Fruit of the womb

In the words of William Blake, in the early 19th century: “Man brings all that he has or can have into the world with him. Man is born like a garden, ready planted and sown”.

Nearly 200 years later, Prof David Barker from the University of South Hampton invoked those lines to describe his theory of foetal programming.

Foetal programming is the idea that our health in middle- and old-age is predetermined by the conditions we experience in the womb. While we’re familiar with the hazards of smoking during pregnancy, people don’t appreciate the critical influence of a pregnant woman’s diet on the long-term health of her offspring.

The story of foetal programming is compelling. Barker was a doctor of epidemiology (the study of disease trends) when he began examining the regional differences in heart disease across Britain in the 1970s. There’d been much speculation about why people in northern England were more likely to get heart disease and stroke than their wealthier peers in the south, but no convincing answers.

Barker happened upon a set of old and detailed birth records, which had been compiled by a team of Hertfordshire midwives under the direction of their supervisor, Ethel Margaret Burnside, between 1911 and 1945.

As he examined these records, Barker realised that the areas where low birth-weight had been most common decades before were the areas where death rates from heart disease and stroke were now highest.

Fortunately, many of the babies identified in these old birth records had grown up and remained in Hertfordshire, and were now entering middle- and old-age.

From 1986, Barker and his team contacted thousands of these adults and monitored them closely over the following years to assess their health outcomes.

Combining their health data with their birth records, he showed that low birth-weight (unless premature) was an important risk factor for obesity, diabetes, high blood pressure, stroke and heart disease in middle-age. While there have been refinements to his model over the intervening years, the basic principal that poor maternal diet in pregnancy yields smaller babies, who are vulnerable to disease in middle-age, has now been proven time and time again in many different populations.

This is all interesting, but what does it mean for the future mothers of Ireland and the overall health of our nation?

Well, we know that many young women in this country have woefully insufficient intakes of critical nutrients like iron, calcium, folate and vitamin D, in addition to excessive alcohol intakes. All of these factors can impair development of the foetal brain, skeleton, cardiovascular system and immune system, yielding babies who are smaller and more likely to succumb to ill-health earlier in adulthood.

Indeed, it’s likely that our current high rates of cardiovascular disease and stroke are at least partially attributable to past deficits in the maternal diet.

And yet, these nutritional deficiencies are so simple to address. By taking a high-fibre breakfast cereal each morning, good quality red meat three days per week, plenty of fruit, vegetables, fortified milk and oily fish, and a daily folic acid and vitamin D supplement, women can cover all of the extra nutritional demands imposed by pregnancy.

Given the profound research discoveries of the past couple of decades, and the health problems that continue to beset Irish adults, the value of doing so cannot be overstated.