The early origins of chronic heart failure: impaired placental growth and initiation of insulin resistance in childhood.
OBJECTIVE
Low birth weight and low placental weight predict later coronary heart disease and hypertension. This has led to the hypothesis that these diseases are initiated by foetal programming, the process by which foetal malnutrition leads to permanent changes in the body in ways that lead to chronic disease in later life. Here we examine the association between body and placental size at birth and later chronic heart failure.


RESULTS
We identified 187 patients taking medications for chronic heart failure in a birth cohort of 13,345 people born in Helsinki, Finland during 1934-44. Chronic heart failure was associated with a small placental surface area. In people born with a placental area less than 225 cm(2), the odds ratio for chronic heart failure was 1.7 (1.1-2.5), compared with people born with a placental area greater than 295 cm(2). The risk of heart failure was further increased by rapid gain in body mass index after the age of 2 years, a path of growth known to be linked to insulin resistance in later life. In a simultaneous regression, low body mass index at 2 years and high body mass index at 11 years were each associated with chronic heart failure (P = 0.008 and 0.001, respectively).


CONCLUSIONS
Chronic heart failure in adult life may be initiated by impaired placental growth which adversely affects cardiac development. People born with a vulnerable heart are more likely to develop chronic heart failure if they become insulin resistant.
Barker
David J P
DJ
Heart Research Center, Oregon Health and Science University, Portland, OR 97201-3098, USA. djpbarker@gmail.com
Gelow
Jill
J
Thornburg
Kent
K
Osmond
Clive
C
Kajantie
Eero
E
Eriksson
Johan G
JG
D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2; D018450:Disease Progression; D004651:Employment; D005260:Female; D048070:Fetal Nutrition Disorders; D005387:Finland / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007333:Insulin Resistance; D008297:Male; D009026:Mortality / Q000639:trends; D016017:Odds Ratio; D010929:Placentation; D011247:Pregnancy; D012307:Risk Factors; D012923:Social Class; D013997:Time Factors