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Programmed disease outcomes are demonstrated more commonly in male offspring compared with females, with these sex\u2010specific outcomes partly attributed to different placenta\u2010regulated growth strategies of the male and female fetus. Pregnancy is known to be a major risk factor for unmasking a number of conditions and can be considered a \u2018second hit\u2019 for women who were born small. As such, female offspring often develop impairments of physiology for the first time during pregnancy that present as pregnancy complications. Numerous maternal stressors can further increase the risk of developing a maternal complication during pregnancy. Importantly, these maternal complications can have long\u2010term consequences for both the mother after pregnancy and the developing fetus. Conditions such as preeclampsia, gestational diabetes and hypertension as well as thyroid, liver and kidney diseases are all conditions that can complicate pregnancy and have long\u2010term consequences for maternal and offspring health. Babies born to mothers who develop these conditions are often at a greater risk of developing disease in adulthood. This has implications as a mechanism for transmission of disease across generations. In this review, we discuss the evidence surrounding long\u2010term intergenerational implications of being born small and\/or experiencing stress during pregnancy on programming outcomes.\n<jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/tjp7210-gra-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p>","DOI":"10.1113\/jp271745","type":"journal-article","created":{"date-parts":[[2016,3,12]],"date-time":"2016-03-12T20:13:50Z","timestamp":1457813630000},"page":"4727-4740","source":"Crossref","is-referenced-by-count":135,"title":["Programming of maternal and offspring disease: impact of growth restriction, fetal sex and transmission across generations"],"prefix":"10.1113","volume":"594","author":[{"given":"Jean N.","family":"Cheong","sequence":"first","affiliation":[{"name":"Department of Physiology Faculty of Medicine, Dentistry and Health Sciences School of Biomedical Sciences University of Melbourne  Parkville Victoria 3010 Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Wlodek","sequence":"additional","affiliation":[{"name":"Department of Physiology Faculty of Medicine, Dentistry and Health Sciences School of Biomedical Sciences University of Melbourne  Parkville Victoria 3010 Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen M.","family":"Moritz","sequence":"additional","affiliation":[{"name":"School of Biomedical Sciences University of Queensland  St Lucia Queensland 4072 Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S. 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