On the back of long-running research that proves that chronic disease in the child starts with the mother, the next step is solving the issue at large.
Last week we had a look at how extreme stress in pregnant women can seriously and permanently impact on their unborn children through epigenetic changes that take place in the womb. Today, I would like to focus on the body, and how, scientists now say, “we are what our (grand)mother eats.” It is another example of how we are literally connected to the past. But first a little recap and update.
A few months ago, a group of scientists from Germany, Holland, Belgium, Finland and the US pulled all the research together that had been done, worldwide, into severely stressed pregnant women and their children. Worryingly, there wasn’t a positive story amongst the academic papers. Time and time again, what researchers found was babies who were stunted in their neurological development had cognitive problems and, worst of all, psychiatric disorders. PTSD, anxiety, depression, bipolar, eating disorders, autism, ADHD, schizophrenia, psychosis and more suicides: it wasn’t a pretty picture. And even more problematic: those illnesses lasted throughout their lives.
One of the most interesting pieces of research included in the study was started 20 years ago and has been running ever since. The lead investigator is Tessa Roseboom, now professor of early development and health at the University of Amsterdam, The Netherlands. But in 1998, she was doing her PhD when she came across detailed records that doctors and nurses in one of Amsterdam’s hospitals had kept, describing the babies that were born in their wards between November 1944 and June 1945. That may sound run-of-the-mill but it is in fact exceptional because during that time the north of Holland, and Amsterdam in particular, suffered through what came to be known as the “hunger winter”, or “Dutch famine”. WWII had started in Holland in May of 1940 and by the end of 1944 the Allied Forces had finally managed to liberate the south of the country. But then Operation Market Garden (to get control of the bridge across the Rhine at Arnhem; remember A Bridge Too Far?), failed and the advance of the Americans, Canadians and Australians stopped. As a response, the Dutch railways went on strike, following a directive of the Dutch government in exile. The Germans were not happy and as a reprisal banned all food transports. Unfortunately, it was an extremely cold winter, so food couldn’t come in by water either, because all the rivers were frozen. In November 1944, rations dipped below 1,000 calories. At the height of the famine, between December 1944 and May 1945, people in Amsterdam, in particular, had no more than between 400 and 800 calories at their disposal. There was also no heat, no gas, no electricity, running water, soap, clothing or shoes. Hospitals had very little medication and were seriously overcrowded. 20,000 people died, but despite the famine, women were still getting pregnant.
The “Dutch Famine Study” has been looking at the babies who were born during or just after the hunger winter. All of their mothers had been suffering from malnutrition during their pregnancy, and Roseboom wanted to know what consequences that had had. She and her team investigated 2,414 people born around the time of the famine, 800 whose mothers had been pregnant during the six months of starvation, and two control groups either side. What Roseboom found was devastating. Almost every one of the 800 was suffering from the effects of the famine, even decades after they were exposed. There was more heart disease, diabetes, kidney disease, early rheumatoid arthritis, disturbed blood coagulation, obesity, risk of breast cancer, vascular damage and obstructive airways disease. Later research into the same group also proved that especially the men had sustained irreversible damage to the developing brain, which had resulted in an altered brain structure and decreased cognitive function during adulthood. For quite a few of them, that had meant a lifetime of struggling to get or hold a job. The same research also wondered about the women. A lot of them had died young, which is why they couldn’t be tested. But that didn’t mean they didn’t suffer from the same ailment.
For Roseboom, it was proof of what is called the “fetal origins hypothesis”, the idea that chronic diseases originate in the womb through adaptions made by the fetus, in response to malnutrition of the mother. The fetus makes those changes so the baby has a better chance of survival once it is born, but Roseboom’s research showed that there was a price to be paid. As she said during a 2014 talk, because when your grandmother was pregnant with your mother and the precursor cell of the egg you developed from was already present in your mother’s ovaries, “you are what your (grand)mother eats.” And if she didn’t eat enough, that has enormous consequences. Not just when the baby is born, but throughout its life.
Of course, scientists have long suspected that malnutrition during pregnancy is not good for the baby. But before Roseboom’s study came along, that could only be proven through research in animals. Not because there aren’t enough human famines around, but because they are usually messy and badly written up. The Dutch famine was special, because it had a sudden onset and relief (by June 1945, a month after the liberation of the country, calorie-intakes quickly went back up to 2,000) and it was accompanied by detailed records on mothers, babies and their rations. Also, these babies grew up in a wealthy country, without exposure to hunger or other deprivations later in life. But despite that, the consequences were still there and apparently irreversible.
The Dutch Famine Study has become Tessa Roseboom’s life’s work. She now cooperates with the Gates Foundation and her research is part of an international databank that collects worldwide information on child development, growth and health. She is also one of the lead researchers connected to the 1000 Days Foundation. It advocates for more attention to the link between malnutrition in pregnant women and the negative outcomes in the next generation. Globally, they say, one in four children under the age of five suffer from what they call “stunting”: serious and often permanent damage to the developing brain and body. 20% of stunting starts in the womb, and calculations have shown that it can reduce a country’s GDP by 12%. Impaired brain development, lower IQ, weakened immune systems, chronic diseases, greater risk of diabetes, cancer and psychiatric disorders all undermine not just the human, but also the economic, power of a country. The 1000 Days Campaign focuses on the time in a baby’s life that runs from pregnancy until the end of its second year, and is asking the world to take notice.
Dr. Akinwumi Adesina, president of the African Development Bank, made it very clear during the speech he gave at the opening of the 2017 Global Nutrition Report. 800 million people live with extreme poverty and hunger, he said, while 1.3 billion tonnes of food go to waste every year. That is a scandal, not just morally, but also financially. “Stunted children today means stunted economies tomorrow. Nutrition is an investment in the future.” Tessa Roseboom’s study has shown why, and what we need to do to fix it. Feed the would-be mothers. It is as simple as that.