SUNDAY, NOVEMBER 14, 2010
Why the health of pregnant women matters to us all
BY ANNIEMURPHY PAUL “P
regnant Is theNewSexy,” read the T-shirt a friend gavemewhenIwasafew weeks away frommy due date. With my swollen
ankles and waddling walk, I wasn’t so sure — but it’s hard to deny that preg- nancy has become rather chic. Glossy magazines flaunt actresses’ andmodels’ rounded, half-clad bellies on their cov- ers. Inside they chronicle celebrities’ pregnancies in breathless detail, from the first “bump” sighting to the second- trimester weight gain to the baby-gear shopping spree. And now comes the news that “What to ExpectWhen You’re Expecting” — the advice bible that has soldmore than 14million copies—will bemade into a feature film. There’s something wrong with this
picture.Even as Americans fuel a rapid- ly growing pregnancy industry of de- signer maternity jeans and artsy preg- nancy portraits, we’re ignoring the real news about these nine months. An emerging science known as the devel- opmental origins of health and disease —DOHaD for short—is revealing that the conditions we encounter in the wombcan have a lifelong impact on our health and well-being, affecting every- thing from our appetite and metabo- lism to our susceptibility to disease to our intelligence and temperament. Themorewe learnabout these effects,
the clearer it becomes that investing in maternalhealthwouldreturnlarger and longer-lasting dividends than almost any other comparable public health in- vestment. But as a nation,we’re heading in exactly the opposite direction, spend- ing more and more of our limited re- sources on the later stages of life instead of where they canmake themost differ- ence: at the very beginning. Take obesity. Many anti-obesity ini-
tiatives concentrateonchanging adults’ behavior, trying to persuade us to eat less and exercise more. But research shows that these efforts have limited effectiveness. A recent analysis of U.S. obesity-prevention campaigns, con- ducted by OlafWerder of theUniversity of New Mexico, concluded that their “overall impact on obesity has been negligible.” Even public health programs aimed
at school-age children come too late: Almost a third of American children over age 2are already overweight or obese, according to theNationalHealth and Nutrition Examination Survey. Clearly, the conditions that contribute to obesity must begin exerting their influence very early in children’s lives— as early as their time in the womb. DOHaD research shows that the in-
trauterine environment of a woman who is significantly overweight when she conceives — or who puts on exces- sive weight during pregnancy—affects the developing fetus in ways that make it more likely to become overweight itself one day. Scientists are still figur- ing out exactly why this happens, but it appears that prenatal experience may alter the functioning of organs such as the heart and the pancreas, may shift the proportion of lean and fat body mass, and may influence the brain circuits that regulate appetite and me- tabolism. In a cleverly designed study pub-
lished in the Journal of Clinical Endo- crinology and Metabolism in 2009, re- searchers compared children born to the same mothers before and after
also affect the odds that her child will become obese. In a study of almost 10,000 mother-child pairs, researchers from the Center for Health Research at Kaiser Permanente Northwest found that women who developed diabetes during pregnancy and were not treated had childrenwhowere twice as likely to become obese as the children ofwomen without that illness. Pregnant women whose diabetes was treated with insu- lin, however, had children with no additional risk of obesity. Simply by controlling their mothers’ blood sugar during pregnancy, in other words, the expected doubling of these children’s obesity risk was completely reversed. Even the mental health of a pregnant
woman can have a long-term impact on her offspring.A2008 study by research- ers at the Kaiser Permanente Oakland Medical Center in California found that women with even mild symptoms of depression are60percentmorelikely to deliver early than other women; those whoare severely depressed have double the risk of premature birth. The babies of depressed women are also more likely to have low birth weight, to be irritable and to have trouble sleeping. Of course, these complications may
come about in part because many de- pressed women don’t take good care of themselves:Theymay eat poorly,smoke or drink alcohol, or fail to get prenatal care. But depression itself may shift the biochemical balance in a woman’s body in a fateful manner. For one thing, the stress hormone cortisol, which is often elevated in people with depression,may cross the placenta, directly affecting fetal development, and it may also affect a pregnant woman’s blood ves- sels, reducing the oxygen and nutrients that reach the fetus.
T
he case seems pretty clear: We should make a nationwide effort to ensure that every obstetrician
checks every pregnant patient’s mental state, along with her weight and blood pressure. Women who show signs of depressionshould be offered therapy or, incases thatwarrant it, carefullyadmin- istered antidepressantmedication. Adult behavior can be difficult to
change, as we know from the general ineffectiveness of anti-obesity cam- paigns. But pregnant women are a special case: They’re usually highly mo- tivated, they’re typically in regular con- tact with health-care providers, and they have to keep up their efforts for only nine months. Pregnancy therefore offers a singular opportunity to im- prove lives for decades to come, via interventions that cost little compared with the enormous price tags for obesi- ty, diabetes, low birth weight and pre- mature delivery. So why isn’t this critical window one
of our top health-care priorities? Part of the reason may simply be our
preference for quick fixes and for deal- ing with only those problems that exist in the here and now. It can be hard to wrap our heads around the notion that a woman’s diet or mental state today will have a serious effect on her chil- dren’s health many years out. But there’s a less obvious reason that resis- tance to maternal health initiatives might crop up among the liberal-lean- ing individuals who typically support public health initiatives and women’s health-care issues: abortion politics. Caring for the fetus, protecting the
fetus from harm — to abortion rights advocates, such measures sound like the steps antiabortion forceshave taken
We’re spending more and more of our limited resources on the later stages of life instead of where they can make the most difference: at the very beginning.
they’d had successful anti-obesity sur- gery. Children born after their mothers’ surgery weighed less at birth and were three times less likely to become severe- ly obese than their older brothers and sisters. Weight-loss surgery isn’t for everyone, of course. Still, what if before conceiving, overweight women were routinely counseled by their doctors about the effects of their weight on future offspring? And what if women who were gaining weight too rapidly in pregnancy were offered more help in controlling it? The resultsmight look something like
those found in studies of diabetes treat- mentduringpregnancy.Researchshows that the children of diabetic women are more likely thanothers todevelopdiabe- tes — in one recent study, seven times more likely. Like obesity, diabetes has a strong genetic component,but scientists are also beginning to focus onthe effects of a diabetic intrauterine environment. For example, a long-running study of the Pima Indians of Arizona, who have one of the highest rates of diabetes in the world, concluded that exposure to the diseasewhile inthewombwas responsi- ble for about 40 percent of the diabetes cases studied. A pregnant woman’s diabetes can
to try to establish a fetus’s rights.What’s the difference between controlling a diabetic pregnant woman’s blood sugar and, say, charging a pregnant woman who uses drugs with child abuse? Be- tweentellinganobese pregnantwoman that her weight may predispose her child to obesity and requiring a woman to look at an ultrasound of her fetus before proceeding with an abortion? The crucial difference lies in the
intent behind the intervention and in the way it’s carried out. Help in achiev- ing a healthy pregnancymust be offered to pregnant women, not forced upon them. And the aim behind such efforts must be to foster the healthandwell-be- ing of the woman and her fetus, not to score political points. Ultimately, research on the develop-
mental origins of health and disease should lead us to a new perspective on pregnancy, one that’s not about coerc- ing or controlling women — nor about ogling or fetishizing them — but about helping them,andtheir future children, be as healthy and as happy as they can be.
Annie Murphy Paul is the author of “Origins: How the Nine Months Before Birth Shape the Rest of Our Lives.”
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E PAUL JULIEN Ruby Bridges, pictured at theNewOrleans elementary school that she integrated as a first-grader 50 years ago.
At age 6, she made history. Now she wants to teach it.
bridges from B1
crowd was gathered outside. We lived New Orleans, so I was accustomed to the crowds ofMardi Gras. I thoughtwe had somehow stumbled into a parade. Police officers on horseback lined the streets, and in the growing crowd, people were shouting. The federal marshals grabbed my
hand and rushed me inside, where I was taken straight to the principal’s office. That’s where I sat for the rest of the school day. Most people in the crowd outside
were parents of other students. They had known that some of the city’s schools were going to be desegregated that day, but they didn’t know which ones. So they stood waiting, ready to pull their children out of class if their school had been chosen. All day, chil- dren left William Frantz as I sat in the principal’s office. Finally, someone came in and told
me that school was dismissed. I re- member thinking that this new school was really easy. The next day, the marshals took us
to school again. By the time we drove up, the crowd had almost doubled in size from the day before. Everyone seemed more agitated: screaming, shouting, chanting, carrying hateful signs. The marshals rushed me in again and said, “Walk straight ahead and don’t look back.” It was completely different inside
the building — dead quiet. The school had been emptied out. When I got to the top of the stairs, someone told me that my classroom was down the hall. A woman stepped out and said: “Hi, my name is Mrs. Henry. I’m your teacher.” I looked up at her. She was white.
Until that day I had never seen a white teacher. She looked exactly like the people who were gathered in that angry crowd. But she told me to take a seat, and
she began to teach me. Though she looked like the people outside, she was nothing like them. She became like a best friend, or like another mother to me. We did more than just study; we played games, did art projects, learned
music. Itwasjust the twoof us for the entire
year. She never missed a day, and neither did I. I learned many things from Barbara
Henry that year, but the primary les- son was the same one that Martin Luther King tried to teach all of us: Never judge peoplebythe color of their skin. I stayed at that school through the
sixth grade.Themost difficult yearwas second grade, when I had a teacher who had refused to teach me the first year. But every fall, more black stu- dents joined me. By the time I left, I seem to recall that William Frantz was about evenly integrated. After the first year, no one really discussed it. The first time I saw the Rockwell painting, I was about 18 years old. A reporter who had come to the city to interviewme showed me the portrait. When I saw it, I realized that I
needed to knowmore about what had happened and why. My experience at WilliamFrantz wasn’t something that we talked about in my family much. Mymotherhadwantedme to be one of the first students to integrate the schools, butmy fatherwas resistant to the idea. He had fought in Korea and had seen how, even after a black soldier had been on the battlefield fighting for the same country side by side with a white solider, he was not able to go back to the same barracks or eat in the same mess hall. This dis- agreement led to conflicts in my par- ents’ marriage and their eventual di- vorce. So in our family, the subjectwas dead and buried. It was not until decades later that I
fully understood how much my first- grade year shapedmy entire life. And I had that realization, of all places, at William Frantz. I had not given much thought to the events ofmy childhood untilmyyoungest brother passed away in 1993 and I began looking after his daughters. They happened to be stu- dents at William Frantz, and I began volunteering there as a parent liaison. At that difficult time inmy life, I felt I had been brought back in touch with my past for some greater cause. Not long after, a reporter called the
school. Psychiatrist Robert Coles had written a children’s book, “The Story of Ruby Bridges,” and people wanted to know what had happened to the little girl in the painting. No one expected to find me back at my old school. Since then, I have been telling my
story, traveling around the country, meeting students and seeing how the history of the civil rights movement is taught. I believe children are getting an incomplete picture. We teach this important chapter in our country’s history as if it were a battle of black vs. white. But there were key figures of all races fighting for civil rights.We need to teach this more complex story. Only with a fuller sense of what happened can we really move forward. That is part of what motivatesmeto
open a newschool now. After a great deal of work, we were
able to get the William Frantz school recognized on theNational Register of Historic Places in April 2005. Four months later, Hurricane Katrina struck. At first I thought that all the workhadbeen for nothing.This school I’d fought to preserve was devastated, like so much of New Orleans. The building was badly damaged, and the roof was caving in; there was talk of just tearing the whole thing down. But thanks to our efforts and the school’s place in history, we were able to pre- serve it. Soon, the Recovery School District
will be breaking ground to refurbish William Frantz Elementary. I will be applying for a charter to
turn it into the type of school I have been dreaming about. I hope that students can walk through the same front doors that I made my way through 50 years ago, and enter a school where history is taught in a different way, and where there is a focus on social justice and community service. I believe that a school like this, and a mission like this, will naturally breed the kind of racial diversity that we need in our schools if children are to grow up learning from and under- standing one another. I am hopeful about what the first
day will bring.
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