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The relatively new research field of the fetal origins of adult disease has matured greatly in the past decade. Recent systematic overviews provide strong evidence that robust inverse epidemiological associations exist between birthweight and later blood pressure/hypertension 1 and glucose intolerance/type 2 diabetes. 2 Consistent associations are also evident for the inverse associations of birthweight with coronary heart disease incidence and mortality. 3,4 Studies with high follow-up rates and adjustment for social and economic variables have to a large extent mitigated earlier criticisms that observed associations were highly subject to confounding and selection bias. 5 Many questions remain, however, about the contributing roles of postnatal growth and development, underlying biological mechanisms, and the importance of the epidemiological findings to public health. This review outlines current challenges—stated in the form of propositions—that epidemiologists in this field currently face.

Epidemiological challenges in studying the fetal origins of adult chronic disease