Module 1: In-Utero Health

Overview

Increasingly, the health and well-being of women, infants, and children are becoming recognized as a public health priority. Their health determines the health of future generations. Efforts are addressing the disparities in maternal, newborn, and child health in order to remove barriers to better health and quality of life.

Fetal Origins

In the doctor’s office, patients answer questions on family history, diet, and exercise habits in order to inform the physician’s personalized medical advice for each patient. The patient’s genetic predispositions and lifestyle choices are extremely pertinent to diagnosis and treatment. In addition to personal health habits and genes, the nine months before birth significantly affect an individual’s health. This crucial period is being investigated in the developing field of fetal origins. This field focuses on understanding the effects of the intrauterine environment on future health, including nutrition, obesity, exposure to harmful toxins, stress/emotional state, and smoking habits. Low birth weight alone is associated with high blood pressure and cardiovascular disease in later life.(1) This single factor, associated with stroke, diabetes, and chronic bronchitis, causes the individual to be “destined to have a shorter, less healthy life”.(2) The idea that a mother’s behavior during pregnancy affects her baby’s health is not a new one. Pregnant mothers are relentlessly given advice to “eat this, don’t drink that, always be vigilant— but never stressed”.(3) However, the emphasis on the importance of the in-utero environment has been overlooked as a time period that permanently affects an individual’s future quality of life, including intelligence, mental health, and vulnerability to disease.

British researcher Dr. David Barker discovered the inverse correlation between birth weight and lifetime risk for heart disease.(4) According to Barker, the lower the weight of a baby at birth, the higher the baby’s risk of heart disease during adulthood will be. This discovery opened up the field of fetal origins, which asserts that the nine months of in-utero health is a critical development period that permanently affects future health, such as the body’s physiology, metabolism, and susceptibility to numerous chronic diseases.(5) Other studies have revealed that low birth weight is also associated with higher blood pressure and a higher risk of stroke and Type 2 diabetes.(6) A lack of nutrients or oxygen in the womb is also associated with small birth size.

According to the Centers for Disease Control (CDC), fewer than half of pregnancies are planned. Addressing unplanned pregnancy and the health of pregnant women may help to curtail health issues in future generations.(7)

Low Birth Weight and Poor Prenatal Nutrition

Fetal-programming expert Jerry Heindel at the National Institute of Environmental Health Sciences states that “the fetus is reading the environment during development and is using that to predict what the environment will be once it's born. If the fetus gets poor nutrition, it will set itself up to be able to adjust to that. If it has poor nutrition during life, it will do quite well. But later in life, if nutrition changes and becomes like the food we're eating today, that is a mismatch, and that will increase the susceptibility to disease”.(8)

As Heindel discusses, prenatal nutrition highly influences fetal health. Since the fetus relies on maternal nutrients for growth, nutrition during pregnancy impacts development, and consequently, the baby’s health throughout childhood and beyond.(9) Birth weight is an indicator for the quality of maternal nutrients passed on to the fetus during pregnancy, and is a predictor of future health. Healthy prenatal nutrition reduces the baby’s chance of developing obesity, diabetes, heart disease, and birth defects.(10) Thus, by eating properly, an expectant mother can effectively decrease her child’s likelihood of suffering from certain chronic diseases later in life. Unfortunately, maternal nutrition is still lacking in many places. For example, in a recent study of urban low income pregnant women in Boston, researchers found that less than 5% of the mothers started folic acid supplements before pregnancy, and approximately one-third of mothers had plasma folate levels that were either too low or too high, which may have important health consequences for both the mother and their children.(11)

The harmful effects of poor maternal nutrition are evidenced by the Dutch famine of 1944, when pregnant women were very under-nourished.(12) An epidemiological study of the famine’s effects concluded that these mothers gave birth to newborns with low birth weight due to poor maternal nutrition. The birth weight was found to be inversely correlated with coronary heart disease and other chronic diseases, implying that poor prenatal nutrition is a significant contributor to heart disease in adulthood.(13)

High Blood Sugar

Gestational diabetes occurs when a pregnant woman's body cannot make enough insulin. All pregnant women have some insulin resistance during late pregnancy. Others have resistance even before getting pregnant. Kaiser Permanente reported that children who have been exposed to an excessive amount of sugar in the womb due to their mother’s gestational diabetes were twice as likely to become obese in early childhood when compared to children of mothers who effectively controlled their diabetes.(14) Lowering blood sugar levels decreases the amount of sugar passed on to the fetus through the placenta. A commitment to reducing gestational diabetes could help to combat the obesity epidemic that will likely affect future generations.(15)

Stress Level and Emotional State

It is common for women to feel anxious about pregnancy and childbirth. When a woman's body goes into a “fight or flight” mode, it sends out hormones that cause the woman’s body to work harder than it already is. Some stress is normal and if it is managed properly, the baby and mother will have a greater success rate. If the mother experiences high levels of stress for prolonged period of time, the unborn fetus and mother are susceptible to health complications.(16)

In-utero health is affected by more than lifestyle choices such as diet or exercise. Researchers have found that high stress levels during pregnancy increase the risk of pre-term labor and low birth weight. Furthermore, there are extensive health issues associated with pre-term birth, including chronic lung disease, developmental delays, learning disorders, and infant mortality.(17) Chronic health issues such as heart disease, high blood pressure, and diabetes are also associated with maternal stress during pregnancy.(18) Using the womb as a predictor of the external environment, the fetus responds to elevated stress hormones in the mother’s body by changing physiologically to adapt to the environment.(19) Recent studies have shown that stress may even affect the temperament of the fetus, and can increase irritability and susceptibility to depression or mental illnesses.

Footnotes

(1) "Global Estimates for Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in Adults." Diabetes Care.

(2) Barker, D. J. (1995). Fetal origins of coronary heart disease. BMJ, 311(6998), 171-174.

(3) "Fetal Origins: How the First Nine Months Shape Your Life - TIME." Breaking News, Analysis, Politics, Blogs, News Photos, Video, Tech Reviews - TIME.com. 13 Sept. 2011.

(4) "Maternal, Infant, and Child Health - Healthy People." Healthy People 2020 - Improving the Health of Americans. Sept. 2011.

(5) "Fetal Origins: How the First Nine Months Shape Your Life - TIME." Breaking News, Analysis, Politics, Blogs, News Photos, Video, Tech Reviews - TIME.com. 13 Sept. 2011.

(6)  Law, C.M., de Swiet, M., Osmond, C., Fayers, P.M., Barker, D.J.P., Cruddas, A.M., et al. Initiation of hypertension in utero and its amplification throughout life. BMJ 1993;306:24–7.

(7) Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR). Recommendations to improve preconception health and health care—United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR 2006;55(RR-6).

(8) Roan, S. "Poor Nutrition in Utero, Heavy Child Tomorrow?" Health Insurance from Blue Cross and Blue Shield Companies â BCBS.com. 11 Nov. 2007.

(9) Barr, S. (2010). FNH 471 Human Nutrition Over the Life Span. Course Notes, Fall. University of British Columbia.

(10) Procter, S.B., & Campbell, C.G. (2014). Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome. Journal of the Academy of Nutrition and Dietetics, 114(7), 1099-1103.

(11) Cheng, T. L., Mistry, K. B., Wang, G., Zuckerman, B., & Wang, X. (2018). Folate nutrition status in mothers of the Boston Birth Cohort, sample of a US urban low-income population. American journal of public health, 108(6), 799-807.

(12) Hornstra, G, Uauy, R., Yang, X. (2004). The impact of maternal nutrition on the offspring. New York: Basel. ISBN 380557780X.

(13) Roseboom, T., de Rooij, S., Painter, R. (2006). "The Dutch famine and its long-term consequences for adult health". Early Human Development (Elsevier Ireland) 82: 485–491.

(14) Kotz, D. "Redirecting You to the Appropriate Form ... Cancel." US News - Health. 22 Sept. 2007.

(15) Cincinnati Children's Hospital Medical Center. (April 2018). "Hypoglycemia in the Newborn." https://www.cincinnatichildrens.org/health/h/hypoglycemia.

(16) March of Dimes. (Oct. 2019). "Stress and Pregnancy." https://www.marchofdimes.org/complications/stress-and-pregnancy.aspx.

(17) Wadhwa, P.D., Entringer, S, Buss, C., & Lu, M.C. (2011) The contribution of maternal stress to preterm birth: issues and considerations. Clinics in perinatology, 38(3), 351-384.

(18) Beydoun, H., & Saftlas, A. F. (2008). Physical and mental health outcomes of prenatal maternal stress in human and animal studies: a review of recent evidence. Paediatric and perinatal epidemiology, 22(5), 438-466.

(19) Collingwood, J. "Work Stress Linked to Low Birthweight and Preterm Birth." (18 Oct. 2018). https://psychcentral.com/lib/work-stress-linked-to-low-birthweight-and-preterm-birth/.