In the last years evidence has shown how lifelong well-being strongly depends on intrauterine growth and development during intrauterine life. Fetal growth can achieve its full potential only with an adequate and fine-tuned interaction between mother, placenta and fetus. Several environmental and maternal factors like maternal diet, body composition and endocrine status may alter this delicate equilibrium. Moreover, placental function and metabolism contribute and regulate the availability of fetal nutrients. Changes in this complex mechanism may compromise the pregnancy outcome. In this chapter we wish to elucidate the physiologic mechanisms that regulate this interaction and how also little modifications may predispose to pathologies like intrauterine growth restriction and gestational diabetes with important consequences on fetal and adult health.

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