The increased DV shunting and thus reduced liver perfusion of well oxygenated and glucose rich blood returning from the placenta may contribute towards impaired liver growth in hypoxaemic growth restricted fetuses (76), a factor that is associated with reduced concentrations of key fetal growth factors, insulin-like growth factor (IGF)-1 and IGF-2 (77), and may predispose FGR born offspring to metabolic syndrome and impaired drug metabolism across the life course (67, 78–82). This evidence concerns the gene IGF2 and metabolic syndrome.