Fetal Programming
Fetal programming is an emerging concept that links environmental conditions during embryonic and fetal development with increased risk of certain diseases later in life. Researchers have found that the environment in the womb, during specific periods of development, can significantly alter the development of the fetus, leading to significant and long-term effects.
The health impacts of certain exposures during pregnancy (i.e. smoking, alcohol, thalidomide) are well known. More subtle changes, such as variations in nutrition and periods of maternal stress, have also been shown to seriously impact the fetal environment, causing changes in gene expression during the development of certain tissues and organs. We now know that these collective changes shape an individuals future health, and often times may determine their risk for developing certain diseases such as obesity, Type 2 Diabetes, and allergies.
Women who are pregnant, or who plan to become pregnant should make a concentrated effort to eat healthy, exercise, and reduce stress in order to create the best environment for their baby to develop and grow in. By controlling these external factors, women have the potential to greatly impact their babys short and long-term health outcomes.
Learn more about fetal programming by visiting the Begin Before Birth website and reviewing the recent articles below.
History of Preterm Birth:
Women with a spontaneous preterm birth are more likely to experience preterm labor and delivery in subsequent pregnancies. The earlier a previous premature birth took place, the more likely it is that the next birth occurs as early or even earlier. Make sure that your Doctor knows about your pregnancy history so that she or he can take all the necessary precautions to prevent a preterm birth from occurring again. If your previous preterm birth was the direct result of a known risk factor (many of which are described on this page), you should attempt to change your behavior prior to becoming pregnant again, or as early into your subsequent pregnancy as possible.
17 alpha-hydroxyprogesterone caproate (more commonly known as 17P, or by the brand name Makena) is a synthetic form of progesterone that has been shown to reduce the recurrence of preterm birth for women with singleton gestations that have a history of at least one preterm delivery. Studies have shown that on average, women who use 17P reduce their chance of having another preterm birth by 33%. If you think you are a candidate for this medication, talk to your physician about how to obtain a prescription.
Inadequate Birth Spacing:
Birth spacing is an important issue that researchers are starting to look at more closely. Women who get pregnant within a year of giving birth are twice as likely to deliver prematurely, compared with women who wait at least 18 months between pregnancies. Limited studies have also shown that a subsequent pregnancy within 18 months of giving birth can result in a higher likelihood of low birth weight, small size for gestational age, and preterm birth.
Some experts believe that closely spaced pregnancies dont give a mother enough time to recover from the physical stress of one pregnancy before moving on to the next. Additionally, pregnancy and breastfeeding are known to deplete a womans stores of essential nutrients, such as iron and folate, and if she were to become pregnant again before replacing those stores, it could negatively affect the health of her unborn baby. On the other side of the argument, researchers point to the fact that closely spaced pregnancies are more likely to be unplanned, and that women who get pregnant shortly after giving birth are more likely to be economically disadvantaged. These factors make accessing prenatal care more challenging, which in itself could be the reason for the complications that women experience when their pregnancies are close together.
As research continues to develop, we encourage women considering a subsequent pregnancy within 18 months of delivering to consult with their physician. Ensuring that you are healthy and prepared to carry a second, third, or fourth baby to term will have positive long-term effects on both mom and child.
In Vitro Fertilization (IVF):
IVF is one of the greatest inventions of modern time, allowing women who otherwise would not have been able to get pregnant the opportunity to carry their own child. Unfortunately, research is starting to show that this practice can put a woman at risk of delivering prematurely. In fact, when compared with a naturally conceived baby, IVF singletons have been found to be twice as likely to be born premature, and twins conceived via IVF are 23% more likely to be born early than twins conceived naturally.
Some researchers attribute the association between IVF and preterm birth to hormonal factors. Women are often given a large dose of hormones to increase the number of eggs they will release, and some scientists believe that these hormones affect the way that the embryo implants in the uterine wall. Others who have looked at the relationship believe that women who tend to seek out IVF services often have underlying risk factors (advanced maternal age, overweight, underlying mental health issues) that cause them to deliver prematurely more often than their natural pregnancy counterparts.
In order to decrease your risk of delivering prematurely when undergoing IVF, you should strive to be as physically and mentally healthy as possible before starting the procedure. Women and their partners should also consider working with trusted fertility Doctors that promote single embryo transfers, a technique that decrease the chance of unplanned multiples.
Maternal Age:
Women who are younger than 17 or older than 35 at the time of delivery, are more likely to have a premature baby. These individuals are often classified as high-risk and will likely be monitored more closely by their physician throughout their pregnancy. When planning a pregnancy, women should always take into consideration their age, and the potential health complications that may arise as a result of getting pregnant on the early or later end of the reproductive age spectrum.
Poor Nutrition:
Proper nutrition is such an important part of achieving a healthy pregnancy, and one of the most easily modifiable behaviors. Studies have found that women who eat a diet rich in vegetable, fruits, and whole grains, and those that consume plenty of water are less likely to deliver prematurely.
Most pregnant women need an additional 300 calories each day, although the exact amount depend on your pre-pregnancy weight. Women should make sure that they are eating foods from each of the five food groups, choosing foods that are high in protein, and putting as much color on their plates as possible. Additionally, staying well hydrated is one of the most important things you can do to prevent some of the minor discomforts of pregnancy. Pregnant women should aim to drink at least 8 glasses of water every day.
The My Plate Checklist Calculator is a great tool for pregnant and breastfeeding moms who want to monitor their caloric intake and meet their food group targets.
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides Federal grants to States for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. For more information or to enroll in the WIC program, please contact your state WIC contact.
