A New Year's Resolution

[Origionally posted to the PPG blog on January 3, 2016 by Dr KL Lagana]

As I gave thanks to some dental work for interrupting my holiday food binging, I reflected on the abundance I experience. As a nurse making a fair living, I cannot remember the last time I was hungry. But that is not the case for many in our country and around the world. A pause was needed to consider first, had I shared enough, and secondly, prospectively what impact does hunger and inadequate nutrition have on our pregnant patients, the fetus, the neonate, the family.  A cursory Google search quickly produced something that I had learned many years ago in graduate school (but had forgotten) about the Dutch Hunger Winter.

The “Dutch Hunger Winter” occurred towards the end of WWII in The Netherlands from October 1944 to May 1945, as a result of the German blockade.  Food stocks in the cities in the western Netherlands rapidly ran out. The adult rations in cities such as Amsterdam dropped to below 1000 kilocalories a day by the end of November 1944 and to 580 kilocalories in the west by the end of February 1945. Starvation occurred and in those women carrying pregnancies, there was a high incidence of pregnancy lost, preterm labor, and small for gestation age birth weight. The Dutch Famine Birth Cohort Study (Stein, et al.1975) found that the children of the women who were pregnant during the famine were smaller, as could be expected. However, surprisingly, when these children grew up and had children, those children were also smaller than average. These data suggested that the famine experienced by the mothers caused some kind of epigenetic changes that were passed on to the next generation.

Findings from ongoing follow-up research on these starvation pregnancies (two generations out) show associated diabetes, heart disease, obesity, and schizophrenia in those offspring AND their offspring (Haij, 2014). Epigenetics has been defined as the study of the mechanisms controlling gene activity during development of “complex organisms" (Holiday, 1990). An area of research called developmental origins of health and disease (DOHAD) has been exploring for some time possible epigenetic changes related to the fetal intrauterine environment.

So where does all this leave us?  Well, we know that famine is bad for anyone. But we do not understand how obesity in subsequent generations is genetically hard-wired. We do not fully understand the impact of micronutrient deficiency on fetal genetics.  What is clear is that nutrition in pregnancy may be one of if not the most fundamental components of prenatal care.

Pacific Perinatal Group will explore this topic further at our spring 2016 conference: Mamatoto: Integrating Maternal, Fetal, & Neonatal Care. For further information go to: http://www.pacificperinatalgroup.com/events/spring16. As we ready ourselves for another year of caring for childbearing women and their babies, it is helpful to consider this early 18th century proverbial saying: “As the twig is bent, so is the tree inclined.”  Early influences can have a permanent effect.

My New Year resolution is this: to do what I can to protect, nourish, nurture, and educate childbearing women as our best hope for future population health. Happy New Year from Pacific Perinatal Group!

References

Hajj, N, Schneider, E, Lehnen, H., & Haaf, T. (2014). Epigenetics and long term consequences. Reproduction, 14 pp. 111–R120

Holliday, R. (1990). DNA Methylation and Epigenetic Inheritance. Philosophical Transactions of the Royal Society of London. Series B,  Biological Sciences. 326 (1235), pp. 329–338.

Stein, Z., Susser M., & Saenger, G, et al. (1975). Famine and Human Development: The Dutch Hunger Winter of 1944–1945. New York: Oxford University Press.