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성인기 질환의 태중기원

Fetal origins of adult disease

최규연
대한산부인과학회 (Korean Soceity of Obstetrics and Gynecology)|2010.06|Obstetrics & Gynecology Science|제53권 제06호|pp. 475-488

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Birth weightAdult diseaseFetal development태아발달성인기 질병자궁내환경출생시 체중모체 영양Intrauterine environmentMaternal nutrition
주제분류산부인과학

초록

성인기의 건강과 질병이 생애 초기 발달과정과 출생 후 초기 발달과정에 의해 결정되고 영향을 받을 수 있다는 이론은 역학연구와 동물 실험연구를 통해 입증되었다. 이들 이론들을 바탕으로 태아기의 부적절한 환경에 대한 적응이 각 개체의 생존을 위한 방식으로 작용되는 형질 발현의 결과로 다양한 만성 성인병들이 발생한다는 발달프로그래밍 가설 (developmental programming hypothesis)이 제기되었다. 각 개체의 발달은 유전학적 인자뿐만 아니라 생애기 초기의 환경적 요인과 생활 습관 등에 의해 영향을 받을 수 있다. 이들 영향이 미치는 비정상적인 과정이 향후 성인기에 발병하는 질병의 중요한 원인이 된다는 기본적인 성인기 질병의 태중기원 (Fetal origins of adult disease, FOAD) 개념으로 정립되었으며, 저체중 출생아와 성인기의 심혈관계 질환, 고혈압, 제2형 당뇨병 등과의 관련성이 이 가설을 입증하고 있다. 임신 중 모체의 질병이나 불량한 영양상태, 심한 스트레스에 태아 발달이 영향을 받을 수 있으며, 특히 모체의 영양 공급 환경에 따른 태아기 성장 저하와 질병 형질 발현에 대해서 현재까지 많은 연구가 진행되었다. 이와 함께 앞으로는 태아기 발달 기간 중에 영향을 주는 다양한 요인뿐만 아니라 출생 후의 외부 환경이 성인기 건강에 미치는 영향에 대한 방향으로 연구가 진행되어야 할 것이며, 이를 통해 성인질병의 예방 및 조기 중재를 통해 결과적으로 공중 보건을 향상시키는 적절한 방법을 모색하는 연구가 진행될 필요가 있다고 사료된다.

Abstract

Human epidemiological and animal studies show that many chronic adult disease have their antecedents in compromised fetal and early postnatal development. Developmental programming is defined as the response by the developing mammalian organism to a specific challenge during a critical time window that alters the trajectory of development with resulting persistent effects on phenotype. Each individual's phenotype is influenced by the developmental environment as much as their genes. Also, the term 'fetal origins of adult disease' was coined on the basis of the inverse association between low birth weight and blood pressure, adult-onset diabetes, coronary heart disease, and stroke seen in numerous epidemiological studies. However, it seems unlikely that birth weight is involved in causal pathways underlying theses observations, and if it were then the significance to public health of these findings is very limited because of our inability to modify birth weight to a relevant extent in humans. There has been a major focus on maternal nutrition. Important targets for future research include distinction between the effects of different pregnancy conditions, such as maternal malnutrition, preeclampsia, and maternal infection, which may have dissimilar late-life consequences. This will be a crucial step when the associations that are currently emerging will be translated into disease prevention.

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