Health Begins in the Womb - and Even Before | Chris Kresser

Health Begins in the Womb – and Even Before

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What determines our health?

On this blog we’ve discussed a number of answers to that question. In fact, I just wrote a series called 9 Steps to Perfect Health in which I listed what I consider to be the most significant lifestyle factors contributing to health and disease.

Then we have the contribution of genes – the DNA we inherited and how it shapes our development and health. Chris Masterjohn is writing an excellent series on genetics over at his blog, The Daily Lipid.

But recent research suggests another powerful influence on lifelong health: your mother’s nutritional status during (and even before) her pregnancy. In fact, some researchers now believe the 9 months of pregnancy are the most consequential period of our lives, permanently influencing the wiring of the brain and the function of organs like the heart, liver and pancreas. They also suggest that the conditions we encounter in utero shape everything from our susceptibility to disease, to our appetite and metabolism, to our intelligence and temperament.

You’re only has healthy as your mother’s womb

The idea that the nutritional environment we encounter in the womb affects not only our health at birth and during infancy, but throughout the rest of our adult lives, has come to be known as the Developmental Origins of Health and Disease theory, or DOHaD (gotta love that acronym).

The theory was first proposed by British researcher David J. Barker in the 1980s to explain a seeming contradiction: as British prosperity increased, so did heart disease. Yet geographically, the highest rates of heart disease were found in the poorest places in Britain. Barker found that rather than smoking, dietary fat or some other lifestyle cause, the factor that was most predictive of whether an individual would develop premature heart disease (before the age of 65) was their weight at birth.

Barker found that infants carried to full term with birth weights between 8.5 and 9.5 pounds had a 45 percent lower risk of developing heart disease later in life than infants born at 5.5 pounds. (They also had a lower risk of stroke, a 70% lower risk of insulin resistance and a slightly lower risk of blood pressure later in life.) As the chart below demonstrates, the risk declined in a linear fashion between 5.5 and 9.5 pounds, but started to increase again as birth weight rose above 9.5 pounds.

Relationship between birth weight and heart disease

How the first nine months shapes the rest of your life

Over the last 25 years, Barker’s original work has been reproduced and expanded. If you do a quick search on Pubmed.org for “developmental origins of disease”, you’ll find references to the fetal origins of cancer, heart disease, allergies, asthma, autoimmune disease, diabetes, obesity, mental illness and degenerative conditions like arthritis, osteoporosis, dementia and Alzheimer’s.

The following list is just a small sampling of the literature on the subject:

  • The metabolic syndrome. In a 2011 paper, Bruce et al showed that the onset of metabolic syndrome is “increasingly likely following exposure to suboptimal nutrition during critical periods of development”.
  • Heart disease & diabetes. In 2002, Barker, the father of the DOHaD hypothesis, published a paper suggesting that slow growth during fetal life and infancy – itself a consequence of poor maternal nutrition – predisposes individuals to coronary heart disease, type 2 diabetes and hypertension later in life.
  • Breast cancer. Hilakivi-Clarke, et al . “Thus, maternal diet and environmental exposure might increase the risk of breast cancer by inducing permanent epigenetic changes in the fetus that alter the susceptibility to factors that can initiate breast cancer.”
  • Polycystic ovary syndrome (PCOS). Dumesic et al 2007. This paper suggested that insulin resistance and resulting increases of testosterone during pregnancy promotes PCOS during adulthood.
  • Obesity. Kalliomaki et al 2008. These researchers found that simply by studying the composition of the maternal gut flora (influenced by nutrition, medications, stress, etc.) they could predict which children will be overweight by age 7!

There are literally hundreds of similar papers in the literature, all pointing to the same conclusion: the nutritional environment in the womb has a significant effect on our health later in life.

Why does Mom’s diet play such a crucial role in determining our future health?

The idea that the nutritional, hormonal and metabolic environment provided by the mother permanently programs the structure and physiology of her offspring was established by Barker back in the 80s.

Essentially, it works like this. Like all living beings in their early lives, humans are able to adapt to their environment. If we couldn’t, we would die. There is a critical period early in life where that adaptation happens, and once that period passes, we become less “plastic” and able to adapt. Our programming is set.

For humans, that critical period when a system is plastic and sensitive to its environment occurs in utero. This makes perfect sense in evolutionary terms. It enables the production of genetic phenotypes that make us better matched to the environment we are likely find ourselves in after we’re born.

For example, if the mother’s nutritional status is poor during pregnancy, the fetus might develop metabolic adaptations that would allow it to store more calories (the “thrifty phenotype” hypothesis). This would have been a protective mechanism that could increase the chances of survival if that fetus was born into an environment where calories were scarce.

Gluckman et al extended this concept of developmental plasticity by showing that fetal programming operates across the range from undernutrition to overnutrition with a U-shaped curve. This means that the future health of the baby will be affected when Mom gets either too little of the right nutrients or too much of the wrong ones.

Roseboom et al found that undernutrition during pregnancy affects different organs of the body and increases the risk of disease independent of birth weight. Other researchers have theorized that maternal diet may regulate blood flow to developing organs (i.e. to the brain vs. the liver) which in turn causes changes in fetal programming that affect body composition at birth and even later in life.

The nutritional conditions in the womb start before conception

We’ve now established that the nutritional environment of a mother’s womb affects her baby’s health not only at birth and during early infancy, but for the rest of his or her life. This leads us to the obvious conclusion that proper maternal nutrition is crucial for the lifelong health of her offspring.

But what determines the mother’s nutritional status during pregnancy? Certainly, the obvious answer is her diet and lifestyle after she has conceived. But I hope it’s also obvious that the mother’s diet in the months and even years leading up to conception is also important.

This is why traditional cultures have sacred fertility foods they feed to mothers-to-be and even fathers-to-be. These include nutrient dense foods like fish eggs, liver, bone marrow, egg yolks and other animal fats. For example, the Masai tribe in Africa only allowed couples to marry and become pregnant after spending several months drinking milk in the wet season when the grass is lush and the nutrient content of the milk is especially high.

Unfortunately this traditional wisdom has been largely lost in the modern world. The role of nutrition during pre-conception is scarcely even mentioned in the media or conventional medical settings. Yet as we’ve seen in this article, a mother’s diet prior to conception and during pregnancy may be one of the most important factors in determining the lifelong health of her baby.

Another problem is that many women are (understandably) confused about what constitutes proper nutrition during the pre-conception and pregnancy period. There’s so much contradictory information out there, and it can be difficult for the layperson to know what to believe and who to trust.

As many of you know, I’ve been teaching a seminar called Grow a Healthy Baby on nutrition for fertility, pregnancy and breastfeeding locally in the Bay Area for the past several months. I’m excited to announce that this material will soon be available as an online home study course. I’m shooting for mid-May as a launch date.

To learn more about the course and sign up to be notified when it becomes available, click here to join the mailing list. I’ll be making a special limited-time offer to people on this list, so be sure to sign up early if you’re interested in the course.

  1. Hi Chris,

    We’re pregnant! And now I’m looking for a prenatal. The Nutrient 950 + Vit K seems great but do you have any concerns about the high Vitamin E (400 i.u.)?

    I’ve read that trials revealed that it doubled the rate of stillbirths, led to low birth weight and increased health complications in the newborn.

    Any insight is welcome. Thank you!

  2. I really would like to order pure encapsulation multivitamins recommended but need fulfillment code. Can anyone help me?

  3. Chris I know this is an antiquated thread but are you still recommending the same prenatal and clo supplements? Thanks!

  4. Hello, I am wondering if Chris or anyone on the team has any updated information on GD, specifically with regard to Chris’ ideas regarding high Fasting Blood Glucose and cortisol dysregulation. In addition to this article I’ve read Chris’ exchange with Kurt Harris on the WHS blog, and a few other related articles, although most of what’s out there focuses on the problems with the OGTT and not with GD / high FBG itself.

    My wife and I have followed Chris for many years and have eaten fairly strict paleo most of the time. Stress and sleep have been big problems sometimes, though. Currently she is 3 months pregnant and showing 95-105 FBG in the morning, post-prandial glucose seems okay. Would love to be pointed at more resources if any are available.

    Sorry for commenting on an ancient post! Perhaps it will pop up on somebody’s radar. Thanks for all you do!

  5. In the paleo community, I can’t find anything on this — how do you address health/nutrition, fertility and prenatal health after a stillbirth or miscarriage. A stillbirth a 9 months is a full pregnancy, any thoughts on how a woman who can’t nurse get healthy again and set herself up for subsequent pregnancies?

  6. Hi Chris.

    Late to the party on this one, but I’m looking into alternatives to prenatals for my pregnancy. I was taking the PE 950 that you recommended but they made me incredibly nauseous so I switched over to Thorne’s Basic Nutrients 2.0. These are working for me, but my question is about vitamin K. Recently I’ve seen some rumblings (echoed on the websites of Weil and Mercola) that too much supplemental K during pregnancy can increase risk of jaundice “and other issues” in the newborn. I’ve been looking for actual studies and can’t seem to find any. Your thoughts on this? The nutrient 950 has a super high dose, so wondering what you’ve come up as far as the safety on this and if it’s a real risk or not. Thanks a bunch!