Prenatal prescription

The Prenatal Prescription
From a book by: Peter Nathanielsz

Pennington Biomedical Research Center
Division of Education


The following information
has been obtained from:
A state-of-the-art program for
optimal prenatal care

Copyright © 2001 by
Peter Nathanielsz, M.D., Ph.D.
HarperCollins Publishers


Prenatal Programming
 Believed that nutritional health during pregnancy
imprints us for health during the rest of our life, and
that the chronic diseases we may experience
later, either begin or are prevented during prenatal
life.
 Dr. David Barker was the originator of this idea
 He related the high rates of heart disease in middle
aged men to industrial and coal mining areas of
England and Wales.


Prenatal Programming:
The New Science of Life in the Womb
 States that our bodies are programmed in analogous
and far-reaching ways by our experiences before
birth. The events to which we are exposed as we
develop our body’s structure and functions during our
life in the womb can improve or worsen our:

–Blood Pressure –Emotional resilience
–Cardiovascular health –Intelligence
–Eating patterns –Susceptibility to Cancer
–Tendency to gain weight –Resistance to Infection


Prenatal Programming:
The New Science of Life in the Womb

In short, prenatal programming
affects every aspect of our
physical and mental health, at
ever stage of our lives.


Findings: From Chapter 1
 Leading researchers studying prenatal life now
believe that the nutritional quality of the womb
environment is often a more important predictor for
risk of heart disease than either genetic
predisposition or post-birth influences like diet and
exercise.
 Studies show that blood pressure in mothers
during pregnancy correlate directly with the blood
pressure of their offspring in adulthood.
 Newborns who have a disproportionate head-to-
waist size, a hallmark of detrimental prenatal
programming due to poor nutrition, are more likely
to develop elevated levels of cholesterol as adults.

10 Principles: Of Prenatal Planning
1. There are critical periods of vulnerability to sub-
optimal conditions for the fetus during
development in the womb, occurring at different
times for different organs in the body.
2. Programming has permanent effects that alter
the body’s responses in later life and can
modify susceptibility to disease.
3. Fetal development is actively dependent.
Normal development is dependent on the
baby’s continuing normal activity in the womb.
4. Programming involves several different
structural changes in important organs.
5. The placenta plays a key role in programming.


10 Principles: Of Prenatal Planning
6. Compensation carries a price. In unfavorable
environments, the developing baby makes
attempts to compensate for deficiencies .
7. Attempts made after birth to reverse the
consequences of programming may have their
own unwanted consequences.
8. Fetuses react differently to sub-optimal
conditions than do newborn babies or adults.
9. The effects of programming may pass across
generations by mechanisms that do not involve
changes in the genes.
10. Programming has different effects in males and
females.

Principle #1 says:
 There are critical periods when certain parts
of the fetus are vulnerable to stress from
exposure to toxins or from lacking nutrients
or lacking oxygen.
 Cells must make a fundamental choice
between growth and specialization.
 These can become competing processes.
 Each cell must make a choice to divide or
specialize at some point, and the process is
irreversible.


Principle #1cont.
 Some types of cells, like nerve
cells, never divide again after they
specialize.
 It is very important that each
developing cell makes the right
decision at the right time.
 If a decision is made too early, an
organ will end up with too few cells
and thus be unequal to the
challenges of later life.


Principle #2 says:
 That programming has permanent effects.
 When nutrition is deficient in the womb
early in gestation, cells divide less
frequently, resulting in fewer total cells in
the baby’s body.
 So, this fetus would be smaller overall, but
all the body parts will be proportionately
relatively normal, known as symmetrical
growth retardation.
 However, when stress is making things
difficult in the 2nd and 3rd trimester, the
cellular community of the growing fetus
prioritizes where nutrients willBiomedical Research Center
Pennington go.

Principle #2 cont.
 Since the brain is the organ most important for
survival both inside and outside the womb, the
largest share of blood, nutrients, and oxygen
gets routed towards the head.
 Many other tissues suffer and don’t grow as
they should, leading to a newborn with a head
that is slightly large in comparison to the
body, referred to as asymmetrical growth .


Available Options
 Researchers recently found that not only did
girls born with low birth weights have a
smaller final stature when they grew to their
full height decades later, but also that many
such girls reached sexual maturity an
average of 1.6 years earlier than girls with
normal birth rate.
 Which makes evolutionary sense in some
ways
 If a girl had been born into a world that was
dangerous, or subject to famine, it would
have made sense to reproduce early, since
there were no guarantees that she would
have survived long enough to reproduce
otherwise.

Principle #3 says:
 Fetal development is activity
dependent, or as put, the fetus must “use
it or lose it”.
 The way that fetal cells develop depends
on how the fetus is using his body.
 He is able to swallow and suck at birth
because he is practicing sucking and
swallowing the amniotic fluid that bathes
him in the womb.
 The nerve cells in the brain wire up
correctly because signals are running
through them, testing them, throughout
the whole time they are developing. Center
Pennington Biomedical Research

Principle #4 says:
 Programming involves structural changes
in the developing organs.
 One cause of the structural changes is
the altered growth of blood vessels in a
challenged fetus.
 If an organ developed too few blood
vessels in utero, it will be harder for the
body to increase the blood supply to that
organ during times of need later in life.


Example of a Structural Change
Fingerprint Patterns
 Fingerprints are not solely determined by
your genes.
 The specific pattern of fingerprint ridges
that form is determined by the extent of
swelling in the finger pads when
fingerprints are forming, ~ the 10th week
of development.
 When the prenatal environment is
challenging, the fetus makes a priority of
getting blood to the brain, thus pushing
more blood upwards and into the
developing finger pads.

Example: Fingerprint Patterns
 More swelling produces a whorl pattern;
whereas, the loop or arch pattern is
observed with less swelling.
 If the fetus has been short on oxygen for a
prolonged period around the time when
fingerprints are forming, it is very likely for
the whorl pattern to be observed.


Principle #5 says:
 The placenta is a crucial organ in
development, the bridge between you and
your child.
 The baby’s placenta not only acts as a
gatekeeper for everything that comes into
and leaves your baby, but it is an important
hormone-producing organ that affects the
way you and your child change physically
and psychologically.


Principle #6 says:
 Compensation for shortcomings during
development carries a price.
 An example is how your baby’s digestive
tract and liver are affected by detrimental
conditions.
 Since most of the baby’s waste can be
processed by the mother’s liver, and
glucose comes across the placenta all the
time from the mother’s bloodstream, the
baby’s liver operates at less than 100
percent efficiency until after birth.

Compensation The liver and
cholesterol transport
 When oxygen or
nutrients are low, the
baby tries to adapt.
 The baby deprives the
unessential organs of
blood, sending the
majority of the blood
supply to the essential
organs.
 However, the rerouting of
blood away from the liver
forces the baby to grow a
small liver.
 As a result, the organ
continues to function less
than it should throughout
life.


Compensation
 Since the liver is central in
regulating cholesterol, it is not hard
to see why growing a small
liver, thereby reducing abdominal
girth, will lead to higher cholesterol
later in life.
 Inadequate growth of the liver and
the pancreas is likely responsible
for the glucose control problems in
later life, which can lead to adult-
onset diabetes (Type 2 DM).


Principle #7 says:
 Attempts made to reverse programming
after birth can have unwanted
consequences.
 This is because so many of the decisions
that cells make during growth are
irreversible.
 For a baby who had little food during
intrauterine life, he/she may not be able to
cope with plentiful, rich food afterwards and
will have a greater likelihood of becoming
obese.
 In animal studies, food restriction during
prenatal life actually led to shorter life

Principle #8 says:
 Fetuses react differently to sub-
optimal conditions than do adults.
 Growing cells need more
oxygen, amino acids, vitamins, and
glucose than those that are not trying
to expand their activities.
 Small shortages can actually kill cells
during development.
 These may never be replaced.


Principle #9 says:
 The prenatal effects may carry from one generation
to another.
 For example, if the developing fetus is female and
has to compromise leading to smaller organs, when
she grows up and becomes pregnant, those smaller
organs may not be able to keep up with the
demand, affecting her fetus.
 Another example would be if there were blood
sugar problems during your pregnancy damaging
the blood sugar regulation in your daughter. This
could lead to the same problems during her
pregnancy, and so on through generations.

Principle #10 says:
 Programming is different in male and
female fetuses.
 Boys and girls grow in slightly different
hormonal environments.
 These differences are subtle but may play
a major role in behavioral and other
functional differences between men and
women.


The First and Best Home
for your Baby: The placenta
Chapter 2
 The placenta has its own blood supply that is
kept separate from the mothers.
 The placenta takes the place of the
lungs, kidney, and digestive system for baby
 The biochemistry of the body changes to
promote energy conservation over usage.
 Sound, touch, and taste are developed in utero.
 Biorhythms


The Placenta
 The placenta shared with your baby is
probably the most talkative and bossy
biological organ there is.
 It sends firm instructions to you as well as to
the baby.
 Placental lactogen is one of the many
hormonal signals that the baby and placenta
send to reshape your body and bend it to
the baby’s needs.
 The baby always gets top priority between
the two of you.


The Fetus
 The fetus keeps tabs on energy supply.
 If there is a shortage of energy, he learns
to prepare for shortage of food and how to
cope with it later.
 The baby also monitors the mother’s
stress level, and high stress hormone
levels will make the baby hypersensitive
to stress hormones after birth.
 It is important for the mother to monitor
stress levels throughout pregnancy.


Biochemistry of the Body:
Sound

 Hearing is a critical skill after birth, and
preparation to hear what is going on in the
world has to begin long before delivery.
 The womb is awash with sound that can
help the brain wire up its sound circuits.
 Research has shown that newborns prefer
the sound of their own mother’s voice over
the voices of others, since her voice has
been the clearest and most familiar sound
all through pregnancy.


Touch
 The gentle bump and caress of the womb’s
wall is a critical part of learning to respond
to touch.
 The occasional gentle contractions of the
mother’s womb during pregnancy – known
as contractures - stimulate the baby’s
nervous system to begin working properly.
 Helps to integrate sensory and motor
neurons in the body and brain


Taste

 Even while in the womb, your baby is
swallowing fluid and taste buds are
learning to recognize differing tastes.
 Some recent research suggests that taste
preferences for garlic, spices, an other
foods may be set and programmed before
birth.
 The idea is that these flavors filter into the
amniotic fluid from the mother’s blood .


Biorhythms
 Certain chemical compounds have
distinct twenty-four-hour rhythms in your
blood even when you are not pregnant.
 Stress hormones, kidney hormones, and
melatonin naturally rise and fall over the
course of the day and night.
 Human fetuses seem to use these
signals to learn about the cycles of the
world outside and to try to adapt their
own cycles to them.


Nutrition in the Womb
Chapter 3

 Nutritional status before conception is
probably as important as nutrition during
pregnancy.
 The mother’s nutritional status during
pregnancy is the single most important
factor in baby’s growth.
 Deprivation during pregnancy can take
generations to overcome.
 The effects of poor nutrition vary according
to the trimester in which problems occur.


Prenatal Eating Habits
 Over the whole course of prenatal
development, the kind of food your child
gets before birth can affect his lifelong:

 Weight
 Blood Pressure
 Blood sugar profile
 Cardiovascular Health


Dutch Hunger Winter
Winter 1944-1945

 Individuals affected by the famine were only
receiving 450 to 750 calories a day compared to
2500 kcal/day before that.
 Babies that were conceived where the entire
intrauterine life was deprived of calories and
nutrients were small and light weight and had the
most health problems growing up.
 Mortality was ten times higher than normal in these
individuals.
 Those that had starvation in the first half of
pregnancy had the most incidence of obesity in
later life.

Modern Effects of Past Poor
Nutrition…
 Animal studies have shown that
poor nutrition in the womb alters the
growth of the pancreas and the
functions of insulin.
 Diabetes can be thought of as a
“cash flow” disease, where glucose
is the main form of “cash” that
makes the body run.
 When you eat, glucose leaves the
gut and enters the bloodstream.
 In response to the rising blood
glucose, the pancreas releases
insulin, which allows glucose to
leave the bloodstream and enter
muscle and fat cells where it can be
used.

Modern Effects of Past Poor
Nutrition…
 In diabetes, the insulin doesn’t work as it
should.
 These starved cells are forced to consume their
own fats and proteins as an alternate source of
energy.
 When there is a high level of fat circulating, it
deposits in wrong places and can weaken cells
and produce problems with eyes, heart and
many other precise organs.


Special Components of a
Healthy Diet
 Iron:
◦ Needed in order to allow your blood supply to increase and
help your baby build her own blood supply from scratch
◦ 30-60 mg a day in pregnancy
◦ Found in red meat (especially liver), eggs, and dried beans
 Calcium:
◦ Main building block of bones and teeth, and also critical for
the proper function of your own and your baby’s nerve cells
and muscles
◦ 1200-1500 mg per day in pregnancy
◦ Found in milk and cheese, also in
broccoli, kale, legumes, and tofu

Healthy Diet
 Chromium
◦ Helps insulin work to keep your baby’s blood sugar at the
right level
◦ 50-200 micrograms per day in pregnancy
◦ Found in whole grains, meats and brewer’s yeast
 Zinc
◦ Important for tissue growth and the reproduction of genes
in DNA
◦ 15 mg per day in pregnancy
◦ Found in whole grains, nuts, dried beans, meat, and eggs


Healthy Diet
 Folic Acid:
◦ Vital for the synthesis of DNA every cell in your baby’s
body and the placenta need an adequate supply
◦ 400 micrograms a day in pregnancy
◦ Found in enriched flours, fresh fruit, and green
vegetables
 Vitamin A:
◦ Helps build key components of the baby’s
skin, eyes, and other tissues
◦ 800 IU (international units) a day in pregnancy
◦ Found in fruits and vegetables (equivalents), meat and
dairy

Healthy Diet
 Vitamin B6:
◦ Helps baby create new tissue he needs to grow, especially
in the brain
◦ ~2.2 mg per day in pregnancy
◦ Found in eggs, whole grains, lean
meat, oatmeal, nuts, dried beans, peas, and
bananas
 Vitamin B12
◦ Plays a central role in the production of new DNA your baby
needs as cells multiply
◦ 2.0-2.2 micrograms a day in pregnancy
◦ Found in meat, fish, eggs, and cheese
 Vitamin C:
◦ Crucial for cell repair after injury and for the development of
new tissues
◦ 70 mg per day in pregnancy
◦ Found in fruits (especially citrus), and dark green, leafy
vegetables Pennington Biomedical Research Center

Nutrition by Trimester: First
 You should only gain a pound a month in the first
trimester; therefore, an increase in caloric intake
shouldn’t be necessary.
 Iron is crucial for the expansion of the blood supply.
 Meeting folic acid requirements is very important in the
first trimester because this is when the spinal cord is
being created.
 If morning sickness leads to vomiting, extra fluids and
salts like potassium will be required.
 These can come from sports drinks; however, they
should not be the main source of fluid since they
contain a lot of glucose.


Nutrition by Trimester: Second
 Consumption of 300 calories more per day
 Protein intake, along with iron and calcium are
crucial.
 Even if you don’t have gestational diabetes, you may
have some episodes of hyperglycemia that are
exacerbated by pregnancy.
 Keep trying to eat small snacks more often.
 Avoid fatty or oily foods because fats interfere
with insulin activity.
 Eat carbohydrate products made with whole
wheat, bran, or other fiber sources.

Nutrition by Trimester: Third
 Calcium continues to be a focus of the diet.
 The baby is becoming much more physically
demanding and he is growing rapidly, needing more
nutrients daily.
 Frequent small meals are still important .
 You should continue to gain about a pound a week, and
if you do happen to be gaining more, never try to lose
weight during the pregnancy, you should speak with the
doctor about possibly cutting back a little on total caloric
consumption.


Stress in the Womb
Chapter 4

High Maternal Stress can:
 Put the pregnancy at a risk
 Have lifelong effects on how the baby’s
brain and body develop
 Affect the child’s temperament
 Make the child overreact to stress
 Make child more susceptible to
depression later in life


Effects of Stress
 People under stress tend not to eat well.
 They either eat too much, too little, or the wrong
kind of food.
 Our bodies respond to stress by releasing cortisol
and other hormones that give us energy to respond
to a crisis.
 With stress present all the time, the individual will
have a higher than normal cortisol level, causing
the baby to be hyper sensitized to stress.
 The child is then more likely to be unable to
concentrate, leading to learning difficulties later in
life.


Defeating Stress
 It is very important that the mother is not overly
stressed during pregnancy and is allowed to relax
and enjoy things.
 Good ideas for stress relief include the following:

Exercise
Progressive relaxation
Meditation
Yoga


Exercising for Two
Chapter 5
 A mother in good shape creates a healthier
newborn with higher initial scores on tests
of physical well-being.
 Exercise helps to:
◦ Allow mothers to cope with stress, lessening
mood swings
◦ Lessen many of the bothersome physical side
effects of pregnancy
◦ Make labor and delivery easier and faster


The History: Exercise during
Pregnancy
 Exercise during pregnancy was generally
not accepted by doctors or the women
themselves in the past.
 During this time, women under physical or
psychological stress did not fare well.
 This began to change in the 1950’s when a
French doctor started to study the effects of
exercise on pregnancy .
 He found that when the woman eats
healthily, does not have psychological
stress, and exercises within reason, it is
good for the mother and the baby.

Exercise: The benefits
 Exercise fosters growth of new blood vessels and
increases cells metabolic efficiency.
 The body also learns to dissipate the heat better
with regular challenges.
 When the woman exercises, she also provides
small physical challenges for the baby, making the
baby better able to handle stress later in life.
 Also, stimulation of the baby in the womb also
helps in brain development.


Important Considerations:
During Exercise

 Don’t overheat
 Be sure to take in enough fluids and
salts
 Stop if you feel pain
 Make the exercise a positive
experience
 Do it right


A Woman Should Absolutely Not
Exercise
If any of the following conditions exist

Premature labor
History of miscarriages Pregnancy-induced
Incompetent cervix hypertension
Persistent bleeding Ruptured membrane
Placental disease
Twins or other multiple
Poor fetal growth
pregnancy


A Woman Should Probably Not Be
Exercising:
If any of the following conditions exist

Anemia
History of poor fetal
Breech presentation growth
after 28-weeks
History of rapid labor
Early pregnancy
bleeding Palpitations or
arrhythmia of the heart
Extremely overweight or
underweight for your Sedentary lifestyle prior
height to pregnancy


Drinks, Pills, and Toxic Spills
Scientists are finding that:
Chapter 6
 The fetus is very vulnerable- Substances can be
toxic or challenging to the fetus in ways that these
substances are not for adults.
 Smoking is bad for the fetus in many ways.
 Alcohol has clearly defined adverse effects on the
embryo and fetus.
 Coffee, in high doses, can cause problems during
pregnancy.
 Some OTC medications can be very toxic.
 Health foods, nutritional supplements, and herbal
teas can be bad. Pennington Biomedical Research Center

Negative Effects: Of Smoking
 The fetus is more vulnerable to the effects of
cigarettes than anyone else.
 Tobacco is a powerful drug which acts on the
neurotransmitter system that controls the heart.
 It also causes constriction of blood vessels in the
placenta, causing increased blood pressure and
heart rate.
 When the mother smokes, she increases the
concentration of carbon monoxide and reduces
oxygen levels to the baby.
 Smoking slows the growth of the placenta.
 It disrupts sleep of the baby andPennington Biomedical REM
reduces Research Center

Negative Effects: Of Alcohol
 Alcohol cuts the blood supply to fetal brain & affects how nerves
communicate.

 In 1968, scientists from France were the first to describe fetal
alcohol syndrome (FAS), in which babies repeatedly exposed to
alcohol in the womb are born with mental retardation and physical
abnormalities.

 But, how much is too much?

 Research shows that the likelihood of miscarriage in the first
trimester is doubled in women who drink as little as one ounce of
alcohol twice in a week.

 Also, drinking as little as two drinks a week has shown increased
agitation and stressful behavior in newborn babies.

Negative Effects: Of Caffeine
 Caffeine is not eliminated as efficiently during
pregnancy and the concentration can get high
quickly.
 It speeds up cell activity and acts as a
stimulant.
 Caffeine seems to be safe in terms of
miscarriage risk if you limit yourself to one or
two cups of coffee a day.
 In high amounts, coffee has been shown to
potentially increase the risk for
miscarriage, along with interfering with the
baby’s sleep patterns in the womb.


OTC Meds and Health foods

 It is important to talk to your doctor
about any prescription or over the
counter meds you are taking.
 Also, health foods may have high
bacterial counts, may be contaminated
with heavy metals or other
contaminants, or may contain a
naturally occurring drug or stimulant.


Preventing Premature Delivery
Chapter 7
 Babies born before 37 weeks of gestation are
considered premature.
 Premature birth often happens because the baby
is under some sort of stress.
 It may be that when conditions in the womb
environment become overly threatening to the
babies health, the child has a better chance of
surviving outside the womb rather than within it.
 The most common reasons for this are infection in
the womb or birth canal, and stressful situations
for either mother or child.

Premature Delivery Stress
 When the baby finds that there is no more room
to grow or when there is a lack of food or
oxygen, stress hormone concentrations in the
baby’s blood may rise, stimulating the production
of estrogen and the beginning of labor.
 And if the mother is under enough stress, her
increased production of androgen may cause the
level of estrogen to rise far sooner than it
should, initiating premature delivery.


Ways to Help Prevent Premature
Delivery
 Avoid stress most of all
◦ Learn stress management
◦ Learn coping skills for emotional stress
 Treat all cuts and blisters promptly
◦ A small bit of redness around a cut is
extremely unlikely to contribute to premature
labor, but if an infection gets started and
spreads to surrounding tissue or throughout
the body it can set off the immune and
hormonal changes that stimulate
contractions .

Ways to Help Prevent Premature
Delivery

 Brush and floss teeth regularly
◦ Recent studies have shown that women with gum
disease have perhaps six times the risk of premature
labor compared to women with normal gums.
 Don’t smoke
◦ Smoking increases the risk of premature labor by
25%.
◦ Smoking also promotes gum disease because it
lowers the normal resistance to bacteria in the mouth.


Birth and Beyond
Chapter 8
Researchers have found that:
 The baby’s environment after birth influences the quality of neural
connections in the growing brain.
 The amount and quality of breast milk is directly related to the
mother’s diet and stress levels.
 Antibodies in breast milk beneficially change the baby’s immune
system.
 Touching, talking to, and playing with your infant can actually
affect neural development and improve brain growth.
 Growth promoting factors are present in breast milk.


Recommendations: For Mothers
 Try to breast-feed your infant for at least the first three
months.
 Use stress reduction techniques in your daily life.
 Continue to exercise  benefits you and your baby
 Enjoy your baby!
◦ Playing, hugging, touching, and talking with your baby
creates the physical and mental foundation upon which she
will build future security and happiness


Breastfeeding
 Requires that the mother consume 500 more
calories per day than the pre-pregnancy diet
 Mothers will also need to eat more:
◦ Protein
◦ Calcium
◦ Iron
◦ Fats
 Alcohol and drugs pass through the breast and into
the baby.
 As well as painkillers and OTC medications.
 Also caffeine.
 Important to avoid these toxins the same as during
pregnancy.


Information provided by:

By: Peter Nathanielsz, M.D., Ph.D

Images provided by:
http://www.google.com/imghp?hl=en&tab=wi&q


Authors
• Heli J. Roy, PhD, RD
• Shanna Lundy, BS
• Beth Kalicki, BS

• Phillip Brantley, PhD, Director
• Division of Education
• Steven Heymsfield, MD, Execute Director
• Pennington Biomedical Research Center


The Pennington Biomedical Research Center is a world-renowned nutrition
research center.
Mission:
To promote healthier lives through research and education in nutrition and
preventive medicine.

The Pennington Center has several research areas, including:
Clinical Obesity Research
Experimental Obesity
Functional Foods
Health and Performance Enhancement
Nutrition and Chronic Diseases
Nutrition and the Brain
Dementia, Alzheimer’s and healthy aging
Diet, exercise, weight loss and weight loss maintenance

The research fostered in these areas can have a profound impact on healthy
living and on the prevention of common chronic diseases, such as heart
disease, cancer, diabetes, hypertension and osteoporosis.
The Division of Education provides education and information to the scientific
community and the public about research findings, training programs and
research areas, and coordinates educational events for the public on various
health issues.
We invite people of all ages and backgrounds to participate in the exciting
research studies being conducted at the Pennington Center in Baton
Rouge, Louisiana. If you would like to take part, visit the clinical trials web
page at www.pbrc.edu or call (225) 763-3000. Pennington Biomedical Research Center

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