Prenatal Exposures and Long Term Health Effects

Most countries use a large fraction of their financial commitment to disease prevention on activities related to the reproductive period. Much less is spent on the research needed to make this prevention evidencebased. Most of the research on reproductive health in the past has focused on cause-effect relationships which span from conception to the first months of life—primarily determinants of fetal growth, reduced pregnancy duration, spontaneous abortion, and congenital malformations. Recently, research activities have also focused on proximal determinants of the biologic ability to reproduce and on long term consequences of the intrauterine hormonal environment or intrauterine growth retardation. In order to address many of these research problems, we need studies with long term follow-up, starting as close to conception as possible. There are now good reasons to believe that the etiologic factors for many chronic diseases accumulate over a person's entire lifetime, and that factors related to embryonal and fetal life are important, perhaps even of crucial importance (1). For most chronic diseases, we are only able to account for a small fraction of incidence and prevalence using the knowledge we have on established risk factors, perhaps because we have not taken the fetal period of life into consideration.