Developmental origins of health and disease: ethical and social considerations

doi:10.1017/CBO9780511544699.037

36 - Developmental origins of health and disease: ethical and social considerations

Published online by Cambridge University Press: 08 August 2009

Ray Noble

Edited by

Peter Gluckman and

Mark Hanson

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Ray Noble: Affiliation:
University College, London
Peter Gluckman: Affiliation:
University of Auckland
Mark Hanson: Affiliation:
University of Southampton

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Summary

Introduction

The discovery of a link between low birthweight and adult disease has opened exciting and rewarding areas of research (Nathanielsz and Thornburg 2003). The ‘Barker hypothesis’ of fetal programming, where fetal adaptations to nutritional deprivation increase vulnerability to disorders in later life (Barker 1998), creates the prospect of new strategies to prevent adult diseases either by changing maternal nutrition or by new therapeutic approaches to fetal growth. With the focus on possible benefits of these strategies and the prospect of breaking the cycle of poverty and disease, there has been little consideration of associated ethical and social issues.

In this chapter I will argue that, as currently presented, the concept of the fetal origin of adult disease creates a pseudo-pathological condition by regarding low birthweight, even within the normal range, as impairment. It renders pathological that which we currently regard as normal. It seeks to fix that which may be damaged later (adult disease) by altering that which is not yet broken (fetal growth and function) (Flake 2003). It establishes and fosters a simplistic creed of ‘big babies good, small babies bad’, and it shifts the focus away from socioeconomic influences and places the onus of responsibility on women.

Furthermore, the aim of increasing mean birthweight and employing therapeutic strategies to protect the fetus may further intensify what some already argue is an intimidating environment, challenging the autonomy and rights of pregnant women (Roth 2000).

Type: Chapter
Information: Developmental Origins of Health and Disease , pp. 472 - 480

DOI: https://doi.org/10.1017/CBO9780511544699.037 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2006

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