Hughson M, Farris AB, Douglas-Denton R et al. (2003) Glomerula number and size in autopsy kidneys: the relationship to birth weight. Kidney Int 63: 2113–2122

    Article  PubMed  Google Scholar 

  12. Huxley RR, Shiell AW, Law CM (2000) The role of size at birth and postnatal catch-up growth in determining systolic blood pressure: a systematic review of the literature. J Hypertens 18: 815–831

    Article  PubMed  Google Scholar 

  13. Huxley R, Neil A, Collins R (2002) Unravelling the fetal origins hypothesis: is there really an inverse association between birthweight and subsequent blood pressure. Lancet 360: 659–656

    Article  PubMed  Google Scholar 

  14. Jarvisalo M, Jartti L, Nanto-Salonen K et al. (2001) Increased aortic intima-media thickness: a marker of preclinical atherosclerosis in high-risk children. Circulation 104: 2943–2947

    PubMed  Google Scholar 

  15. Kingdom JC, McQueen J, Connell JMC et al. (1993) Fetal angiotensin II levels and vascular (type I) angiotensin receptors in pregnancies complicated by intrauterine growth retardation. Br J Obstet Gynaecol 100: 476–482

    PubMed  Google Scholar 

  16. Law CM, Shiell AW (1996) Is blood pressure inversely related to birth weight? The strength of evidence from a systematic review of the literature. J Hypertens 14: 935–941

    Article  PubMed  Google Scholar 

  17. Leeson C, Kattenhorn M, Morley R et al. (2001) Impact of low birth weight and cardiovascular risk factors on endothelial function in early adult life. Circulation 103: 1264–1268

    PubMed  Google Scholar 

  18. Lohmeier TE (2001) The sympathetic nervous system and long-term blood pressure regulation. Am J Hypertens 14: 14–54

    Article  PubMed  Google Scholar 

  19. McTernan CL, Draper N, Nicholson H et al. (2001) Reduced placental 11β-hydroxysteroid dehydrogenase Type 2 mRNA levels in human pregnancies complicated by intrauterine growth restriction; an analysis of possible mechanisms. J Clin Endocrinol Metabol 86: 4979–4983

    Article  Google Scholar 

  20. Osmond C, Barker DJ, Winter PD (1993) Early growth and death from cardiovascular disease in women. Br Med J 307: 1519–1524

    Google Scholar 

  21. Phillips DI, Walker BR, Reynolds RM et al. (2000) Low birth weight predicts elevated plasma cortisol concentrations in adults from three populations. Hypertension 35: 1301–1306

    PubMed  Google Scholar 

  22. Prospective studies collaboration (1995) cholesterol, diastolic blood pressure, and stroke: 13.000 strokes in 450.000 people in 45 prospective cohorts. Lancet 346: 1647–1653

    Article  PubMed  Google Scholar 

  23. Qureshi AL, Suri MF, Mohammad Y et al. (2002) Isolated and borderline isolated systolic hypertension relative to long-term risk and type of stroke: a 20 year follow-up of the national health and nutrition survey. Stroke 33: 2781–2788

    Article  PubMed  Google Scholar 

  24. Ringelstein EB, Knecht S (2006) Bluthochdruck und isolierter systolischer Hypertonus – wichtigste Risikofaktoren des Schlaganfalls. Deutsch Arztebl 103: 1906–1911

    Google Scholar 

  25. Rose G (1985) Sick individuals and sick populations. Int J Epidemiol 14: 32–38

    PubMed  Google Scholar 

  26. Roseboom TJ, Meulen JH van der, Osmond C et al. (2000) Coronary heart disease after prenatal exposure to the Dutch famine, 1944–1945. Heart 84: 595–598

    Article  PubMed  Google Scholar 

  27. Skilton MR, Evans N, Griffiths KA et al. (2005) Aortic wall thickness in newborns with intrauterine growth restriction. Lancet 365: 1484–1486

    Article  PubMed  Google Scholar 

  28. Stanner SA, Bulmer K, Andres C et al. (1997) Does malnutrition in utero determine diabetes and coronary heart disease in adulthood? Results from the Leningrad siege study, a cross sectional study. BMJ 315: 1342–1348

    PubMed  Google Scholar 

  29. Wirth A, (2004) Lebensstiländerung zur Prävention und Therapie von arteriosklerotischen Krankheiten. Deutsch Arztebl 101: 1398–1305

    Google Scholar 

  30. Wolf-Maier K, Cooper RS, Banegas JR et al. (2003) Hypertension prevalence and blood pressure levels in 6 European countries, Canada and the Unites States. JAMA 289: 2363–2369

    Article  PubMed  Google Scholar 

  31. Young BJ (2002) Programming of sympathoadrenal function. Trends in Endocrinol Metabol 2002;13: 381–385

    Google Scholar 

  32. Matthews SG (2006) Early programming of the hypothalamic-pituitary-adrenal axis. Trends Endocrinol Metab 13: 363

    Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to E. Beinder.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beinder, E. Fetale Wachstumsrestriktion und Herz-Kreislauf-Erkrankungen im Erwachsenenalter. Gynäkologe 40, 241–247 (2007). https://doi.org/10.1007/s00129-007-1962-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00129-007-1962-2

Schlüsselwörter

Keywords

Navigation