CARDIOVASCULAR RISK FACTORS VIEWED AS ADAPTATIONS TO PREGNANCY: THE MATERNAL ORIGINS HYPOTHESIS Prof. Nigel Paneth, Michigan, United States of America    - Biography English - 2007-10-07
Speaker Disclosure no conflicts

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I propose that cardiovascular disease (CVD) risk factors are the historical residue of genetic adaptations for maternal/fetal survival of pregnancy. Four CVD risk factors - obesity, fat deposition, hyperlipemia and insulin resistance - are maternal adaptations to the fetal requirement for transfer of energy and nutrients. Three additional CVD risk factors - vasoconstriction, hypertension and hypercoagulability - are maternal adaptations that protect against delivery blood loss, historically the major cause of maternal death. While most human populations have mixtures of genes promoting both maternal and fetal survival, the evidence for the maternal origins of CVD risk factors is found in populations that have evolved to favor one set of genes over the other. Populations especially adapted to maternal transfer of nutrients, perhaps because of intermittent and irregular food supply, have high rates of diabetes and obesity, and large babies with high rates of neonatal survival even under adverse circumstances. This fetally-adapted genome is found in its most extreme form among Pima Indians. Populations especially adapted to maternal survival of delivery are found in malarial zones where maternal anemia makes delivery blood loss especially threatening to maternal survival. Such populations have high rates of pre-eclampsia and hypertension and fetuses with shorter gestations and slower rates of fetal growth, even at the expense of neonatal survival. This maternally-adapted genome is found in its most extreme form among West Africans. Humans in all populations inherit genes for maternal and fetal survival of pregnancy that exert a price in CVD risk later in life.