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The Prenatal Prescription By: Peter Nathanielsz Pennington Biomedical Research Center Division of Education.

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1 The Prenatal Prescription By: Peter Nathanielsz Pennington Biomedical Research Center Division of Education

2 PBRC 2009 The following information has been obtained from: The Prenatal Prescription A state-of-the-art program for optimal prenatal care Copyright © 2001 by Peter Nathanielsz, M.D., Ph.D. HarperCollins Publishers

3 PBRC 2009 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.

4 PBRC 2009 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: –Emotional resilience –Intelligence –Susceptibility to Cancer –Resistance to Infection –Blood Pressure –Cardiovascular health –Eating patterns –Tendency to gain weight

5 PBRC 2009 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.

6 PBRC 2009 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.

7 PBRC 2009 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.

8 PBRC 2009 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.

9 PBRC 2009 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.

10 PBRC 2009 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.

11 PBRC 2009 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 2 nd and 3 rd trimester, the cellular community of the growing fetus prioritizes where nutrients will go.

12 PBRC 2009 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.

13 PBRC 2009 Researchers recently found that not only did girls born with low birth weights have a smaller final stature when they have grown to their full height decades later, but also that many such girls reach 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 is dangerous, or subject to famine, it would make sense to reproduce early, since there would be no guarantee that she would survive long enough to reproduce otherwise.

14 PBRC 2009 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.

15 PBRC 2009 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.

16 PBRC 2009 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 10 th 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 of a Structural Change Fingerprint Patterns

17 PBRC 2009 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.

18 PBRC 2009 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.

19 PBRC 2009 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.

20 PBRC 2009 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. The liver and cholesterol transport

21 PBRC 2009 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).

22 PBRC 2009 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 during plenty after birth.

23 PBRC 2009 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.

24 PBRC 2009 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.

25 PBRC 2009 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.

26 PBRC 2009 The First and Best Home for your Baby: The placenta 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 Chapter 2

27 PBRC 2009 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.

28 PBRC 2009 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. Important for the mother to monitor stress levels throughout pregnancy.

29 PBRC 2009 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.

30 PBRC 2009 Biochemistry of the Body: 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 nerurons in the body and brain

31 PBRC 2009 Biochemistry of the Body: 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.

32 PBRC 2009 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.

33 PBRC 2009 Nutrition in the Womb 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. Chapter 3

34 PBRC 2009 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

35 PBRC 2009 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.

36 PBRC 2009 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.

37 PBRC 2009 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.

38 PBRC 2009 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

39 PBRC 2009 Special Components of a 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

40 PBRC 2009 Special Components of a 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

41 PBRC 2009 Special Components of a 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

42 PBRC 2009 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.

43 PBRC 2009 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.

44 PBRC 2009 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.

45 PBRC 2009 Stress in the Womb 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 Chapter 4

46 PBRC 2009 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.

47 PBRC 2009 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

48 PBRC 2009 Exercising for Two 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 Chapter 5

49 PBRC 2009 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.

50 PBRC 2009 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.

51 PBRC 2009 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

52 PBRC 2009 A Woman Should Absolutely Not Exercise : If any of the following conditions exist History of miscarriages Incompetent cervix Persistent bleeding Placental disease Poor fetal growth Premature labor Pregnancy-induced hypertension Ruptured membrane Twins or other multiple pregnancy

53 PBRC 2009 A Woman Should Probably Not Be Exercising: If any of the following conditions exist Anemia Breech presentation after 28-weeks Early pregnancy bleeding Extremely overweight or underweight for your height History of poor fetal growth History of rapid labor Palpitations or arrhythmia of the heart Sedentary lifestyle prior to pregnancy

54 PBRC 2009 Drinks, Pills, and Toxic Spills Scientists are finding that: 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. Chapter 6

55 PBRC 2009 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 and reduces REM sleep.

56 PBRC 2009 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.

57 PBRC 2009 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.

58 PBRC 2009 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.

59 PBRC 2009 Preventing Premature Delivery 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. Chapter 7

60 PBRC 2009 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.

61 PBRC 2009 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.

62 PBRC 2009 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.

63 PBRC 2009 Birth and Beyond 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. Chapter 8

64 PBRC 2009 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

65 PBRC 2009 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.

66 PBRC 2009 Information provided by: The Prenatal Prescription By: Peter Nathanielsz, M.D., Ph.D Images provided by:

67 PBRC 2009 Pennington Biomedical Research Center Division of Education Heli J. Roy, PhD, RD Shanna Lundy, BS Beth Kalicki Phillip Brantley, PhD, Director Edited : October 2009

68 About Our Company PBRC 2009 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 or call (225) 763-3000.

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