June 20, 2013

An Ounce of Prevention is Worth a Lifetime

Prenatal care is the reason for the dramatic reduction of maternal illness and mortality in the United States. Initially, this care was focused on the major pregnancy complications: blood pressure, infection and hemorrhage. As medicine has evolved, so has the goal of prenatal care. Its focus is to the developing fetus with the reduction of neonatal morbidity, prematurity and toward the prevention and diagnosis of congenital anomalies.

Early and attentive care prenatally is anticipated to result in long-lasting effects. Philosophically, optimizing fetal care should work to prevent both childhood and adult disease. The in utero environment may act to manipulate and to alter structure and function of genes and gene products. This theory is called developmental programming. In developmental programming, there is a permanent alteration of tissue structure and/or function as the result of prenatal environmental exposure. These effects can be long-lasting.

Amazingly, 50% of cell divisions (cell growth) occurs between the moment of conception and birth, so it is not surprising that the effects of stressors in utero can effect health. Both epidemiologic studies and animal models have founded the theory of developmental programming. For instance, altered maternal nutrition (both excess and deficient), stress and environmental toxins affect organ structure and function. These exposures can cause changes to how genes are expressed in the future and are termed, epigenetic changes. These changes are the immediate response to the perceived harm which causes tissues to adapt and re-organize. It is the ultimate in survival techniques.

The most notable of developmental programming may be metabolic syndrome. It is often diagnosed in adults and consists of the triad of obesity, diabetes and hypertension. But is it possible that it could have stemmed prenatally? The evidence is suggestive.

Developmentally programming for metabolic syndrome may start with maternal exposures. Suboptimal nutrition, substance abuse (inclusive of tobacco), stressors and environmental exposures cause immediate changes prenatally. The fetus may experience growth restriction, reduced energy expenditure and increased fat storage. As a result of this re-programming, the neonate may have an enhanced appetite with rapid catch-up growth and higher body weight and body mass indices (BMI). The result of these continued stressors is adaptation and resultant metabolic syndrome.

Treatment for this outcome starts with prevention. The best strategies involve education and counseling as well as monitoring prenatal and preconception care. It is for this reason, that much emphasis is placed on optimizing healthful lifestyles (inclusive of weight) prior to conception. Here, an ounce of prevention is worth a lifetime.

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Danielle Vitiello, Ph.D., M.D.

Danielle Vitiello, Ph.D., M.D. Board-Certified in Obstetrics and Gynecology, Reproductive Endocrinology and Infertility