In utero adverse exposures and cardiovascular health in the offspring

Cardiovascular disease (CVD) remains the leading cause of global mortality, with a concerning trend toward younger onset. This shift highlights the urgent need to advance the window of attention and intervention for cardiovascular health (CVH). The Developmental Origins of Health and Disease (DOHaD) hypothesis proposes that adverse intrauterine exposures can program long-term alterations in offspring CVH, underscoring the significance of early-life origins. Maternal health conditions during pregnancy, environmental exposures, and lifestyle factors are consistently associated with adverse cardiovascular outcomes in children, including elevated blood pressure, structural and functional abnormalities, and impaired cardiometabolic profiles. These associations are mediated through pathways involving placental dysfunction, inflammation, oxidative stress, and hormonal imbalance, which collectively reshape fetal cardiovascular development and increase susceptibility to CVD later in life. From a management perspective, adverse intrauterine exposures should be integrated into pediatric CVH risk assessment, and preventive strategies should be shifted to the preconception and prenatal periods. This review highlights intrauterine environment as a critical determinant of intergenerational cardiovascular risk and emphasizes the necessity of implementing precision prevention strategies beginning from the earliest stages of life.