Perinatal Heart Programming: Long-term Consequences

Objective: evaluate the relationship between impaired growth during intrauterine life and adult risk of cardiovascular disease and death. Materials: review of the most important contributions to the relationship between intrauterine fetal life and heart disease insurgence in childhood and adulthood, starting with a schematic representation of the principal steps in human heart development, discussion of the new theory on the relevance of the number of cardiomyocytes that every heart shows at birth. Results: intrauterine environment defines the epigenetic profile of newborns, with implications for the risk of developing diseases later in adult life. This means that the programming of cardiovascular risk and other pathologies, such as obesity, in adulthood takes place starting from intrauterine life. Conclusions: it can be hypothesized that by preventing and eventually treating cardiovascular diseases in the pediatric age, if these are already present in their early and/or in light forms, the long-term management of complications could be approached differently and more effectively than by postponing the treatment to adulthood. The future challenge in this fascinating field of clinical research is the discovery of the molecular mechanisms underlying the association between intrauterine growth restriction and fetal onset of adult cardiac disease, so as to make a dream come true by applying primary prevention of adult heart disease in the womb.