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Perinatal Programming of Arterial Pressure

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Pediatric Hypertension

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Abstract

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.

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Authors and Affiliations

  1. Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Melbourne, Victoria, Australia

    Reetu R. Singh, Kate M. Denton & John F. Bertram

  2. Department of Physiology, Monash University, Melbourne, Victoria, Australia

    Reetu R. Singh & Kate M. Denton

  3. Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Monash University, Melbourne, Victoria, Australia

    John F. Bertram

Authors
  1. Reetu R. Singh
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  2. Kate M. Denton
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  3. John F. Bertram
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Correspondence to John F. Bertram .

Editor information

Editors and Affiliations

  1. University of Washington School of Medicine, Department of Pediatrics and Seattle Children’s Hospital Division of Nephrology, Seattle, WA, USA

    Joseph T. Flynn

  2. Division of Nephrology MassGeneral for Children at Massachusetts General Hospital, Harvard Medical School Department of Pediatrics, Boston, MA, USA

    Julie R. Ingelfinger

  3. St. Luke’s Health System, Children’s Nephrology and Hypertension, Boise, ID, USA

    Karen M. Redwine

Section Editor information

  1. Pediatric Nephrology Unit, MassGeneral Hospital for Children at MGH, Harvard Medical School, Fruit St. 55, 02114, Boston, MA, USA

    Julie R. Ingelfinger M.D.

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Singh, R.R., Denton, K.M., Bertram, J.F. (2018). Perinatal Programming of Arterial Pressure. In: Flynn, J., Ingelfinger, J., Redwine, K. (eds) Pediatric Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-31107-4_40

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