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The Circle of Life“All I am I owe to my Mother. I attribute all my success in life to the moral, intellectual and physical education I received from her.” –George Washington

“All that I am, or hope to be, I owe to my angel mother.” –Abraham Lincoln

Turns out that both Washington and Lincoln were more right than they knew. Our two most celebrated presidents were referring to the effect their mothers had on them after birth, of course, but recent scientific discoveries have shed light on how important a baby’s first environment—the womb—truly is.

The idea that mothers are crucial factors in their children’s health is not new. We have long understood that both parents’ genetics and the environment in which they raise their children have a synergistic effect on health outcomes. From the mundane (eye color) to the bafflingly complex (intelligence), our physical and emotional traits are the results of complex interplays between nature and nurture. What we are just starting to comprehend, though, is how complicated these interactions are. For example, the new science of epigenetics is shining a bright light on gene-environment relationships.

“At its most basic, epigenetics is the study of changes in gene activity that do not involve alterations to the genetic code but still get passed down to at least one successive generation. These patterns of gene expression are governed by the cellular material—the epigenome—that sits on top of the genome, just outside it (hence the prefix epi-, which means above). It is these epigenetic “marks” that tell your genes to switch on or off, to speak loudly or whisper. It is through epigenetic marks that environmental factors like diet, stress and prenatal nutrition can make an imprint on genes that is passed from one generation to the next.”  Why Your DNA Isn’t Your Destiny (Time/CNN)

Let’s look at nutrition as a specific example. I was recently presenting a talk with my associate, Dr. Heather Jeney, at the 2010 Holistic Moms Network national conference, a gathering attended by hundreds of moms (and several dads, to be truthful), including quite a few pregnant ones (the moms that is). I was curious about what they must be thinking, nurturing life already in their bodies, listening to what they should and shouldn’t be eating. Of course, the “should” and “shouldn’t” changes depending on who’s talking and who’s listening. In any case, the concept of “eating for two” was made very present and palpable. This process is eloquently presented in Annie Murphy Paul’s stimulating book, Origins: How the Nine Months Before Birth Shape the Rest of Our Lives. The author explores the current science on “fetal origins of adult disease” through the lens of her own pregnancy. In essence, to some degree, what and how a woman eats during her pregnancy determines how healthy (or unhealthy) her child will be not only at birth or during infancy, but as an adult as well. There is a growing literature describing the effects of maternal obesity during pregnancy on the development of obesity and diabetes in her grown children. Wow. Think about that for a moment. It appears that there are controllable factors influencing the baby’s first environment and subsequent health outcomes, like nutrition and obesity. Changes in mom’s health affect the expression of the genetic code she passes on (of course, with the baby’s father) and these changes in genetic expression (the epigenetic phenomena) may carry forward now from generation to generation.

But what about other environmental epigenetic influences that are not as personally controllable, such as airborne toxins? What are we to do about those factors? Take, for instance, tobacco smoke. First, it was established that smoking negatively impacts one’s own health. Next, we learned that “second-hand” smoke—a parent smoking in the presence of a child—can lead to asthma. Now we are discovering the dangers of “third-hand” smoking: Researchers in Greece have found that “passive exposure of pregnant women to environmental tobacco smoke (ETS) during the third trimester is positively associated with asthma- and allergy-related symptoms in their preschool age children.” Simply put, pregnant woman exposed to ETS—women who did not smoke themselves—had children who were more likely to develop asthma and allergies. This is epigenetics in action. And it’s pretty frightening.

What are we to do about this? What are our options? Well, as I’ve written before, I’m an optimist. Complex challenges are opportunities that call for complex solutions. One woman I greatly admire for taking on this challenge is doula Debra Pascali-Bonaro, President of Mother-Love, Inc., CD (DONA), LCCE, Lamaze International childbirth educator, co-chair of the International MotherBaby Childbirth Initiative, and mother of five children. Debra’s film, the provocatively titled, “Orgasmic Birth,” encourages women to reclaim birth as a joyous, natural experience, not the fearful, medicalized process it has become. I was interviewed for the film several years ago because Debra’s vision made room for the revolutionary concept that the birth process affects the baby’s physical and emotional health as well as the mother’s. Follow me through this, now. More women, especially in the United States, are undergoing caesarean sections, and it’s likely that many of these procedures are not strictly medically necessary. A baby born via c-section is not introduced the same protective flora (probiotic bacteria) as a baby born via vaginal delivery. A baby born via c-section is less likely to be breastfed and therefore deprived of many healthful immune constituents of breast milk, a second strike against the development of a normally functioning immune system. These babies, it turns out, are therefore more likely to develop allergies. Is it plausible that the increasing rates of C-sections in our country are in some way related to increasing rates of chronic diseases in our children, such as food allergies and asthma? I’m just connecting the dots, here. What Debra and her colleagues are seeking to do is change long-term health outcomes by addressing the system as a whole. What’s best for a mother’s well being is likely what’s best for her baby’s.

As a pediatrician, it is increasingly clear to me that I, too, need to care about family health. I need to help families understand that what they do—even prior to conception—can play a role in their babies’ lives. They need to be counseled about this as adolescents so that they hopefully become happy and healthy young adults who hopefully some day have happy and healthy babies. And so on. We are starting to realize what the animals in Disney’s ‘The Lion King’ already know. And not a moment too soon.

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