The developmental origins of health and disease(DOHaD) – why it is so important to those who work in fetal medicine J.P. Newnham Ultrasound Obstet Gynecol 2007;29:121-3 Editional

A paradigm shift for healthcare The early origins of many of chronic diseases of adult life The early origins of many of chronic diseases of adult life Intrauterine development occupy center- stage at an exciting and very important time for healthcare Intrauterine development occupy center- stage at an exciting and very important time for healthcare Fetal medicine should be perceived no longer only to produce a liveborn and health infant with normal Apgar scores, but expand to consider the life-long implication of their measurements and therapies Fetal medicine should be perceived no longer only to produce a liveborn and health infant with normal Apgar scores, but expand to consider the life-long implication of their measurements and therapies

Mothers, Babies, and Disease in Later Life (BMJ;1994) Low birth weight is associated with increased rates of type II diabetes, heart disease and many other components of metabolic syndrome in adult life Low birth weight is associated with increased rates of type II diabetes, heart disease and many other components of metabolic syndrome in adult life ‘Fetal origins of adult disease’ ‘Fetal origins of adult disease’ The Developmental origins of Health and Disease(DOHaD) ( Gluckman PD, Hanson MA Science 2004;305: ) The Developmental origins of Health and Disease(DOHaD) ( Gluckman PD, Hanson MA Science 2004;305: )

‘Thrifty phenotype hypothesis’ & ‘Fetal programming’ Pregnant women by high exercise, low nutrition, programs her child for similar life. This programming sequence appears to involve insulin and leptin resistance, optimizing the individual’s chance in a harsh environment. Pregnant women by high exercise, low nutrition, programs her child for similar life. This programming sequence appears to involve insulin and leptin resistance, optimizing the individual’s chance in a harsh environment. If, however, the offspring lives a life of plenty, characterized by low exercise, high caloric intake, the adaptations in metabolism resulting in obesity, diabetes and host of related conditions If, however, the offspring lives a life of plenty, characterized by low exercise, high caloric intake, the adaptations in metabolism resulting in obesity, diabetes and host of related conditions The millions of people currently make rapid transitions from thrifty to plenty, and explain the early development of these disease The millions of people currently make rapid transitions from thrifty to plenty, and explain the early development of these disease The concept of fetal programming explain why low birth weight may be followed by diabetes and obesity in adult life The concept of fetal programming explain why low birth weight may be followed by diabetes and obesity in adult life

What shall we do in the important field of fetal development ? To view fetal development and pathology with a border outlook rather than just focusing on the perinatal period To view fetal development and pathology with a border outlook rather than just focusing on the perinatal period 1. Clinical perspective, the design of our research studies and our interaction with our patients 2. Such experimental information sufficient to counsel pregnant women as to the optimal lifelong care of a child whose prenatal growth has been compromised.

To embrace the exciting opportunities that DOHaD brings to our daily work To embrace the exciting opportunities that DOHaD brings to our daily work 1. To join a common goal of preventing illness at their origin of child health, mental health, diabetes and cardiac disease. 2. The spectrum from genes to society, from conception to adulthood, and from behavior to physical disease 3. Many of the measurements such as detailed fetal biometry, estimation of blood flow patterns have the potential to amplify the value of research (twin- twin transfusion syndrome)

To incorporate into fetal medicine the knowledge gained by many colleagues from different directions To incorporate into fetal medicine the knowledge gained by many colleagues from different directions 1. Prospective long-term study 2. Fetal biometry from 18 weeks’ gestation from 1989, now up to years, the U- shape relationship between birth weight and features of metabolic syndrome in childhood 3. Long-term studies of outcome of twin-twin transfusion syndrome

5th International Congress on Developmental Origins of Health & Disease 6 – 10 November 2007 Perth Convention Exhibition Centre Perth, Western Australia Invitation