While personal behavior is important, it is also easy to make the mistake of giving it too much weight compared to the rest of the expectations that are placed on pregnant women.
For example, there is no conclusive evidence that playing music to babies or reading to them while they are in the womb makes any difference. And while it is advisable to avoid certain foods, there is no magic diet that guarantees positive results.
Furthermore, giving pregnant women too many warnings about what they should avoid may only cause unnecessary stress. The truth is that there are risks that no one can reduce or eliminate. Individual choices are important, but public policies are even more important.
Public policy
Conditions inside the womb can have long-lasting effects.
“They have a lasting impact on a child’s future physical and mental health, as well as their work life, education, and income,” said Princeton economist Janet Currie.
Many studies have revealed, for example, a certain relationship between a lower birth weight and a lower level of educational achievement and employment success, and that a higher birth weight is associated with better academic and employment achievements.
The evidence highlights the importance of several public health aspects such as access to clean water, clean air, vaccines, nutrition, and direct support, including measures to combat racism, to help pregnant women, particularly those with lower incomes.
Actions to prevent contamination are one example. Flint, Michigan, and Newark, New Jersey, like many other districts, have suffered public health crises caused by contaminated water. Moreover, lead, which is harmful to anyone who consumes it, wreaks havoc especially on children, even from the womb, and can cause lifelong disadvantages.
Pandemic preparedness is another example. The 1918 flu pandemic affected about one-third of pregnant women and their fetuses. Some studies found that those who were affected were more likely to have health problems in their children later in life. Some researchers also found lower educational attainment levels, consistent with a study of prenatal exposure to influenza from 1959 to 2004.
Due to a lack of data, it is too early to identify the effects that children of mothers who suffered from the disease caused by the coronavirus during pregnancy will exhibit.
Two years ago, we asked our readers what the next major public health campaign in the United States should be, and several said more funding for the nonprofit Nurse-Family Partnership, which schedules home visits by nurses to new mothers in low-income households.
A study showed that women who lived in states with greater access to Medicaid had better health outcomes before pregnancy, during pregnancy, and after giving birth. Research has highlighted how difficult it is for pregnant women of color to access health care. Among the disparities are that African-American women, as well as American Indian and Alaska Native women, are much more likely to die from pregnancy-related complications than white women, according to a report from the Centers for Disease Control and Prevention.
Last summer, the American Academy of Pediatrics stated the effects of racism on child development, beginning before birth: “The evidence demonstrating the persistent negative impact of racism on health and well-being through implicit and explicit biases, institutional structures, and interpersonal relationships is clear.”
Individual decisions
While public policy has a great deal of influence, that doesn’t mean that individual decisions don’t matter. During the baby boom generation, pregnant women were told they could safely smoke and drink alcohol, so many did. According to conventional wisdom at the time, the placenta protected the fetus from harm.
We now know that these and other sources of stress and adversity can be harmful to children’s health even before birth, and can cause lasting damage, as proposed by the fetal origins of disease hypothesis.
So it stands to reason that some toxins, such as those produced by drinking, smoking, and other drug use, may have long-term consequences. Some studies have linked prenatal alcohol exposure to performance problems later in life (although it is unclear whether occasional drinking is harmful in many pregnancies).
Other studies have shown that fasting during pregnancy can also have negative effects on children (the month of Ramadan, during which many Muslims fast from sunrise to sunset, offers a natural experiment that several groups of researchers have taken advantage of).
Although there is overwhelming evidence that certain conditions within the womb can have lifelong consequences, it is not known for certain how this occurs.
A theory called epigenesis, which has no consensus, holds that traumas we suffer early in life leave chemical marks on genes that change the way they operate. To establish this connection, it would be necessary to collect genetic material from early life and associate it with development many decades later, explained Colter Mitchell, an assistant professor in the research area at the University of Michigan.
“Study design of this type is extremely complicated in humans, although work is already underway to begin doing so,” he said.
Giving too many warnings about what pregnant women should avoid could cause unnecessary stress for some women who may already be anxious about being pregnant. (Melissa Golden/The New York Times)
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