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References

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Barker DJP (1996): Fetal growth and long-term consequences. In: Boulton J, Laron Z, Rey J (eds). Long-Term Consequences of Early Feeding. Nestle Nutrition Workshop Series vol 36. Nestec Ltd./Lippincott- Raven Publishers: Vevey/Philadelphia.

Barker DJP (1994): Mothers, Babies and Disease in Later Life. British Medical Journal Books: London.

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Discussion


IUGR babies show some catch-up growth later in life, but remain smaller. How much of this is due to their experience in utero, and how much is attributable to the continuity of adverse circumstances after birth? Partial answers to this question come from different types of studies.

Dutch babies, born to mothers whose third trimester of pregnancy coincided with the famine during WW2, were born with a subnormal weight, but showed no height deficit at conscription. This study is unique in the sense that IUGR can be attributed mainly to undernutrition and other factors that are frequently associated with IUGR were not present in a disproportionate number.

Animal experiments, e.g. the crossing of Shire horses and Shetland ponies suggest that maternal constraints can have lasting effects. Children of smokers remain smaller, at least up to 5 or 7 years of age. The babies of black mothers in the US are, on average, about 200 g lighter at birth than the babies of white mothers. In mixed couples' the baby tends to be born with the weight predicted by the mother's race.

Twins are often born with considerable differences in birthweight and height; these differences tend to become smaller with age. Twins with an initial weight difference of 200 g tend to have similar weights and heights as adults. If the initial differences are greater, they can persist, even in monozygotic twins. Paternal influences tend to be small initially, but by the time the offspring reaches adulthood, maternal and paternal height seem to account for about the same degree of variance in the height of the offspring.

IUGR babies in developed countries show some catch-up growth in height, especially during the first two years of life, insofar as their average height tends to move closer to the mean with age, but this is not enough to fully compensate for prenatal growth retardation, and they remain about 5 cm shorter and 5 kg lighter as adults.

Adoption studies show that the age at adoption is important. Small, malnourished children adopted by middle-class families in affluent countries show remarkable catch-up growth if they are adopted before three years of age; if they are adopted at a later age, catch-up growth is far less impressive.

IUGR babies have lower work capacity as adults; this is mostly attributable to their lower fat-free mass. The degree to which work capacity in absolute terms, assessed by maximum oxygen consumption, is a determinant of actual work performance, depends on the nature of the work to be done. In laborers paid by work output, wages could be used as an indicator of actual work performance.


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