In Reply: The presence of a robust and consistent association between maternal height and child health compels the need to understand the mechanisms that underlie this association. Dr Handel and colleagues highlight, and we concur, that epigenetics may be one such mechanism.
However, teasing out the distinct role of different factors in explaining the association between maternal height and offspring health is challenging. For instance, biological pathways may themselves play a role in epigenetics, as syndromes related to intrauterine growth restriction may act as epigenetic triggers down-regulating fetal growth, with future health consequences.1
Özaltin E, Subramanian SV. Association Between Maternal Height and Childhood Outcomes—Reply. JAMA. 2010;304(6):638-639. doi:10.1001/jama.2010.1108