Birth of a new perspective

In August, medicine lost one of its towering figures — a man whose work on maternal nutrition had led to the conclusion that what happens to us in the womb is the most important determinant of our health in middle and old-age.

Prof David Barker was born in 1938 and evacuated to Hertfordshire, in the English countryside, during the bombing blitz on London. After training in medicine, he studied epidemiology (disease patterns).

While working in Southampton, he studied why poorer people in the north of England were more likely to die early of heart disease than their wealthier peers in the south. Premature heart disease and stroke were prevalent in large industrial towns in the north, like Bolton and Preston, where infant mortality had been most common in the early part of the 20th century.

He speculated that these high rates of infant death were reflective of environmental hardship, poverty and poor nutrition in these areas in the early 1900s, and that these deficits would have compromised the development of foetuses as they grew in the womb. Barker suggested that this “nutritional insult” during pregnancy was the major cause of the high heart disease and stroke rates observed in these areas several decades later.

It was an audacious assertion, and one which garnered little support. Without hard data to support his theory, it’s likely that the ‘Barker hypothesis’ would have receded into obscurity.

Fortunately, Barker’s team got a lucky break.

Birth records were discovered of the weight and physical characteristics of babies born in Hertfordshire between 1911 and 1948, and while the data-protection rules dictated that accessing these records was problematic, the local registrar took a more sympathetic view, when told of Prof Barker’s enforced childhood sabbatical in the locality during the war years.

In achieving this coup, the ‘local boy made good’ now had the meticulously detailed birth-record information he needed to prove his theory.

In total, 12,000 of the 15,000 people captured in the Hertfordshire birth records were still alive, with the majority still living in the local area.

By following 6,000 of these now middle- to old-aged men as they began to succumb to chronic disease, Prof. Barker demonstrated a link between low birth-weight (a crude indicator of poor gestational conditions) and increased risk of high blood pressure and death from heart disease, in adult life.

The findings of this research work were published in the late 1980s and early 1990s, and have since been corroborated by a multitude of similar studies worldwide.

In terms of intervention, these studies consistently demonstrate the role of poor maternal nutrition in high blood pressure, heart disease, stroke and diabetes in later life; more importantly, they indicate that the corollary is also true — that diets high in fruit, vegetables, oily fish, lean, red meat, low-fat dairy products and wholegrain cereals will yield long term-health benefits for the developing foetus.

As of now, however, the monumental discoveries of this trail-blazing pioneer, and their implications for public health, are yet to be fully appreciated at policy level. When they are, the full realisation of this remarkable man’s genius, and the void left by his passing, will be all the more apparent.

* Dr Daniel McCartney is lecturer in human nutrition and dietetics at DIT.

Tips for staying healthy in pregnancy

* Eat a wide variety of fruit and vegetables, especially dark-green leafy ones, and brightly coloured, red, orange and yellow varieties. Take at least five servings per day.

* Take fresh, lean, red meat three to four times a week. These contain valuable nutrients like iron, zinc and vitamin B12, which are essential for you and your developing baby.

* Have three servings of low-fat dairy foods each day (a glass of milk, a pot of natural yoghurt, etc). These have calcium to protect your bones and build your baby’s skeleton.

* Oily fish contain valuable Omega-3 oils, required for your baby’s brain development — go for small varieties like herring, mackerel and especially sardines.

* Supplements — don’t forget to take your folic acid (400 micrograms per day before and throughout your pregnancy) and vitamin D (10 micrograms per day).


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