Prenatal Programming: How Mothers' Health Affects Their Babies

Dr. Michael C. Lu's paradigm shift in medicine is called a "life course perspective": the idea that health is not isolated to stages of life, but that those stages are interconnected. It is the philosophical underpinning behind his devotion to prenatal care. Indeed, there are some surprising connections between mothers' lifestyles and nutrition during pregnancy and lifelong health effects on their children.

Lu is an associate professor of obstetrics and gynecology and public health at UCLA and the author of the book Get Ready to Get Pregnant (2009). He is a lead investigator of the National Children's Study and an ambitious health reformer with a long-term perspective. He began his talk at the seminars of the California Health Journalism Fellowships with this Chinese proverb:

"If you want one year of prosperity, grow grain. If you want 10 years of prosperity, grow trees. If you want 100 years of prosperity, grow people."

Growing healthy people begins with devotion to creating healthy mothers, Lu told California Endowment Health Journalism Fellows and the program's board members at a luncheon in Los Angeles on Friday. Lu gives this metaphor: "If you fail the midterm, you have to work a lot harder to pass the final." Here is some of the research he presented that underlines the importance of prenatal and pre-prenatal health:

• A study published twenty years ago, known as the Barker hypothesis, demonstrated the connection between low birth weight and coronary heart disease.

• A 2001 study demonstrated the connection between prenatal stress and the child's cognitive function. Lu made the distinction between experiencing stress and being "stressed out," or experiencing chronic stress (such as the type one social epidemiologist documented in low-income communities in Philadelphia)

• Diets rich in folic acid turn off a gene associated with obesity. Much research has been done on the effects of diet during pregnancy on childhood obesity.

• Preterm birth is the leading cause of racial disparities in infant mortality. Women who have a preterm birth are more likely to have a heart attack in the next 20 years than women who did not have a preterm birth. What can we do to prevent preterm birth? "We've got to start taking care of women before they get pregnant," Lu said.

• Racial discrimination has real adverse health effects. Lu wrote a paper outlining 12 ways to close the racial gap in birth outcomes.

Dr. R. Jan Gurley, one of this year's fellows, expressed doubts about some of these studies and "prenatal programming" or life course theories. "Where's the hard data?" she asked. Gurley worries that coverage of this kind of research may foster unfair blame-the-mom narratives.

Lu said that his life course theory is still in its early stages. It highlights new conditions that are outside mothers' control. "We definitely need to do a lot more in improving the science," he said. "But we need to pay attention to how this science is used. It should not be used to 'blame the victim.'"

You can find slides from a similar talk Lu gave in 2008 here.