ReviewFrom the α to the ω-3: Breaking the link between impaired fetal growth and adult cardiovascular disease

- Impaired fetal growth is associated with cardiovascular diseases and other chronic diseases in adulthood.
- There is currently no clinically proven targeted strategy to prevent cardiovascular events resulting from impaired fetal growth.
- Noninvasive assessment of cardiovascular risk markers provides a means by which to assess the likely benefit of putative prevention strategies; particularly relevant in this instance given the decades-long time difference between fetal exposure and adult clinical outcomes.
- Recent evidence suggests that ω-3 polyunsaturated fatty acids, including α-linolenic acid, eicosapentaenoic acid, and docosahexaenoic acid, may improve vascular health and lower blood pressure in children and adults who were born with impaired fetal growth.

Atherosclerotic vascular disease is an important cause of premature morbidity and mortality. An extensive body of epidemiologic data links impaired fetal growth, evidenced by reductions in birth weight, with a higher risk for cardiovascular disease in adulthood. This association appears to be at least partially independent of established cardiovascular risk factors, such as hypertension and type 2 diabetes. There is currently no clinically established strategy to prevent cardiovascular events secondary to being born with poor fetal growth. This review summarizes recent evidence that suggests that ω-3 polyunsaturated fatty acids may be beneficial for this indication; in particular being associated with more marked reductions in blood pressure and subclinical atherosclerosis in people who were born with poor fetal growth, than in those with healthy birth weight. Possible mechanisms, and the evidence base required to support the implementation of dietary guidelines specific to people born with impaired fetal growth are also described.