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The "fetal" or "early" origins of adult disease hypothesis was originally put forward by David Barker and colleagues and stated that environmental factors, particularly nutrition, act in early life to program the risks for adverse health outcomes in adult life. This hypothesis has been supported by a worldwide series of epidemiological studies that have provided evidence for the association between the perturbation of the early nutritional environment and the major risk factors (hypertension, insulin resistance, and obesity) for cardiovascular disease, diabetes, and the metabolic syndrome in adult life. It is also clear from experimental studies that a range of molecular, cellular, metabolic, neuroendocrine, and physiological adaptations to changes in the early nutritional environment result in a permanent alteration of the developmental pattern of cellular proliferation and differentiation in key tissue and organ systems that result in pathological consequences in adult life. This review focuses on those experimental studies that have investigated the critical windows during which perturbations of the intrauterine environment have major effects, the nature of the epigenetic, structural, and functional adaptive responses which result in a permanent programming of cardiovascular and metabolic function, and the role of the interaction between the pre- and postnatal environment in determining final health outcomes.

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Objective To determine the effect of antenatal dietary and lifestyle interventions on health outcomes in overweight and obese pregnant women.Design Multicentre randomised trial. We utilised a central telephone randomisation server, with computer generated schedule, balanced variable blocks, and stratification for parity, body mass index (BMI) category, and hospital.Setting Three public maternity hospitals across South Australia.Participants 2212 women with a singleton pregnancy, between 10+0 and 20+0 weeks' gestation, and BMI ≥25.Interventions 1108 women were randomised to a comprehensive dietary and lifestyle intervention delivered by research staff; 1104 were randomised to standard care and received pregnancy care according to local guidelines, which did not include such information.

The perinatal prognosis in cases of eclampsia could be improved if it were possible to predict its onset so that appropriate treatment could be given as early as possible. The investigators performed cerebral magnetic resonance imaging (MRI) in 41 women with severe preeclampsia in an attempt to identify ways in which this imaging procedure can be most effective. Six patients had systemic seizures and 14 had visual symptoms apart from retinal detachment. Urinary protein exceeding 2.5 g daily was noted in 12 cases. All patients received magnesium sulfate prophylactically, and some also received alpha methyldopa, labetalol hydrochloride, or calcium channel blockers such as nicardipine. All participants had MRI studies regardless of whether headaches or visual symptoms were part of the picture.Abnormal MR images were obtained in 11 patients, 9 with vasogenic edema and 3 with minor cerebral embolism. Vasoconstriction was observed in 4 cases. Six of the 11 patients with abnormal MRI findings had seizures. Abnormal cerebral MRI findings had a predictive accuracy of 85%. Only 14% of patients had been diagnosed by radiologic imaging. Diastolic blood pressure and elevated serum levels of liver enzymes predicted abnormal MRI findings with 83% accuracy. Thirty-three women underwent emergency cesarean section. Labor was induced in 5 cases, leading to vaginal delivery. Three women delivered spontaneously. The neonatal prognosis was consistently good, and all women recovered without sequelae.Although MRI may not be clinically cost-effective when done routinely in women with preeclampsia, it is recommended when delivery is delayed in those with severe preeclampsia. This is especially the case when diastolic blood pressure and liver enzymes are elevated. In women with eclampsia, MRI should be repeated until cerebral edema no longer is present. ABSTRACTPreterm birth (PTB) remains the leading cause of perinatal morbidity and mortality and also is associated with cerebral palsy and suboptimal performance at school. Adverse outcomes are especially likely if there is intrauterine infection and inflammation. Because of its subclinical nature, however, the diagnosis depends on examining amniotic fluid, a relatively invasive procedure. In this study, amniotic fluid and cervical fluid were evaluated, and the presence in the latter of interleukin (IL)-6 and IL-8 was related to microbial invasion of amniotic fluid, intraamniotic inflammation, and PTB in women with singleton pregnancies who were in preterm labor before 34 weeks gestation and whose membranes were intact. Cervical fluid was sampled from the external cervical os within 12 hours of admission in 91 women and amniotic fluid in 56. The polymerase chain reaction technique was used to detect Ureaplasma urealyticum and Mycoplasma hominis. Interleukins 6 and 8 were estimated by enzyme-linked immunosorbent assay.Women had a median gestational age of 30 weeks at the time of the study; 38% delivered before 34 weeks gestation. No woman had clinical chorioamnionitis. Although the presence o...