Perinatal programming of arterial pressure

A suboptimal perinatal environment can adversely influence gamete, embryonic, fetal, and infant development, setting in motion a train of events that increases the risk of hypertension and cardiovascular disease throughout life. This chapter summarizes the evidence linking an adverse maternal environment to developmental plasticity, in which the fetus adapts to the prevailing environmental conditions, subsequently altering the adult phenotype. Early studies linked low birth weight to the programming of high blood pressure. However, it is now evident that altered fetal development can also occur independently of low birth weight. Thus, the health implications of the maternal environment are much greater than predicted by the proportion of babies suffering growth restriction.We discuss both the stimuli and mechanisms that drive the perinatal programming of arterial pressure. We will consider kidney structure and function as a primary determinant of arterial pressure, as well as vascular, cardiac, and neural adaptations. Finally, therapeutic options to prevent, limit, or reverse these adverse consequences of a challenging start to life are explored.