Early Developmental Conditioning of Later Health and Disease: Physiology or Pathophysiology?
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Extensive experimental animal studies and epidemiological observations have shown that environmental influences during early development affect the risk of later pathophysiological processes associated with chronic, especially noncommunicable, disease (NCD). This field is recognized as the developmental origins of health and disease (DOHaD). We discuss the extent to which DOHaD represents the result of the physiological processes of developmental plasticity, which may have potential adverse consequences in terms of NCD risk later, or whether it is the manifestation of pathophysiological processes acting in early life but only becoming apparent as disease later. We argue that the evidence suggests the former, through the operation of conditioning processes induced across the normal range of developmental environments, and we summarize current knowledge of the physiological processes involved. The adaptive pathway to later risk accords with current concepts in evolutionary developmental biology, especially those concerning parental effects. Outside the normal range, effects on development can result in nonadaptive processes, and we review their underlying mechanisms and consequences. New concepts concerning the underlying epigenetic and other mechanisms involved in both disruptive and nondisruptive pathways to disease are reviewed, including the evidence for transgenerational passage of risk from both maternal and paternal lines. These concepts have wider implications for understanding the causes and possible prevention of NCDs such as type 2 diabetes and cardiovascular disease, for broader social policy and for the increasing attention paid in public health to the lifecourse approach to NCD prevention.
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The fetus exhibits plasticity enabling physiological adaptations to adverse intrauterine conditions such as nutrient deprivation or hormonal imbalances.
“The fetus exhibits a remarkable degree of plasticity, enabling physiological adaptations to adverse intrauterine conditions, such as nutrient deprivation or hormonal imbalances.”
From Maternal Overnutrition and Fetal Programming: Long-Term Metabolic, Cognitive, and Epigenetic Consequences (2026) · cites this paper as [4]
Both undernutrition and overnutrition affect fetal metabolism, predisposing offspring to obesity and cardiometabolic disorders in adulthood.
“Both undernutrition and overnutrition affect fetal metabolism, predisposing offspring to obesity and cardiometabolic disorders in adulthood.”
From Maternal Overnutrition and Fetal Programming: Long-Term Metabolic, Cognitive, and Epigenetic Consequences (2026) · cites this paper as [4]
Fetal adaptations to adverse intrauterine conditions may predispose the individual to metabolic, cardiovascular, and neurodevelopmental disorders later in life.
“However, such adaptations—while advantageous for short-term survival—may predispose the individual to metabolic, cardiovascular, and neurodevelopmental disorders later in life, a phenomenon often referred to as “fetal programming” [3,4].”
From Maternal Overnutrition and Fetal Programming: Long-Term Metabolic, Cognitive, and Epigenetic Consequences (2026) · cites this paper as [4]
Perturbation of gene expression or cell proliferation and differentiation during vulnerable periods by nutritional and other environmental influences can alter the structure and functional capacity of major organ systems for life, a process known as developmental programming.
“Perturbation of gene expression or cell proliferation and differentiation during vulnerable periods by nutritional and other environmental influences can alter the structure and functional capacity of major organ systems for life, a process known as developmental programming.”
From Placental Origins of Chronic Disease (2016) · cites this paper as [237]
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Early-life nutrition modulates the epigenetic state of specific rDNA genetic variants in mice
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Wang, N., Deng, Z., Wen, L. M., Ding, Y., & He, G. (2019) · JMIR mhealth and uhealth · doi:10.2196/12631 · Cited by 106 · see citing works
Praegnatio Perturbatio—Impact of Endocrine-Disrupting Chemicals
Padmanabhan, V., Song, W., & Puttabyatappa, M. (2021) · Endocrine Reviews · doi:10.1210/endrev/bnaa035 · Cited by 103 · see citing works
Nutrition therapy within and beyond gestational diabetes
Hernandez, T. L., Mande, A., & Barbour, L. A. (2018) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2018.04.004 · Cited by 86 · see citing works
van Dijk, M. R., Koster, M. P. H., Oostingh, E. C., Willemsen, S. P., Steegers, E. A. P., & Steegers-Theunissen, R. P. M. (2020) · Journal of Medical Internet Research · doi:10.2196/15773 · Cited by 80 · see citing works
Bagby, S. P., Martin, D., Chung, S. T., & Rajapakse, N. (2019) · American Journal of Public Health · doi:10.2105/ajph.2018.304864 · Cited by 79 · see citing works
Miller, G. E., Borders, A. E., Crockett, A. H., Ross, K. M., Qadir, S., Keenan-Devlin, L., Leigh, A. K., Ham, P., Ma, J., Arevalo, J. M. G., et al. (2017) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2017.04.014 · Cited by 62 · see citing works
Maternal overnutrition induces long-term cognitive deficits across several generations
Sarker, G., & Peleg-Raibstein, D. (2018) · Nutrients · doi:10.3390/nu11010007 · Cited by 52 · see citing works
Nutrition Therapy in Gestational Diabetes Mellitus: Time to Move Forward
Hernandez, T. L., & Brand-Miller, J. C. (2018) · Diabetes Care · doi:10.2337/dci18-0014 · Cited by 52 · see citing works
Son, H., Kim, S., Jung, D.-H., Baek, J. H., Lee, D. H., Roh, G. S., Kang, S. S., Cho, G. J., Choi, W. S., Lee, D. K., et al. (2019) · Scientific Reports · doi:10.1038/s41598-018-36619-2 · Cited by 39 · see citing works
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Placental Drug Delivery to Treat Pre‐Eclampsia and Fetal Growth Restriction
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Unpacking developmental programming: a conceptual and historical analysis in the context of DOHaD
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“8 Despite this proposed shift in terminology, the articles included in this review suggest that DP remains frequently utilized in DOHaD research.”
Panteris, E., Kakatsaki, I., Koukou, Z., Kolvatzis, C., Papanikolaou, S., & Hatzidaki, E. (2026) · Pathophysiology · doi:10.3390/pathophysiology33030067
Tsaqifah, N. A., Hanifah, R., Husna, F. A., Hidayati, M. D., Widyawati, D., Putri, G. F. T., & Al Shadrina, A. (2025) · Nusantara Medical Science Journal · doi:10.20956/nmsj.v10i2.47907
- Authors
- Hanson, M. A., & Gluckman, P. D.
- Affiliations
- University of Auckland (NZ)
- Venue
- Physiological Reviews
- Publisher
- American Physiological Society
- Published
- 2014-10
- Volume
- 94
- Issue
- 4
- Pages
- 1027-1076
- ISSN
- 0031-9333 (ISSN-L)
- 1522-1210
- PMC
- PMC4187033
- OpenAlex
- W2065973763
- Cited by
- 1,188
- References
- 686
- Citations by year
- 2026: 91 · 2025: 83 · 2024: 87 · 2023: 91 · 2022: 119 · 2021: 121 · 2020: 123 · 2019: 102 · 2018: 95 · 2017: 125 · 2016: 94 · 2015: 52 · 2014: 1 · 2013: 1
- FWCI
- 13.47
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Physiological Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Funders
- British Heart Foundation
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Health, Environment, Cognitive Aging
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Epigenetics and DNA Methylation
- Keywords
- developmental origins of health and disease, developmental plasticity, non-communicable diseases, parental effects, evolutionary developmental biology, epigenetics, transgenerational epigenetic inheritance, type 2 diabetes, cardiovascular disease, disease prevention
- MeSH terms
- Cardiovascular Diseases, Chronic Disease, Disease, Humans, Human Development, Life Style, Risk Factors, Time Factors, Epigenomics
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