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Microalbuminuria in Adults after Prenatal Exposure to the Dutch Famine

Rebecca C. Painter^*, Tessa J. Roseboom^*, Gert A. van Montfrans, Patrick M.M. Bossuyt^*, Raymond T. Krediet, Clive Osmond, David J.P. Barker and Otto P. Bleker^||

Departments of ^* Clinical Epidemiology and Biostatistics and Internal Medicine, Academic Medical Center at the University of Amsterdam, Amsterdam, the Netherlands; MRC Epidemiology Resource Centre and Developmental Origins of Adult Disease Centre, University of Southampton, Southampton, United Kingdom; and ^|| Department of Obstetrics and Gynecology, Academic Medical Center at the University of Amsterdam, Amsterdam, the Netherlands

Address correspondence to: Dr. Rebecca Painter, P.O. Box 22660, 1100 DD Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Phone: 31-20-56-66-934; Fax: 31-20-69-12-683; E-mail: r.c.painter{at}amc.uva.nl

Maternal undernutrition during gestation is associated with an increase in cardiovascular risk factors in the offspring in adult life. The effect of famine exposure during different stages of gestation on adult microalbuminuria (MA) was studied. MA was measured in 724 people, aged 48 to 53, who were born as term singletons in a university hospital in Amsterdam, the Netherlands, around the time of the Dutch famine 1944 to 1945. Twelve percent of people who were exposed to famine in mid gestation had MA (defined as albumin/creatinine ratio 2.5) compared with 7% of those who were not prenatally exposed to famine (odds ratio 2.1; 95% confidence interval 1.0 to 4.3). Correcting for BP, diabetes, and other influences that affect MA did not attenuate this association (adjusted odds ratio 3.2; 95% confidence interval 1.4 to 7.7). The effect of famine was independent of size at birth. Midgestation is a period of rapid increase in nephron number, which is critical in determining nephron endowment at birth. Fetal undernutrition may lead to lower nephron endowment with consequent MA in adult life.

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