Developmental Origins of Health and Disease(DOHaD

Maternal Factors such as obesity, diabetes, stress, smoking, environmental pollution and a poor lifestyle affect the development of the progency

Non-communicable diseases (NCDs) account for more than 70% of all deaths globally. 1 in 4 Indians have the risks of dying less than 70 years of age with Non Communicable Diseases. The non communicable diseases are now traced back to the womb. What we are today is due to what we were in the womb. Non-communicable diseases are communicable – across generations. Risk is passed across generations, by processes which are not simply genetic. Epignetics plays an important role. Epigenetics is the study of how the expression of DNA(functionality) can be changed without changing the structure of DNA itself The epigenetic modifications is the cause for Developmental Origins of Health and Disease. .. esp. non communicable disease.

What is DOHaD?

DOHaD embraces the concept that environmental exposures that occur before and during pregnancy have an impact on health outcomes of adults. It contends that “during early life (at conception, and/or during foetal life, infancy and early childhood) the environment induces changes in development that have long term impact on later health and disease risk” This happens because of epigenetic changes.

What Happens in the womb lasts a lifetime. Children of today are at risk of Asthma & lung disease, Obesity, diabetes, cardiovascular disease, learning disabilities, IQ issues, Reproductive organ disorders and various forms of cancer

Current Scenario of our Pregnant Women

According to various reports (such as WHO, ICMR, our own clinical observations, etc,.) Among the pregnant women, one in three are obese, one in four to five pregnant women have diabetes; one in 10 have hypertension

Obesity            

One in three women in urban areas are obese, raising levels of maternal obesity has its impact on pregnancy and beyond in terms of the cardio vascular health of the mother and the offspring. Maternal obesity propagates obesity and diabetes to the next generation. Interruption of this before, during and after pregnancy may help to stem the tide of raising incidence of NCDs.

Gestational diabetes-
Effects of gestational diabetes on the mother - Nearly 50% of mothers with Gestational Diabetes can become diabetics with in 5-10years, adding to the enormous burden of diabetes in our country.
In women who have had gestational diabetes, there is a 2 fold higher risk of developing hypertension, CardiovascularDisease and Non Alcoholic Fatty Liver Disease.

Foetal and intergenerational effect
The hyperglycemia (increased sugars in the blood) cycle perpetuates and passes on to future generations. Mother has a larger influence than the father on prevalence of diabetes in childhood.

Fetal hyperglycaemia leads to metabolic imprinting:
Children born to women with diabetes or Gestational Diabetes Mellitus are prone for 2 times the rate of obesity, insulin resistance and metabolic syndrome. They are prone for accelerated growth in their teens (and hence higher Body Mass Index) and higher atherogenic indices leading to cardiovascular accidents.

What can we do
Life-course model suggests that early prevention is needed and indicates periods to intervene. Scientists and medical researchers across the world have found out that the steep rise in non-communicable diseases among grown up individuals is due to defects in the gene pattern and poor lifestyle and poor care during pregnancy & child birth.

Though the situation is alarming, the silver lining is. . . .that it is preventable! Optimum care during Pre- conception, Pregnancy and Delivery can make the future generations healthy and disease free.

As care givers in pregnancy, delivery and postpartum, it is important for all stakeholders to have the knowledge of epigenetics and DOHaD

Role of pre-conceptional care
Pre conceptional care is the first step towards optimization of physical, mental and emotional health of the mother, appropriate for child birth.

Women should keep in mind that the implantation and early development of the baby starts even before she misses her first period.

The whole idea of the pre conception clinic is to ensure that every woman is NO RISK before she begins her journey to motherhood
Preconceptional care is aimed @life style changes which includes

  •        Healthy diet, inclusive of macro and micronutrients
  •        Appropriate physical activity for optimum weight
  •       Stress management for good emotional & mental health
  •       Managing pre-existing or long-term conditions, previous pregnancy conditions
  •       Appropriate planning of time of pregnancy

PoHAD- Paternal origin of health and diseases- obesity and unhealthy habits increases the sperm abnormality leading to impaired health of the child

Role of care during pregnancy (inverted pyramid of care)
Inverted pyramid of care emphasises on more intense surveillance on fetomaternal health in early pregnancy and risk stratification of every pregnant woman and her fetus leading to better management and better health of both mother and the child

Important aspects of care during pregnancy includes
Screening for

  •        Diabetes,
  •        Hypertension,
  •        Pre eclampsia with first trimester scan and biochemical markers
  •        Foetal structural and chromosomal anomaly with first trimester scans Counselling regarding
  •        DOHaD
  •        Healthy life style,
  •        Good nutrition and
  •        Stress reduction through yoga

Care during delivery
A woman is designed by nature to get pregnant and deliver vaginally – Normal vaginal delivery is a natural process that has distinct advantages for the health of both mother and child, both short term and long term The advantages of normal delivery are

  •      It is safer, as you avoid major surgery, anaesthesia and its complications
  •      Future pregnancies and deliveries are low risk
  •      Transfer of beneficial gut microbiomes leading to lower risk of asthma and prevents diabetes and obesity.
  •      Better IQ in the progeny

Gestational hypertension/ Preeclampsia(PE/Hypertension in pregnancy)
Pre eclampsiais a risk factor for cardiovascular disease later in life.Women with preeclampsia are at>200% increased risk of Hypertension, Ischaemic heart disease, Diabetes, Strokeand Overall morbidity(ill health)

What Happens in the womb lasts a lifetime.
Children of today are more at risk of Asthma & lung disease, Obesity, diabetes, cardiovascular disease, Learning disabilities, IQ issues, Reproductive organ disorders and various forms of cancer

What can we do
Life-course model suggests that early prevention is needed and indicates periods to intervene. Scientists and medical researchers across the world have found out that the steep rise in non-communicable diseases among grown up individuals is due to defects in the gene pattern and poor lifestyle and poor care during pregnancy & child birth.

Though the situation is alarming, the silver lining is.... that it is preventable! Optimum care during Pre- conception, Pregnancy and Delivery can make the future generations healthy and disease free.

As care givers in pregnancy, delivery and postpartum, it is important for all stakeholders to have the knowledge of epigenetics and DOHaD

Role of pre-conceptional care
Pre conceptional care is the first step towards optimization of physical, mental and emotional health of the mother, appropriate for child birth.

Women should keep in mind that the implantation and early development of the baby starts even before she misses her first period.

Current Scenario of our Pregnant Women
According to various reports (such as WHO, ICMR, our own clinical observations, etc,.) Among the pregnant women, one in three are obese, one in four to five pregnant women have diabetes; one in 10 have hypertension

Obesity                                                                                                                                                        

One in three women in urban areas are obese, raising levels of maternal obesity has its impact on pregnancy and beyond in terms of the cardio vascular health of the mother and the offspring. Maternal obesity propagates obesity and diabetes to the next generation. Interruption of this before, during and after pregnancy may help to stem the tide of raising incidence of NCDs.

Gestational diabetes-
Effects of gestational diabetes on the mother -
Nearly 50% of mothers with Gestational Diabetes can become diabetics with in 5-10years, adding to the enormous burden of diabetes in our country.
In women who have had gestational diabetes, there is a 2 fold higher risk of developing hypertension, CardiovascularDisease and Non Alcoholic Fatty Liver Disease.

Foetal and intergenerational effect
The hyperglycemia (increased sugars in the blood) cycle perpetuates and passes on to future generations. Mother has a larger influence than the father on prevalence of diabetes in childhood.

Fetal hyperglycaemia leads to metabolic imprinting:
Children born to women with diabetes or Gestational Diabetes Mellitus are prone for 2 times the rate of obesity, insulin resistance and metabolic syndrome. They are prone for accelerated growth in their teens (and hence higher Body Mass Index) and higher atherogenic indices leading to cardiovascular accidents.

Gestational hypertension/ Preeclampsia(PE/Hypertension in pregnancy)
Pre eclampsiais a risk factor for cardiovascular disease later in life.Women with preeclampsia are at>200% increased risk of Hypertension, Ischaemic heart disease, Diabetes, Strokeand Overall morbidity(ill health)

What Happens in the womb lasts a lifetime.
Children of today are more at risk of Asthma & lung disease, Obesity, diabetes, cardiovascular disease, Learning disabilities, IQ issues, Reproductive organ disorders and various forms of cancer

For babies born by Caesarean section, emerging evidences point to inadequate transfer of gut microbiomes to the baby and reduced immunity, which makes them more prone for asthma, eczema, diabetes, obesity, metabolic syndrome and its complications at a much younger age.
Care during post partum

Breast feeding is the best feeding because

  •     Infants who are exclusively breastfed are 10 times more protected from pneumonia and diarrhea
  •     Breastfeeding can lead to higher IQ, lower risk of obesity, food allergies, asthma, eczema, Celiac Disease, and Type I           and Type II diabetes, among others.
  •     Moms who breastfeed have lower rates of ovarian, breast and endometrial cancer.

In summary, Preconception, pregnancy, delivery and postpartum care play a very important role in determining the quality of progeny that a couple produce. Specialists, general practitioners, paramedics should take the opportunity to give the best care for the couple to get the best progeny. Counseling regarding DOHaD should be a part of Obstetric care.

Education of the parents and society at large regarding the fact
“ The foetus passes through many more physical and developmental milestones while in the womb than after birth. It’s not just enough to provide care after birth. Parents should be aware of giving the best while in womb to get the best offspring.” Is an important aspect of preventing Non Communicable Diseases.
Over the last couple of decades, radical changes in our life style has affected the quality of the progeny resulting in suboptimal health of these individuals as adults. This can perpetuate through generations and weaken the health of the individuals at a younger age, affecting the society at large. The long-term aim is to make the parents of tomorrow healthier so that they will not only have healthier lives as they grow up to become adults, but also so that they will pass on greater health to the next generation
 

 

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