Developmental programming of non-communicable diseases is now an established paradigm. With respect to hypertension and chronic kidney disease, adverse events experienced in utero can affect development of the fetal kidney and reduce final nephron number. Low birth weight and prematurity are the most consistent clinical surrogates for a low nephron number, and are associated with increased risk of hypertension, proteinuria and kidney disease in later life. Rapid weight gain in childhood or adolescence further compounds these risks. Low birth weight, prematurity and rapid childhood weight gain should alert clinicians to an individual's life-long risk of hypertension and kidney disease, prompting education to minimize additional risk factors and ensuring follow-up. Birth weight and prematurity are significantly impacted by maternal nutrition and health during pregnancy. Optimization of maternal health and early childhood nutrition could therefore attenuate this programming cycle and reduce the global burden of hypertension and kidney disease in the future.

Although the absolute risk of ESRD in women who have had preeclampsia is low, preeclampsia is a marker for an increased risk of subsequent ESRD.