Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- 1 The developmental origins of health and disease: an overview
- 2 The ‘developmental origins’ hypothesis: epidemiology
- 3 The conceptual basis for the developmental origins of health and disease
- 4 The periconceptional and embryonic period
- 5 Epigenetic mechanisms
- 6 A mitochondrial component of developmental programming
- 7 Role of exposure to environmental chemicals in developmental origins of health and disease
- 8 Maternal nutrition and fetal growth and development
- 9 Placental mechanisms and developmental origins of health and disease
- 10 Control of fetal metabolism: relevance to developmental origins of health and disease
- 11 Lipid metabolism: relevance to developmental origins of health and disease
- 12 Prenatal hypoxia: relevance to developmental origins of health and disease
- 13 The fetal hypothalamic–pituitary–adrenal axis: relevance to developmental origins of health and disease
- 14 Perinatal influences on the endocrine and metabolic axes during childhood
- 15 Patterns of growth: relevance to developmental origins of health and disease
- 16 The developmental environment and the endocrine pancreas
- 17 The developmental environment and insulin resistance
- 18 The developmental environment and the development of obesity
- 19 The developmental environment and its role in the metabolic syndrome
- 20 Programming the cardiovascular system
- 21 The role of vascular dysfunction in developmental origins of health and disease: evidence from human and animal studies
- 22 The developmental environment and atherogenesis
- 23 The developmental environment, renal function and disease
- 24 The developmental environment: effect on fluid and electrolyte homeostasis
- 25 The developmental environment: effects on lung structure and function
- 26 Developmental origins of asthma and related allergic disorders
- 27 The developmental environment: influences on subsequent cognitive function and behaviour
- 28 The developmental environment and the origins of neurological disorders
- 29 The developmental environment: clinical perspectives on effects on the musculoskeletal system
- 30 The developmental environment: experimental perspectives on skeletal development
- 31 The developmental environment and the early origins of cancer
- 32 The developmental environment: implications for ageing and life span
- 33 Developmental origins of health and disease: implications for primary intervention for cardiovascular and metabolic disease
- 34 Developmental origins of health and disease: public-health perspectives
- 35 Developmental origins of health and disease: implications for developing countries
- 36 Developmental origins of health and disease: ethical and social considerations
- 37 Past obstacles and future promise
- Index
- References
36 - Developmental origins of health and disease: ethical and social considerations
Published online by Cambridge University Press: 08 August 2009
By
Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- 1 The developmental origins of health and disease: an overview
- 2 The ‘developmental origins’ hypothesis: epidemiology
- 3 The conceptual basis for the developmental origins of health and disease
- 4 The periconceptional and embryonic period
- 5 Epigenetic mechanisms
- 6 A mitochondrial component of developmental programming
- 7 Role of exposure to environmental chemicals in developmental origins of health and disease
- 8 Maternal nutrition and fetal growth and development
- 9 Placental mechanisms and developmental origins of health and disease
- 10 Control of fetal metabolism: relevance to developmental origins of health and disease
- 11 Lipid metabolism: relevance to developmental origins of health and disease
- 12 Prenatal hypoxia: relevance to developmental origins of health and disease
- 13 The fetal hypothalamic–pituitary–adrenal axis: relevance to developmental origins of health and disease
- 14 Perinatal influences on the endocrine and metabolic axes during childhood
- 15 Patterns of growth: relevance to developmental origins of health and disease
- 16 The developmental environment and the endocrine pancreas
- 17 The developmental environment and insulin resistance
- 18 The developmental environment and the development of obesity
- 19 The developmental environment and its role in the metabolic syndrome
- 20 Programming the cardiovascular system
- 21 The role of vascular dysfunction in developmental origins of health and disease: evidence from human and animal studies
- 22 The developmental environment and atherogenesis
- 23 The developmental environment, renal function and disease
- 24 The developmental environment: effect on fluid and electrolyte homeostasis
- 25 The developmental environment: effects on lung structure and function
- 26 Developmental origins of asthma and related allergic disorders
- 27 The developmental environment: influences on subsequent cognitive function and behaviour
- 28 The developmental environment and the origins of neurological disorders
- 29 The developmental environment: clinical perspectives on effects on the musculoskeletal system
- 30 The developmental environment: experimental perspectives on skeletal development
- 31 The developmental environment and the early origins of cancer
- 32 The developmental environment: implications for ageing and life span
- 33 Developmental origins of health and disease: implications for primary intervention for cardiovascular and metabolic disease
- 34 Developmental origins of health and disease: public-health perspectives
- 35 Developmental origins of health and disease: implications for developing countries
- 36 Developmental origins of health and disease: ethical and social considerations
- 37 Past obstacles and future promise
- Index
- References
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 - 480Publisher: Cambridge University PressPrint publication year: 2006
References
Anon. (2001). Mens Health, 7 (9).
(1998). In utero programming of chronic disease. Clin. Sci., 95, 115–28.CrossRefGoogle ScholarPubMed
Bewley, S. (2002). Restricting the freedom of pregnant women. In Ethical Issues in Maternal–Fetal Medicine (ed. ). Cambridge:Cambridge University Press, pp. 131–46.CrossRefGoogle Scholar
(2002). Long chain polyunsaturated fatty acids and fetal programming. Electronic letter. BMJ. www.bmj.com/cgi/eletters/324/7335/447.Google Scholar
(2001). Reflections on the limitations to epidemiology. J. Clin. Epidemiol., 54, 325–31.Google Scholar
, and (2001). Should adolescents be specifically targeted for nutrition in developing countries? To address which problems, and how? World Health Organization. www.who.int/child-adolescent-health.Google Scholar
, , , , and (1995). Fetal and infant growth and cardiovascular risk factors in women. BMJ, 310, 428–32.CrossRefGoogle ScholarPubMed
(1994). Women's health: an overview. Int. J. Gynaecol. Obstet., 46, 105–18.CrossRefGoogle ScholarPubMed
(2003). Surgery in the human fetus: the future. J. Physiol., 547, 45–51.CrossRefGoogle ScholarPubMed
Gallagher, J. (1995). Collective bad faith: ‘protecting’ the Fetus. In Reproduction, Ethics, and the Law: Feminist Perspectives. (ed. ). Bloomington, IN: Indiana University Press, pp. 343–79.Google Scholar
and (1992). Type 2 (non-insulin-dependent) diabetus mellitus: the thrifty phenotype hypothesis. Diabetologia, 35, 595–601.CrossRefGoogle Scholar
and (2003). The dangerous road of catch-up growth. J. Physiol., 547, 5–10.CrossRefGoogle ScholarPubMed
(2001). The nutritional basis of the fetal origin of adult disease. Int. J. Epidemiol., 30, 15–23.CrossRefGoogle Scholar
and (1999). Intrauterine nutrition: its importance during critical periods for cardiovascular and endocrine development. J. Physiol., 514, 617–27.CrossRefGoogle ScholarPubMed
International Federation of Red Cross and Red Crescent Societies (1999). The public health – human rights dialogue. In Health and Human Rights (ed. , , and ). New York, NY: Routledge, pp. 46–53.Google Scholar
Mahowald, M. B. (1995). As if there were fetuses without women: a remedial essay. In Reproduction, Ethics, and the Law: Feminist Perspectives (ed. ). Bloomington, IN: Indiana University Press, pp. 199–218.Google Scholar
(1995). Social Misconstruction: the Neglect of Biology in Contemporary British Sociology. Sociological Notes, 22. London: Libertarian Alliance.Google Scholar
, , et al. (2003). Nutrtitional interventions during pregnancy for the prevention or treatment of impaired fetal growth: an overview of randomized controlled trials. J. Nutr., 133, 1626–31S.CrossRefGoogle ScholarPubMed
and (2003). Fetal programming: from gene to functional systems. An overview. J. Physiol., 547, 3–4.CrossRefGoogle Scholar
Nuffield Council on Bioethics (1999). The Ethics of Clinical Research in Developing Countries. London: Nuffield Council.
Ottawa Charter (1986). Ottawa Charter for Health Promotion. Presented at the first International Conference on Health Promotion, Ottawa, 1986.
, , , and (1999). Obesity at the age of 50 years in men and women exposed to famine prenatally. Am. J. Clin. Nutr., 70, 811–16.CrossRefGoogle Scholar
(2000). Making Women Pay: the Hidden Costs of Fetal Rights. New York, NY: Cornell University Press.Google Scholar
Rush D. (1989). Effects of changes in maternal energy and protein intake during pregnancy, with special reference to fetal growth. In Fetal Growth (ed. , and ). London: Royal College of Obstetricians and Gynaecologists, pp. 203–29.CrossRefGoogle Scholar
, and (1990). Maternal growth during pregnancy and decreased infant birth weight. Am. J. Clin. Nutr., 51, 790–3.CrossRefGoogle ScholarPubMed
Tones, K. (1988). Health education and the promotion of health: seeking wisely to empower. In Health and Empowerment: Research and Practice (ed. ). London: Arnold, pp. 57–88.Google Scholar
, and , eds. (1988). Inequalities in Health: The Black Report and the Health Divide. London: Penguin.Google Scholar
University of Southampton (2003). Centre for the Origins of Adult Disease. Press release, 5 June 2003.
, , et al. (2003). Characteristics of randomized controlled trials included in systematic reviews of nutritional interventions reporting maternal morbidity, mortality, preterm delivery, intrauterine growth restriction and small for gestational age and birth weight outcomes. J. Nutr., 133, 1632–9S.CrossRefGoogle ScholarPubMed
(2000). Mind the Gap: Heirarchies, Health and Human Evolution. London: Weidenfeld and Nicolson.Google Scholar
World Health Organization (1978). Declaration of Alma-Ata. ‘Health for All’ series, no. 1. Geneva: WHO.
World Medical Association (1964). Declaration of Helisnki: Ethical Principles for Medical Research Involving Human Subjects. Adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964.