Fetal programming of the neuroendocrine response to stress: Links between low birth weight and the metabolic syndrome

There is now substantial agreement that small size at birth is associated with increased rates of the metabolic syndrome (glucose intolerance, high blood pressure, and dyslipidaemia) and related pathologies including cardiovascular disease in adult life. Evidence is also emerging that suggests programming of hormonal systems in response to an adverse fetal environment may be one of the mechanisms underlying these long-term consequences of early life events. In particular, alterations in the neuroendocrine response to stress may play an important part. Recent research suggests that increased adrenocortical and sympathoadrenal responses are associated with small size at birth. Evidence from epidemiological studies shows that subtle alterations in these neuroendocrine systems appear to exert a powerful influence on the levels of cardiovascular risk factors including plasma glucose and lipid concentrations and blood pressure.