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Perinatal Origins of Cardiovascular Health Disparities Across the Life Course.

The World Health Organization has declared a “life-course approach” to be essential for achieving the population health goals of the United Nations 2030 Agenda for Sustainable Development. Because of increasing evidence linking intrauterine exposures with future disease risks, action must focus on preconception, pregnancy, fetal development, and the most vulnerable life stages. 1 However, despite a growing recognition of the long-term effects of early-life stressors, little attention has been given to their potential role in the origin of health disparities across the life course. New evidence suggests that racial/ethnic disparities in cardiovascular disease (CVD) might be linked with similar disparities that exist in preterm birth. We hypothesize that perinatal stressors are important factors underlying both the development of CVD later in life and racial/ethnic disparities in CVD. 2 Prior studies have shown that CVD may originate early in life due to environmental exposures in childhood and adolescence. Low socioeconomic status (SES) in childhood has been linked with behavioral risk factors such as poor diet and obesity that track into adulthood, potentially leading to hypertension, diabetes, and CVD. In addition, higher allostatic load and systemic cortisol levels in response to chronic psychosocial stress may also contribute to early development of atherosclerosis. Subclinical atherosclerotic changes have been detected in adolescence and are more common in racial/ethnic minority and low SES groups. In response to such evidence, the American Academy of Pediatrics has asserted that “many adult diseases should be viewed as developmental disorders that begin early in life, and that persistent health disparities associated