Master Class

The fetal origins hypothesis



On Aug. 27, 2013, the field of obstetrics and gynecology suffered a great loss: the passing of Dr. David J.P. Barker. Dr. Barker was a visionary and leader whose hypothesis about the links between a mother’s health and the long-term health of her children was controversial when he first posed it in the late 1980s. However, after subsequent decades of maternal-fetal practice and research, his idea that preventing chronic disease starts with a healthy mother and baby, is embraced by the medical and science communities today.

Dr. E. Albert Reece

I was just starting my career when Dr. Barker’s hypothesis, known then as the "fetal origins hypothesis" but subsequently referred to as the "Barker Hypothesis," was published. During my fellowship in maternal-fetal medicine at Yale University, I had the privilege of attending one of Dr. Barker’s lectures and meeting him. While my colleagues and I thought him an eloquent and impassioned speaker, Dr. Barker’s theory – that there was a relationship between a person’s birth weight and his or her lifetime risk for chronic disease – was highly contentious. He had based his hypothesis on large epidemiological studies conducted in Finland, India, the Netherlands, the United Kingdom, and the United States – all of which revealed that the lower a person’s birth weight, the higher his or her risk for developing coronary heart disease. In addition, he concluded that the lower a person’s birth weight, but the faster the weight gain after age 2 years, the higher a person’s risk for hypertension, stroke, and type 2 diabetes.

At that time, we did not fully realize the significance, gravity, and enormity of Dr. Barker’s contribution to the ob.gyn. field. I could not imagine the impact that his work would have on my professional path. Dr. Barker’s early papers often concluded with a section looking to the future, and in one of them he stated that "we now need to progress beyond epidemiologic associations [between in utero conditions and health later in life] to greater understanding of the cellular and molecular processes that underlie them"( Am. J. Clin. Nutr. 2000;71:1344s-52s ). From my work as a physician with diabetic pregnant women to my scientific research devoted to understanding how, at the molecular level, maternal diabetes affects the developing fetus, I have a great appreciation and respect for Dr. Barker’s work.

Therefore, I am very pleased that this month’s Master Class is devoted to a discussion of how the Barker Hypothesis applies today. We have invited Dr. Thomas R. Moore, a perinatologist who is chair of the department of reproductive medicine at the University of California, San Diego, to give his reflection on how Dr. Barker’s once radical ideas revolutionized our field.

Dr. Reece, who specializes in maternal-fetal medicine, is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. Dr. Reece said he had no relevant financial disclosures. He is the medical editor of the Master Class column. Contact him at

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