Not so long ago, doctors told women it is ok to drink and smoke during pregnancy…

Early in the twentieth century, scientists and doctors believed that nutrition and lifestyle of a pregnant woman have no effect on her unborn child. The placenta was thought to be the perfect filter/barrier, protecting the baby from every kind of environmental toxicity. Reassured by their doctors’ advice, pregnant women in the 50s and 60s continued their preconception lifestyle and diet.  They were advised against putting too much weight during pregnancy and were told it was “fine to light a cigarette and knock back a few drinks”. Unsurprisingly, during the 60s, about half of pregnant women in the US were smoking.

It took a few decades, a handful of tragic historical cases of in utero poisoning and thousands of affected babies for science to realize that many toxins pass through the placenta and affect greatly the immediate and long term health of the developing fetus. Two well-known examples include birth defects resulting from the use of thalidomide in the early 1960s –extensively prescribed by doctors of that time for morning sickness- and fetal alcohol syndrome due to alcohol consumption during pregnancy, officially recognized in the early 1970s. Now, we are approaching an entirely new paradigm in pregnancy, which teaches us that avoiding such gruesome poisons is but a first step towards the long-term health of the baby. We can proactively reinforce the present and future wellbeing of the unborn baby in ways we never thought possible.

The fetal origins of adult disease

What if the time we spend in utero is actually much more critical and defining than we ever thought?  Is avoiding all the possible toxins the best beginning we can offer to our children?

The answer is a resounding no.

No matter how dangerous they may sound, difficult-to-pronounce toxins are in fact only half, or less, of the story. Research shows that the mother’s nutrition during pregnancy is another major influence of a person’s future health. Prenatal nutrition “programs” specific metabolic characteristics to the developing baby, predisposing for disease or health during adulthood, even when an infant is born 100% healthy.

Dr. David Barker, a British epidemiologist, published in 1986 findings of a direct link between prenatal nutrition and health issues developed in later life, such as heart disease, type II diabetes and obesity. These findings formed the basis of the theory of fetal origin of disease, which extends beyond the effects of toxic substances on an unborn child and dives right into the uncharted territory of nutritional programing of the fetus. Barker suggested that babies starved for essential nutrients during pregnancy are more likely to become overweight as adults and develop cardiovascular and metabolic diseases. Based on his data from UK, Barker showed that the effects of the nutritional conditions during the intrauterine life persist throughout our lives and could remain latent for years, until they fully manifest. Since then, his results have been confirmed in countries in all continents, except for Africa.

There are probably different ways that prenatal nutrition influences the future health of babies. But we do have some pretty good ideas about how this could happen. For example, we have enough evidence to suspect that a diet based on highly processed food during pregnancy is not just delivering excessive amounts of empty calories to the baby (lack of nutrients), but also affects how the brain will process and make food-related decisions in the future. In other words, the diet of the mother defines and “programs” the future food choices of her baby and to a certain point her health.

An interesting study shows that women who eat junk food during pregnancy give birth to children who also follow a similar nutrition, based on processed, nutrient-poor diet. However, this is not the classic argument about children adopting the family’s eating habits. Research shows that the brain cells of these kids are actually hardwired to like and seek foods rich in commercial, trans fats and sugar, similar to those that the mother was eating during pregnancy. This is a scary example of the transgenerational effect of prenatal nutrition, one of the very few we have in our hands. The dietary choices of the mother determine what kind of food the baby’s brain will demand in the long run and therefore the choices realistically available to their children. Free choice is effectively bypassed…

Psychology and hormones – Beyond Baker’s theory!

Thanks to the progress of molecular biology and genetics, we are now able to confirm that even Barker’s theory is not complete; apart from avoiding poisons that cross the placenta and optimizing the nutrition of pregnant women, psychology and therefore hormones of the expectant mother can be as defining as nutrient availability, affecting the baby’s DNA and more specifically the length of telomeres. Short length of these tiny protective caps at the end of each chromosome is an indication of current or predisposition for chronic disease and even mental health problems. Seniors or people who are currently suffering from serious, chronic diseases have shorter telomeres, compared to healthy people.

So, how the feelings of the mother are connected with the baby’s DNA and long-term health? Research shows that the adult children of women who experienced a major upsetting situation during pregnancy have consistently shorter telomeres than the adult children of women with happy and relaxed pregnancies and therefore carry a genetic predisposition for chronic disease earlier in life. How it is possible the feelings and hormone changes in the mother can affect the baby’s DNA and future health?

The truth is, we have no idea…

Future pediatrics

Our understanding of what is safe or ideal for the baby during pregnancy has gone through some pretty radical changes in the last 60-70 years. We went from essentially recommending smoking and drinking to pregnant women, to rapidly realizing that the fetus is actually very vulnerable to many kinds of toxins. Now we know that the future wellbeing of the unborn child depends on the uninterrupted availability of the right kind of nutrients during pregnancy and of course throughout babyhood and childhood, but also the psychological state of the mother during pregnancy.

If we accept the theory of the fetal origins of disease, pregnancy care will be irreversibly and radically changed forever. Nutritional and hormonal damage in utero is originally a lot more subtle than we thought. We have come to realize that there is a large continuum between an unhealthy and a healthy child. A healthy newborn may carry significant predisposition for disease sooner or later in life.

The question we have to ask when it comes to the future of pregnancy care is what is really optimal for the baby. How can we minimize or even eliminate the chances that a baby will suffer a debilitating disease later in life?  How can we bring to life children with built-in physical resilience that will give them an advantage for the rest of their lives?

Thanks to the advances of medicine, we are not talking about mere survival anymore. We are not talking about the minimum care we can/should provide to avoid serious health problems that are too obvious to dismiss or even worse, death. This is about thriving and preventing disease from happening altogether; we are talking about long-term wellbeing and resilience at all physical levels. The future of pregnancy care is about creating a generation of children who are healthy, look healthy and their genes are programmed to keep them healthy for life, children who were optimally taken care since conception and pregnancy.

Perhaps in a few decades we will eradicate adult disease by making sure that expectant mothers follow ideal nutrition and lifestyle, even before they get pregnant. The new pregnancy care will also be the new pediatrics. In the future, preventing, rather than treating diseases on an individual basis could become the new normal.