It is well known that living healthily reduces our risk of suffering from common diseases such as cardiovascular disease, obesity, type 2 diabetes or various mental disorders later in life. Epidemiological (register) studies show that there is also a connection between foetal health and exposure in the womb, and the health of the individual in advanced middle age.
Lifestyle before conception may affect the foetus later
To reduce the risk of any negative effect on the foetus, a lot of focus is currently placed on the mother’s lifestyle once pregnancy is confirmed, usually 7–8 weeks after conception. The future mother receives advice on what to eat and the effects of smoking, medication and alcohol.
However, according to Peter M Nilsson, research in the last few years (recently summarised in three articles in the Lancet) shows that the mother’s lifestyle particularly plays a role in early pregnancy, as well as before and during the actual conception. Researchers have now begun discussing periconceptional health (around the time of conception) in women. This term refers to the health impact of the six months before pregnancy and up to the tenth week of pregnancy when the embryo develops and early organ development has usually taken place”, explains Peter M Nilsson.
“It’s very interesting to be able to show that what happens to the woman already before conception may affect the foetus later. Many young women today have a less healthy lifestyle, and if this can be improved by counselling, without adding to their worry and anxiety, better health conditions can also be created for growing foetuses – the adults of tomorrow. However, the foetus is affected not only by the future mother’s lifestyle, but also the future father’s”.
It may seem strange that the health and lifestyle of our parents before and at the precise time when we came to be may affect our future health. The explanation is that when the female and male reproductive cells mature, they may be affected by lifestyle factors. It takes 3–4 months for a sperm to form and this development has been shown to suffer from smoking and alcohol. The female ovum is also sensitive to external factors during the time the cell matures in the ovaries, is released and transported through the Fallopian tube and fertilised. The cells in the fertilised egg continue to be particularly exposed until the egg is embedded in the uterine wall.
The mother’s lifestyle plays a role in early pregnancy, as well as before and during theactual conception.
Factors that may negatively affect reproductive cells and the newly fertilised egg include smoking, alcohol, overweight/obesity and poor diet with vitamin deficiency (B12, folic acid), but also infections like German measles (rubella). When such factors cause changes in the cells – changes that affect the body’s functions and the risk of disease in the adult individual – it is referred to as cells being programmed.
One explanation as to why the cell development of the foetus can be programmed is known as epigenetic mechanisms. For example, the genes in the DNA sequence may acquire a group of additional molecules, which then control which genes are activated or deactivated depending on the circumstances in our lives.
Peter M Nilsson compares our genes to the black and white keys on a piano. In order for the keys to interact and create a melody, a hand needs to press the keys. Only the pressed keys are heard. The fingers of the hand (environmental factors) correspond to the epigenetic mechanisms that can switch the gene on or off depending on the circumstances in our lives.
“The question of which events during the foetal stage affect the risk of disease in the adult individual is more complex than previously believed”, says Peter M Nilsson. “Research in recent years increasingly shows that the effects of programming are not only related to what happens during the actual foetal period, but also during the time before and after pregnancy.”
With regard to the post-partum period, it is mainly the development of the brain nerve cells (neurons) that continues long after the child is born.
Children need a good start
“A good start in life with a normal, healthy pregnancy, smoke-free home, stimulation, good nutrition and loving care, enables the normal development of the child and its neurons and their connections, e.g. mirror neurons. This gives the child a chance of good cognitive development and of making informed decisions about, for example, their choice of lifestyle.”
Overall, Peter M Nilsson believes that, when it comes to common diseases, we need investment in preventive health and lifestyle initiatives covering the entire period from conception, foetal life, childhood and adolescence, to life as a young couple planning to have children.
“We also need to invest more to increase our understanding of how periconceptional health affects reproductive cells as well as embryonic and foetal development”, emphasises Peter M Nilsson.
The importance of periconceptional health for young women was recently the focus of three review articles in the Lancet [Lancet 2018; 391(10132), pp: 1830–1841, 1842–1852 and 1853–1864].