Events before birth remain important, but we need to consider later modifiers too

Epidemiological studies have largely contributed to our understanding of the natural history of coronary heart disease. Although clinical manifestations of the disease usually become evident in adult life, early signs are recognisable in childhood. The discovery that individuals who develop coronary heart disease grow differently during early life has led to the recognition of new developmental models for the disease. In 1995 David Barker wrote: “The fetal origins hypothesis states that fetal undernutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease.”1 Now, 10 years later, the importance of events before birth for lifetime health has been confirmed in many populations.2^–4 In humans, birth size serves as a marker of the intrauterine environment. Considering that birth size is just one snapshot of the trajectory of fetal growth it is fascinating that long term …