The early origins of chronic heart failure: Impaired placental growth and initiation of insulin resistance in childhood

David J.P. Barker, Jill Gelow, Kent Thornburg, Clive Osmond, Eero Kajantie, Johan G. Eriksson

Research output: Contribution to journalArticlepeer-review

131 Scopus citations


Aims Low birth weight and low placental weight predict later coronary heart disease and hypertension. This has led to the hypothesis that these diseases are initiated by foetal programming, the process by which foetal malnutrition leads to permanent changes in the body in ways that lead to chronic disease in later life. Here we examine the association between body and placental size at birth and later chronic heart failure.Methods and resultsWe identified 187 patients taking medications for chronic heart failure in a birth cohort of 13 345 people born in Helsinki, Finland during 1934-44. Chronic heart failure was associated with a small placental surface area. In people born with a placental area less than 225 cm 2, the odds ratio for chronic heart failure was 1.7 (1.1-2.5), compared with people born with a placental area greater than 295 cm 2. The risk of heart failure was further increased by rapid gain in body mass index after the age of 2 years, a path of growth known to be linked to insulin resistance in later life. In a simultaneous regression, low body mass index at 2 years and high body mass index at 11 years were each associated with chronic heart failure (P = 0.008 and 0.001, respectively).ConclusionChronic heart failure in adult life may be initiated by impaired placental growth which adversely affects cardiac development. People born with a vulnerable heart are more likely to develop chronic heart failure if they become insulin resistant.

Original languageEnglish (US)
Pages (from-to)819-825
Number of pages7
JournalEuropean Journal of Heart Failure
Issue number8
StatePublished - Aug 2010
Externally publishedYes


  • Childhood growth
  • Heart failure
  • Maternal stature
  • Placenta
  • Type 2 diabetes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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