Fetal origins of adult disease and developmental health outcomes

¶ … Utero Development on the Health and Well Being

The effects of in Utero development on the health and Well-being

Fetal origins of health and disease has developed into a new medical frontier for researchers. The growing body of research evidence has affirmed positive associations between the gestational environment and the development of various physical and mental disorders in the infant, adolescent and the adult population. A decade ago, attributing fetal origins to disease conditions might have evoked a scoffing response but the plethora of scientific evidence that is available today has changed it. A healthy, stress free maternity period is critical for the healthy fetal development and the healthy future life of the offspring.

Introduction

Biological science has made vast progress. The development of genetics and the heredity theory offered revealing and conclusive explanations for anything from the origin of diseases to physical appearance to the intelligence quota of a person. Genetic predisposition to chronic conditions such as obesity, diabetes, and asthma are now accepted as unalterable. However, a fast developing field of medical science is providing a new perspective, a new origin for diseases both mental and physical, by taking diagnosis back to the gestational period asserting it as the most "consequential period of our lives." [Annie Paul] 'Fetal origins', the new research field, contends that our vulnerability to diseases, intelligence, metabolism and even our temperament are already influenced during these vital nine months. The intra-uterine environment, the researchers claim, could explain diseases like cancer, asthma, diabetes, allergies, hypertension, obesity, mental disorders among adults and even carries the blueprints for old age diseases such as osteoporosis, arthritis, dementia and other cognitive disorders. The growing number of research articles over the last decade, provide overwhelming evidence to the fetal origin theory of diseases and mental disorders. A brief overview of the theory of 'Fetal origins' with a discussion of some relevant studies would help highlight the significance of the gestational period and its effects on the health and well-being throughout childhood and adult life.

Fetal Origins (the Origins)

David Barker, a noted British physician is generally regarded as the pioneer in the developmental origins of diseases. Twenty years ago, Barker was pondering on a seemingly inexplicable correlation of the higher incidence of heart diseases among some of the poorest sections of the British population. Curious to find out the reason, Barker started an exhaustive study analyzing the health records of 15,000 subjects and comparing it with their birth weights. The results indicated a strong correlation between poor birth weights and heart ailments. Barker hypothesized that the poor nourishment during gestation made the fetus allot most of the nutrients to the brain while the heart and the other organs were inadequately supplied. This, Barker thought, would explain the increased association between poor birth weights and heart ailments in adults. The results were surprising and ridiculed by his peers. As Barker says, "Heart disease was supposed to be all about genetics or adult lifestyle factors. People scoffed at the idea that it could have anything to do with intrauterine experience." [Annie Paul] Since then significant amount of research has been done that have substantiated the fetal origin theory of diseases. A discussion of some of these studies that attest to the fetal origin theory will provide more insight into the topic.

Obesity and its Fetal Origins

Obesity is a condition that is primarily ascribed as genetic in nature. However, a growing body of evidence gathered from some of the recent research on the subject tends to show another contributing factor, one of intra-uterine origin. A 2009 study by Alison et.al focused on maternal gestational weight gain, pre-pregnancy BMI and the onset of later obesity in the daughter. This retrospective study included a total of 26,506 mothers and nurse daughters. The mothers in this study also completed a questionnaire about their daughter in 2001. The results from the study showed that at 18 years, 561 (2.1%) of the daughters and at 2001-5,442 (22.0%) were clinically obese (BMI > 30). The results also suggested that women whose mothers reported a high gestational weight gain (40+ lbs) carried greater risk for developing obesity at 18 (or 1.81, 95%CI 1.22 -- 2.69). This study clearly implicates that GWG and pre-pregnancy weight are "modifiable fetal origins" that affect the onset of obesity in the children. [Alison et.al, (2009)] a 2006 study by Barry E. Levin, which was an exhaustive review of perinatal and prenatal nutritional exposure concluded that permanent changes are wired during gestation that affect the energy homeostasis. In particular, a review of rat study by the author revealed that undernutrition as well as high fat diet in pregnant rats resulted in offspring's that are obese and insulin resistant. [Barry E. Levin, (2006)]

Stress, depression (Fetal Origins)

Fetal environmental exposure to maternal stress has been proved to cause negative emotional attributes in the child. As Catherine Monk, a researcher at the Columbia University says, "Research indicates that even before birth, mothers' moods may affect child development," [Annie Paul] Research by Huizink et.al (2000) and Wadhwa et.al (2001) concluded that the higher degree of maternal stress as measured by the levels of stress hormones ACTH and CORT had a positive relation to abnormal and maladaptive behaviors in their children. The authors concluded that infant stress reactivity is conditioned by maternal stress hormone levels and that these intra-uterine stress exposure impacts postnatal temperament. [Irwing Wiener, pg 120]

Suboptimal fetal development characterized by low birth weight (LBW) is found to be related to the onset of depression among adults. A study by Elizabeth et.al focused on LBW in female and male subjects and its impact on the onset of adolescent depression. For the study the researchers assessed a population-based sample in North Carolina between the age group 9 and 16. The study authors then assessed LBW as an independent predictor of depression, and in other models that included LBW, perinatal and prenatal adversities, LBW, Perinatal and childhood adversities. The results showed that a high depression rate of 38.1% (95% confidence interval [CI], 16.3%-66.0%) for LBW adolescent girls compared to 8.4% (95% CI, 5.2%-13.3%) for normal birth weight adolescent girls. There was not a significant effect on adolescent boys. The authors concluded that low birth weight was a predictor for adolescent depression among girls strongly supporting the fetal programming theory. [Elizabeth et.al (2007)]

Fetal health and infant mortality (Social interventions)

The U.S. is the economic powerhouse of the world and the global leader in science and technology. However, it is a deplorable fact that it has a very poor infant mortality record with 6.4 deaths per 1000 births. [CIA, (2010)] the statistics have remained stagnant for the last five years or so. Most other European nations are ahead of us. A comprehensive program that addresses the social, health, economic and environmental factors that affect fetal health is required to control fetal and infant mortality rates in our country. Over the last few years, the State of California has instituted a program to reduce the infant mortality rates. Such a proactive community based intervention is vital to bring down our national infant mortality rate. The program includes five components namely 'Family Support', 'Maternal Interview', 'Records review', 'case review' and 'Community action'. (FIMR, 2010)

The FIMR Process

FIMR Informed of Fetal/Infant Death

Family Support

Data Collection/Record Review

Maternal Interview

Records Review

Case Review

Community Action

Improved Maternal & Infant Health

(FIMR)

Conclusion

Fetal origins of health and disease has developed into a new medical frontier for researchers. The growing body of research evidence has affirmed positive associations between the gestational environment and the development of various physical and mental disorders in the infant, adolescent and the adult population. The new knowledge that even gestational diet composition has the ability to alter the human epigenome resulting in the expression of undesirable genes and the onset of obesity, diabetes, cancer and other chronic health conditions, is convincing scientific evidence for pregnant women to be careful and cautious in their diet choices. Results from the studies on maternal stress and its impact on postnatal temperament have provided further evidence for the importance of stress free maternity. A decade ago, attributing fetal origins to disease conditions might have evoked a scoffing response, but the plethora of scientific evidence that is available today has changed it. A healthy, stress free maternity period is critical for the healthy fetal development and healthy future life of the offspring.