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Working towards precision medicine in developmental programming.

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Giussani, Dino A 


The gene-environment interaction before birth is just us, if not more, important than the gene-lifestyle interaction after birth in setting a risk of disease in later life through a process known as developmental programming (1). The best evidence in humans to support developmental programming comes from studies of obese women who have fallen pregnant before and after having bariatric surgery (2). These studies show that siblings born before the surgery have an increased risk of cardiometabolic disease compared to those born after. Therefore, such studies underscore that alterations in the environment at critical periods of intrauterine development even within the same womb can directly influences long-term cardiovascular health in offspring of the same family. Consequently, there has been an exponential growth of studies in this field of developmental programming aiming to identify underlying mechanisms and thereby treatment, most recently focussed on improving precision medicine by applying basic principles of personalised medicine to intrauterine therapy (3). Two relevant examples are provided by studies aiming to improve organelle-targeted therapy (4-6) and by the growing awareness that the sex of the offspring and of its placenta ought to be included as biological variables into experimental design and analysis when studying vertebrate animals and humans (7-9).



Female, Fetal Development, Gene-Environment Interaction, Humans, Precision Medicine, Pregnancy

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Pediatr Res

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Springer Science and Business Media LLC


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British Heart Foundation (RG/17/8/32924)
The Lister Institute for Preventive Medicine