Search tips
Search criteria 


Logo of bmjThe BMJ
BMJ. 1995 July 15; 311(6998): 171–174.
PMCID: PMC2550226

Fetal origins of coronary heart disease.


The fetal origins hypothesis states that fetal undernutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease. Animal studies have shown that undernutrition before birth programmes persisting changes in a range of metabolic, physiological, and structural parameters. Studies in humans have shown that men and women whose birth weights were at the lower end of the normal range, who were thin or short at birth, or who were small in relation to placental size have increased rates of coronary heart disease. We are beginning to understand something of the mechanisms underlying these associations. The programming of blood pressure, insulin responses to glucose, cholesterol metabolism, blood coagulation, and hormonal settings are all areas of active research.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (954K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Paneth N, Susser M. Early origin of coronary heart disease (the "Barker hypothesis") BMJ. 1995 Feb 18;310(6977):411–412. [PMC free article] [PubMed]
  • Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition and cardiovascular disease in adult life. Lancet. 1993 Apr 10;341(8850):938–941. [PubMed]
  • Widdowson EM, McCance RA. A review: new thoughts on growth. Pediatr Res. 1975 Mar;9(3):154–156. [PubMed]
  • McCance RA, Widdowson EM. The determinants of growth and form. Proc R Soc Lond B Biol Sci. 1974 Jan 22;185(1078):1–17. [PubMed]
  • Osmond C, Barker DJ, Winter PD, Fall CH, Simmonds SJ. Early growth and death from cardiovascular disease in women. BMJ. 1993 Dec 11;307(6918):1519–1524. [PMC free article] [PubMed]
  • Barker DJ, Osmond C, Simmonds SJ, Wield GA. The relation of small head circumference and thinness at birth to death from cardiovascular disease in adult life. BMJ. 1993 Feb 13;306(6875):422–426. [PMC free article] [PubMed]
  • Hales CN, Barker DJ, Clark PM, Cox LJ, Fall C, Osmond C, Winter PD. Fetal and infant growth and impaired glucose tolerance at age 64. BMJ. 1991 Oct 26;303(6809):1019–1022. [PMC free article] [PubMed]
  • Fall CH, Barker DJ, Osmond C, Winter PD, Clark PM, Hales CN. Relation of infant feeding to adult serum cholesterol concentration and death from ischaemic heart disease. BMJ. 1992 Mar 28;304(6830):801–805. [PMC free article] [PubMed]
  • Yajnik CS, Fall CH, Vaidya U, Pandit AN, Bavdekar A, Bhat DS, Osmond C, Hales CN, Barker DJ. Fetal growth and glucose and insulin metabolism in four-year-old Indian children. Diabet Med. 1995 Apr;12(4):330–336. [PubMed]
  • Law CM, Gordon GS, Shiell AW, Barker DJ, Hales CN. Thinness at birth and glucose tolerance in seven-year-old children. Diabet Med. 1995 Jan;12(1):24–29. [PubMed]
  • Law CM, de Swiet M, Osmond C, Fayers PM, Barker DJ, Cruddas AM, Fall CH. Initiation of hypertension in utero and its amplification throughout life. BMJ. 1993 Jan 2;306(6869):24–27. [PMC free article] [PubMed]
  • McCance DR, Pettitt DJ, Hanson RL, Jacobsson LT, Knowler WC, Bennett PH. Birth weight and non-insulin dependent diabetes: thrifty genotype, thrifty phenotype, or surviving small baby genotype? BMJ. 1994 Apr 9;308(6934):942–945. [PMC free article] [PubMed]
  • Barker DJ, Hales CN, Fall CH, Osmond C, Phipps K, Clark PM. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia. 1993 Jan;36(1):62–67. [PubMed]
  • Phillips DI, Barker DJ, Hales CN, Hirst S, Osmond C. Thinness at birth and insulin resistance in adult life. Diabetologia. 1994 Feb;37(2):150–154. [PubMed]
  • Fowden AL. The role of insulin in prenatal growth. J Dev Physiol. 1989 Oct;12(4):173–182. [PubMed]
  • Barker DJ, Martyn CN, Osmond C, Hales CN, Fall CH. Growth in utero and serum cholesterol concentrations in adult life. BMJ. 1993 Dec 11;307(6918):1524–1527. [PMC free article] [PubMed]
  • Martyn CN, Meade TW, Stirling Y, Barker DJ. Plasma concentrations of fibrinogen and factor VII in adult life and their relation to intra-uterine growth. Br J Haematol. 1995 Jan;89(1):142–146. [PubMed]
  • Edwards CR, Benediktsson R, Lindsay RS, Seckl JR. Dysfunction of placental glucocorticoid barrier: link between fetal environment and adult hypertension? Lancet. 1993 Feb 6;341(8841):355–357. [PubMed]
  • Langley SC, Jackson AA. Increased systolic blood pressure in adult rats induced by fetal exposure to maternal low protein diets. Clin Sci (Lond) 1994 Feb;86(2):217–121. [PubMed]
  • Fall CH, Vijayakumar M, Barker DJ, Osmond C, Duggleby S. Weight in infancy and prevalence of coronary heart disease in adult life. BMJ. 1995 Jan 7;310(6971):17–19. [PMC free article] [PubMed]
  • Barker DJ, Winter PD, Osmond C, Phillips DI, Sultan HY. Weight gain in infancy and cancer of the ovary. Lancet. 1995 Apr 29;345(8957):1087–1088. [PubMed]
  • Barker DJ, Bull AR, Osmond C, Simmonds SJ. Fetal and placental size and risk of hypertension in adult life. BMJ. 1990 Aug 4;301(6746):259–262. [PMC free article] [PubMed]
  • Law CM, Barker DJ, Bull AR, Osmond C. Maternal and fetal influences on blood pressure. Arch Dis Child. 1991 Nov;66(11):1291–1295. [PMC free article] [PubMed]
  • Wheeler T, Sollero C, Alderman S, Landen J, Anthony F, Osmond C. Relation between maternal haemoglobin and placental hormone concentrations in early pregnancy. Lancet. 1994 Feb 26;343(8896):511–513. [PubMed]
  • Vågerö D, Leon D. Ischaemic heart disease and low birth weight: a test of the fetal-origins hypothesis from the Swedish Twin Registry. Lancet. 1994 Jan 29;343(8892):260–263. [PubMed]
  • Leveno KJ, Santos-Ramos R, Duenhoelter JH, Reisch JS, Whalley PJ. Sonar cephalometry in twins: a table of biparietal diameters for normal twin fetuses and a comparison with singletons. Am J Obstet Gynecol. 1979 Nov 15;135(6):727–730. [PubMed]
  • Barker DJ, Martyn CN, Osmond C, Wield GA. Abnormal liver growth in utero and death from coronary heart disease. BMJ. 1995 Mar 18;310(6981):703–704. [PMC free article] [PubMed]
  • Launer LJ, Hofman A, Grobbee DE. Relation between birth weight and blood pressure: longitudinal study of infants and children. BMJ. 1993 Dec 4;307(6917):1451–1454. [PMC free article] [PubMed]

Articles from The BMJ are provided here courtesy of BMJ Publishing Group