Health Begins in the Womb - and Even Before | Chris Kresser
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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 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. Confussing. . .My mom is now 92 years old. She has had basically NO real heal issues through her life. My father died at age 90 2 years ago. He did everything wrong and did not have troubles with Celiac diesease until two years, before his death. AND The Hospital wasn’t sure that he even had Celiac Disease. He just had the Blister created from Gluten. . . .BUT THEY weren’t even sure of that. Anyway I have Autoimmune issues and have been on the several different diets to Paleo, Special Carbohydrate diet. . .etc. AND have not found anyway to get rid of inflammation in my body. I have always tried to do whats right to be healthier. Yet, I’m the one who is sick. It just doesn’t make sense to me. Could you possible explain how my parents could be healthy BUT I am not. I have been compliant and diligent to do whats best for my Body, BUT Still have not gotten rid of inflammation. True, it’s probably better than it was, BUT I still have inflammation that I have not been able to get rid of. How much does stress cause inflammation. I’m at the age where I and my husband are taking care of two parents. My mother, who lives with us and My Mother-in-law who lives down the street. Is is stress that can also cause inflammation. My husband and I do our best to keep a positive attitude and prayer really makes a difference, when I focus on God, my heavenly father. BUT its still a difficult situation and can’t deny that. BUT is an obligation that Both my husband and I feel we must keep to our Parents. So, please don’t ask me to stop. Are there any other solutions I could look into that would help with taking care of our parents. Both my husband and I have been in and out of Counseling to help and we are going to a support group for parents with Cognitive issues. Is this something I just need to ride it out? and this Inflammation is not going to go away at this time, because of the stress with taking care of two parents with Cognitive issues?

    • Have you tried probiotics? Check out dint worry, I don’t make money off of recommending them :), I just believe in the power of good gut bacteria and a balanced inner ecosystem and she seems to have great success. Hope it is at least a little helpful!

  2. Hello I am studying an MA in Social Work and I was hoping that Chris or one of his staff would be able to send me over some of references that he has used for the articles so I can take a look at them for my studies. I’m just writing a section on how stress can affect childhood development and raise the likelihood of mental health illnesses. Any help would be great.

  3. I am following a paleo/primal diet (for the most part), so I’m wondering if I really need to take any vitamins at all while pregnant. If I’m eating a well rounded diet I’m not sure I want to over do it with a bunch of vitamins too. Please help!

  4. Hi, So I am concerned with my health now having three children of my own. I was born 4.4 lbs and my mother smoked. I am worried of dying young and not being there for my children as we also have major heart disease in my family. How can I lengthen and change my future? I have done everything in my power to feed myself and my kids healthy knowing that if affects their entire life.

  5. Hi Chris>

    I have just attended a course run by Elisabet Stener-Victorin from
    > sweden on the use of acupuncture on PCOS, Insulin resistance, and
    > other womens health issues. You may be familiar with her work but if
    > not check out her studies. I think she has one recent one not
    > published that shows acupuncture and exercises reduce testosterone in
    > PCOS- pretty cool stuff.
    > The other study you may find interesting is
    > This looks at the timing of gluten exposure and coeliac disease. It
    > concluded that exposing children to gluten at around 4-6 months
    > reduced the likelihood of coeliac than before 3 or after 7 months. I
    > am no expert at appraising studies but I expect that parents who are
    > already coeliac of at least gluten sensitive are more likely to wait
    > till after 7 months?


  6. I also would like to know what to do about auto immune and pregnancy. I just found out last week I have Hashimotos and my 2nd son (2.5yo) was born hypothyroid. I am 36 and would like more children. Not sure how to approach this while still having more babies. Any guidance is much appreciated!

  7. Still halfway on the Healthy Baby Code, it has been great so far, highly recommended. I don’t’ know if you have discussed this on the blog or if it’ll be in the Healthy Baby Code, but I’d like to know your opinion on what would change in the diet of a mother to be if she’s having some kind of autoimmune/ general inflammatory process going on. Would you change anything in the diet (increase the intake of anything or remove something from the diet) or would you consider supplementing with anything? I’ve read a bit about anti-inflammatory diet but I’d like to know your opinion on that and about the safety of supplementing with high dose of omega-3 fatty acids or alike. Thanks!

  8. Thank you! I ordered the fermented cod liver oil capsules, since I travel and I can include them in my carry-on luggage. Does anyone know how to convert the capsules to mL?

  9. Hi Chris,

    My husband and I love your blog and can’t wait to purchase your Healthy Baby course. I actually just found out that I am pregnant on Sunday (yay!). So, although we are hoping to go through the online course this weekend, I want to get my supplements in check now. I have been taking a prental vitamin that contains folic acid as well as a high quality Omega 3 fish oil supplement for several months now. My husband heard you say on Rob Wolff’s podcast that you recommend tetrahydrofolate rather than folic acid (which is what my prenatal contains). We listened to your FAQ that goes with the Healthy Baby course and you recommended fermented cod liver oil. You also mentioned a vitamin you think is ok (I think you actually said it is “pretty close to what you would put into a multivitamin if you designed one.). I follow a paleo diet with very little dairy, lots of grass-fed beef, and organic fruits and vegetables. Unfortunately I’m still pretty picky about my veggies and I cannot stomach liver (although I ate lots of it when I was a baby, and so did my mom while she was pregnant with me, and I’ve always been super healthy, go figure).

    Anyway, the reason I am writing you this super long comment is that I would really like to get my supplements in check ASAP. Should I completely stop taking my prenatal? I also travel quite a bit for work and sometimes I do not have a lot of produce available, so I wonder if I shouldn’t have a vitamin available to take during weeks when I have few healthy food choices around. Is it safe to take the vitamin you recommended with fermented cod liver oil? Do you just recommend the dosage listed on the FCLO package for a pregnant woman? Like I said, I am healthy (no autoimmune problems, I just feel better eating paleo), I’m 26, I’m 5’10 and weigh 135, so I have a pretty healthy BMI, I’m fairly active, and I follow a paleo diet, with occasional potato, cheese, and very rare sugar indulgences.

    I know there is no “magic formula” but I trust your advice and I just want make sure I am doing what’s best for me and the babe and I also want to make sure there is no way I’m overdosing on Vitamin A or any other nutrient.

    Thanks so much!!


    • FCLO dosage during pregnancy: 10 mL/d. The multi I recommend is Nutrient 950 with vitamin K, by Pure Encapsulations. It’s nearly impossible to overdose on vitamin A as long as you have sufficient levels of vitamins D & K. I explain this in detail in the course. Congratulations on your pregnancy!

      • Hi Chris
        Thanks so much for providing such helpful, thorough, understandable information. I have learned so much from you.
        I am pregnant and nursing a toddler and have started taking 2tbsp fclo/bo (before breakfast) and 6 capsules of PE nutrient 950 with vitamin k (3 after breakfast & 3 after dinner). Since starting I have experienced some painful stomach cramping and diarrhea (not constant. Usually in the morning). Could it be the supplements causing this?
        Thanks for your help

        • Monique: try splitting it into several doses throughout the day, and see if that helps.

      • Thanks, Dr. Kresser!
        Why do you recommend the Nutrient 950 with Vit. K, instead of the Prenatal Nutrients made by the same company?

  10. Chris- for me this is an important article. Though I’ve been aware in general of the importance of nutrition during pregnancy, this article raises the significance to a whole new level. I forwarded it to my niece who’s just about to graduate from a midwifery program.

  11. Great article, Chris… Very impressed with your blog and site so far. My wife and I have found that the simple act of changing the way our kids eat has gotten rid of many of the issues we’ve had with ear infections, excema, sleeping problems and asthma. All four of our kids have had success changing around diet patterns impacting health. It’s okay to be a healthy skeptic!

  12. Hi Chris, I’ve been a follower of you for a while now and I found your site very informative. I happen to have a very unhealthy first pregancy my following 2 and my current are indeed the best so far. Thank you for sharing such valuable articles.

  13. Hey Chris, I teach birth classes (Bradley method) and we are very active in promoting nutrition.

    We advocate Dr. Brewer’s “Brewer Diet” – which recommends plenty of milk, eggs, butter, meats, fish. We have a chart the women fill out with their food intake that calculates how much protein they are getting. We really emphasize eating sufficient protein.

    You might want to hook up with local Bradley teachers and bounce your ideas off of them.

  14. I noticed you are in the bay area. I’m 33, and am interested in getting my hormones tested to find out what their levels are and how those levels may be predictive (not a guarantee) of how long, or if I even am fertile (I have no reason not to think I am.) Basically I want to make a more informed guess about how long I can or can’t wait, is this something you could do at your clinic? If not, what information should I start learning about? (I know I can get tests via LEF, but would prefer someone that knows more than me to help)

    Related to the article, it seems like, based on how diet can modify disease, that just because you had a crappy womb environment doesn’t mean all hope is lost? Any thoughts on that?

  15. I am a post World War 2 baby – 1953 born in the UK, of a malnourished mother. I look at her wedding photographs and I see an anorexic (happy) woman… I was born 13 months later. From birth I was a sickly screaming child. Mum could not breast feed so I was placed on diluted cows milk (I think). At the age of two I was opearated on for intussusception (life threatening), and have had bowel probelms all my life. I can relate to this article and hypothesis. My Mother was starved, I was born at just under 5lbs….. I have autoimmune disease diagnosed now and, somehow this theory makes sense. I eat healthy but it makes no difference.

  16. It was discovered by a nursing mother – working in the aerospace industry – who was working with solvents in a confined space, she could smell those solvents on her babies breath – they were being transmitted to the baby via her breast milk.

  17. I think moms get the idea that they need to eat well during pregnancy, but they have no idea what “eating well” means, do they? I pray your class is wild success. Pregnant moms and nursing babies are our hope for a healthy humanity. Thanks for writing such great content.

  18. Chris – This is great information, thank you. The other issue I’ve been trying to figure out is the role of breastfeeding mother’s nutrition after birth. Suppose a mom eats an adequate amount of nutrient dense foods, so no deficiencies per se, but what about additional problematic foods and substances? Say, sugar, fructose, refined grains, etc? Do we know what affect these will have on baby, shape the cravings but is that also predictive in certain health conditions later on?

  19. I just saw an article on TIME magazine’s website about how low-carbing pregnant women are dooming, just DOOMING, their babies to a lifetime of fatness.

    The article does not say how much fatter kids are when their mothers have low-carbed. I don’t even know their *definition* of low-carbing. And they did not compare this group to other groups of pregnant women following other diets, such as veganism or heavy industrial prepackaged food intake.

    And they completely failed to note that a baby born at 9 pounds or heavier is at greater risk for diabetes later in life and, more immediately, the larger the baby is at birth, the greater the risk of labor complications, Caesarian section, and maternal death.

    Furious would not even begin to describe me. Especially when one considers that women with gestational diabetes *must* eat a lower-carb diet in order to effectively control their blood sugar and, by extension, rate of fetal growth.

    I’ll be blogging about this later, and probably linking to you too, because you seem to have a much better-balanced perspective on the whole issue. Thank you for your work.

  20. As a woman in her mid-20’s who hopes to start a happy, healthy family of my own someday, I am just so thankful to have found you and all of this truly vital information that you make so accesible. Keep up the great work!