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When Health Begins: What You Need to Know


Prenatal Factors and Lifelong Health

Here are some examples describing the long-term consequences of prenatal events. There is no substitute at any age for a well balanced diet and avoiding exposure to harmful substances.

Supplementation with folic acid before and during early pregnancy decreases the risk of neural tube defects1 —the most common of which is spina bifida.2 Neural tube defects occur within four weeks after fertilization—before most women even know they are pregnant. The Centers for Disease Control and many other organizations have long recommended daily folic acid supplements in women of childbearing age.3

Folic acid deficiency before and during pregnancy has additional consequences beyond the risk of neural tube defects. It is also associated with an increased risk of low birth weight and premature birth.4 In fact, a recent study found that pregnant women who take folic acid supplements beginning one year prior to conception experienced a 70% reduction in the incidence of severe prematurity (prior to 26 weeks postconception) and a 50% reduction in moderately severe prematurity (prior to 30 weeks postconception).5

It is well established that iodine deficiency during pregnancy and early childhood impairs the production of thyroid hormone and may lead to hypothyroidism and brain damage.6 This is the leading cause of preventable mental retardation in many parts of the world.7 For this reason, table salt is supplemented with iodine in many parts of the world in an effort to address widespread iodine deficiency.

Vitamin D deficiency during pregnancyis associated with lower bone mass at birth8 and lower bone mass by ages 8 or 9 years old,9 which raises the risk later in life of developing osteoporosis10, a condition particularly common in women.

Asthma, the leading cause of school absenteeism among chronic illnesses,11 has recently been linked to low vitamin E intake during pregnancy. A 2005 study reported a five-fold increase in the risk of asthma or asthma-like symptoms among five-year-old children whose mothers reported low Vitamin E intake as compared to children of mothers with high Vitamin E intake.12 Giving vitamin E to these five-year-old children did not improve their asthma.

The same study also reported a nearly two-fold increased risk of asthma in five-year-olds whose mothers had the lowest zinc intake during pregnancy.13

Low vitamin D intake during pregnancy is associated with increased wheezing symptoms in five-year-old children (but not asthma), independent of their vitamin D intake after birth.14

An increased risk of ADHD and anxiety was reported among 8- and 9-year-olds whose mothers experienced high stress levels between 12 and 22 weeks of postmenstrual age (or between 10 and 20 weeks postfertilization).15

High levels of stress later in pregnancy did not translate into increased risks in the children under study.

It is well known that smoking during pregnancy impairs fetal growth,16 and is associated with a higher risk of miscarriage17 and premature birth.18 It also slightly increases the risk of certain brain cancers in young children.19

Prenatal tobacco exposure is also linked to a higher risk of obesity at ages 3,20 4½,21 5 to 7,22 and 33.23 This effect appears to be dose related—the more a pregnant woman smokes, the higher the risk of obesity in her children.24

Other reported complications include: a two- to six-fold greater risk of Sudden Infant Death Syndrome (SIDS),25 and an increased risk of Attention Deficit Hyperactivity Disorder (ADHD),26 noninsulin-dependent diabetes,27 and tobacco experimentation during childhood.28 The risk of nicotine dependence in adults is also elevated.29

Additionally, prenatal tobacco exposure is linked with an increased risk of conduct disorder,30 a collection of emotional and behavioral disabilities.

Prenatal alcohol exposure is widely known as the sole cause of Fetal Alcohol Syndrome, which is the most common preventable cause of mental retardation in the United States31 and other developed countries. It is also associated with lower IQ and a higher rate of fetal mortality.

Less well known is the increased risk of ADHD,32 conduct disorder,33 and intrauterine growth retardation.34 Prenatal alcohol exposure is also associated with an increased risk of alcohol use during adolescence,35 a higher risk of alcohol dependence in early adulthood,36 and lower academic performance.37 Heavy alcohol use during pregnancy is associated with very early premature birth.38

Inadequate nutrition during pregnancy is a major cause of intrauterine growth retardation (IUGR) and low birth weight, which are associated with decreased adult height39 and cognitive ability,40 and an increased risk of hypertension or high blood pressure,41 stroke,42 non-insulin dependent diabetes,43 and coronary artery disease leading to heart attack.44

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1 Williams JL et al., 2006. S67; Williams LJ et al., 2005. 580; Blencowe H et al., 2010. i118.
2 Bukowski R et al., 2009. 6.
3 Coming Soon, 2010. 100.
4 Scholl TO, Johnson WG, 2000. 1295s; Ashworth CJ, Antipatis C, 2001. 532.
5 Bukowski R et al., 2009. 6.
6 Coming Soon, 2010. 100.
7 Ashworth CJ, Antipatis C, 2001. 533.
8 Coming Soon, 2010. 100.
9 Cooper C et al., 2005. 2730S; Javaid MK et al., 2006. 36.
10 Coming Soon, 2010. 100.
12 Devereux G et al., 2006. 502; Litonjua AA et al., 2006. 853.
13 Coming Soon, 2010. 100.
14 Devereux G et al., 2007. 855.
15 Van den Bergh BR, Marcoen A, 2004. 1092.
16 Fasting MH et al., 2008. 2.
17 Chatenoud L et al., 1998. 524; Cunningham FG et al., 2001. 859; Brown DC, 1996. 102.
18 Spong CY, 2007. 407; Cnattingius S et al., 1999. 947.
19 Brooks DR et al., 2004. 1000.
20 Adams AK et al,, 2005. 396-397.
21 Dubois and Girard, 2006. 610.
22 von Kries R et al., 2002. 954.
23 Power C, Jefferis BJ, 2002. 416-417; Montgomery SM, Ekbom A, 2002. 26-27.
24 Bergen HT, 2006. 6; von Kries R et al., 2002. 954&956.
25 Salihu HM, Wilson RE, 2007. 717-718; Chong DS et al., 2004. 471, 478.
26 Linnet KM et al., 2003. 1028; Braun JM et al., 2006. 1904; Millichap JG, 2008. e360.
27 Montgomery SM, Ekbom A, 2002. 26-27.
28 Cornelius MD et al., 2000. 45.
29 Buka SL et al., 2003. 1983; Al Mamun A et al., 2006. 457.
30 Wakschlag LS et al., 1997. 670; Fergusson DM et al., 1998. 726; Langley K et al., 2007. e-article.
32 Millichap JG, 2008. e360.
33 Fryer SL et al., 2007. e737.
34 Little RE, Streissguth AP, 1981. 160.
35 Griesler PC, Kandel DB, 1998. 297.
36 Baer JS et al., 2003. 377, 383.
37 Goldschmidt L et al., 1996. 766-767; Streissguth AP et al., 1994. 253.
38 Coming Soon, 2010. 100.
39 Victora CG et al., 2008. 340; Case A, Paxson C, 2006. 8,11,19,32,40.
40 Case A, Paxson C, 2006. 6.
41 Leon DA et al., 1996. 405.
42 Eriksson JG et al., 2000. 873.
43 Ong KK, Dunger DB, 2002. 202; International Diabetes Federation website, 2002. e-article.
44 Barker, Winter, et al., 1989. 579; Barker DJ, 1999. 305.


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von Kries R, Toschke AM, Koletzko B, Slikker W, Jr. 2002. Maternal smoking during pregnancy and childhood obesity. Am J Epidemiol. 156:954-961.
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Ashworth CJ, Antipatis C. 2001. Micronutrient programming of development throughout gestation. Reproduction. Oct;122(4):527-35.
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Dubois L, Girard M. 2006. Early determinants of overweight at 4.5 years in a population-based longitudinal study. Int J Obes (Lond). 30:610-617.
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Power C, Jefferis BJ. 2002. Fetal environment and subsequent obesity: a study of maternal smoking. Int J Epidemiol. 31:413-419.
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Adams AK, Harvey HE, Prince RJ. 2005. Association of maternal smoking with overweight at age 3 y in American Indian children. Am J Clin Nutr. 82:393-398.
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Griesler PC, Kandel DB. 1998. The impact of maternal drinking during and after pregnancy on the drinking of adolescent offspring. J Stud Alcohol. 1998 May;59(3):292-304.
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Goldschmidt L, Richardson GA, Stoffer DS, Geva D, Day NL. 1996. Prenatal alcohol exposure and academic achievement at age six: a nonlinear fit. Alcohol Clin Exp Res. Jun;20(4):763-70.
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Streissguth AP, Barr HM, Olson HC, Sampson PD, Bookstein FL, Burgess DM. 1994. Drinking during pregnancy decreases word attack and arithmetic scores on standardized tests: adolescent data from a population-based prospective study. Alcohol Clin Exp Res. Apr;18(2):248-54.
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Fryer SL, McGee CL, Matt GE, Riley EP, Mattson SN. 2007. Evaluation of psychopathological conditions in children with heavy prenatal alcohol exposure. Pediatrics. Mar;119(3):e733-41.
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Fergusson DM, Woodward LJ, Horwood LJ. 1998. Maternal smoking during pregnancy and psychiatric adjustment in late adolescence. Arch Gen Psychiatry. Aug;55(8):721-7.
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Wakschlag LS, Lahey BB, Loeber R, Green SM, Gordon RA, Leventhal BL. 1997. Maternal smoking during pregnancy and the risk of conduct disorder in boys. Arch Gen Psychiatry. Jul;54(7):670-6.
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Linnet KM, Dalsgaard S, Obel C, Wisborg K, Henriksen TB, Rodriguez A, Kotimaa A, Moilanen I, Thomsen PH, Olsen J, Jarvelin MR. 2003. Maternal lifestyle factors in pregnancy risk of attention deficit hyperactivity disorder and associated behaviors: review of the current evidence. Am J Psychiatry. Jun;160(6):1028-40.
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Cooper C, Javaid K, Westlake S, Harvey N, Dennison E. 2005. Developmental origins of osteoporotic fracture: the role of maternal vitamin D insufficiency. J Nutr. Nov;135(11):2728S-34S.
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Little RE, Streissguth AP. 1981. Effects of alcohol on the fetus: impact and prevention. Can Med Assoc J. Jul 15;125(2):159-64.
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Baer JS, Sampson PD, Barr HM, Connor PD, Streissguth AP. 2003. A 21-year longitudinal analysis of the effects of prenatal alcohol exposure on young adult drinking. Arch Gen Psychiatry. Apr;60(4):377-85.
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Devereux G, Litonjua AA, Turner SW, Craig LC, McNeill G, Martindale S, Helms PJ, Seaton A, Weiss ST. 2007. Maternal vitamin D intake during pregnancy and early childhood wheezing. Am J Clin Nutr. Mar;85(3):853-9.
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Scholl TO, Johnson WG. 2000. Folic acid: influence on the outcome of pregnancy. Am J Clin Nutr. May;71(5 Suppl):1295S-1303S.
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Litonjua AA, Rifas-Shiman SL, Ly NP, Tantisira KG, Rich-Edwards JW, Camargo CA Jr, Weiss ST, Gillman MW, Gold DR. 2006. Maternal antioxidant intake in pregnancy and wheezing illnesses in children at 2 y of age. Am J Clin Nutr. Oct;84(4):903-11.
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Williams JL, Abelman SM, Fassett EM, Stone CE, Petrini JR, Damus K, Mulinare J. 2006. Health care provider knowledge and practices regarding folic acid, United States, 2002-2003. Matern Child Health J. Sep;10(5 Suppl):S67-72.
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Buka SL, Shenassa ED, Niaura R. 2003. Elevated risk of tobacco dependence among offspring of mothers who smoked during pregnancy: a 30-year prospective study. Am J Psychiatry. Nov;160(11):1978-84.
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Al Mamun A, O'Callaghan FV, Alati R, O'Callaghan M, Najman JM, Williams GM, Bor W. 2006. Does maternal smoking during pregnancy predict the smoking patterns of young adult offspring? A birth cohort study. Tob Control. Dec;15(6):452-7.
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Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS; Maternal and Child Undernutrition Study Group. 2008. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. Jan 26;371(9609):340-57.
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Leon DA, Koupilova I, Lithell HO, Berglund L, Mohsen R, Vagero D, Lithell UB, McKeigue PM. 1996. Failure to realise growth potential in utero and adult obesity in relation to blood pressure in 50 year old Swedish men. BMJ. Feb 17;312(7028):401-6.
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Brooks DR, Mucci LA, Hatch EE, Cnattingius S. 2004. Maternal smoking during pregnancy and risk of brain tumors in the offspring. A prospective study of 1.4 million Swedish births. Cancer Causes Control. Dec;15(10):997-1005.
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Fasting MH, Oien T, Storrø O, Nilsen TI, Johnsen R, Vik T. 2008. Maternal smoking cessation in early pregnancy and offspring weight status at four years of age. A prospective birth cohort study. Early Hum Dev. Jul 2.
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Chatenoud L, Parazzini F, di Cintio E, Zanconato G, Benzi G, Bortolus R, La Vecchia C. 1998. Paternal and maternal smoking habits before conception and during the first trimester: relation to spontaneous abortion. Ann Epidemiol. Nov;8(8):520-6.
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Spong CY. 2007. Prediction and prevention of recurrent spontaneous preterm birth. Obstet Gynecol. Aug;110(2 Pt 1):405-15.
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Langley K, Holmans PA, van den Bree MB, Thapar A. 2007. Effects of low birth weight, maternal smoking in pregnancy and social class on the phenotypic manifestation of Attention Deficit Hyperactivity Disorder and associated antisocial behaviour: investigation in a clinical sample. BMC Psychiatry. Jun 20;7:26.
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Salihu HM, Wilson RE. 2007. Epidemiology of prenatal smoking and perinatal outcomes. Early Hum Dev. Nov;83(11):713-20.
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Millichap JG. 2008. Etiologic classification of attention-deficit/hyperactivity disorder. Pediatrics. Feb;121(2):e358-65.
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Van den Bergh BR, Marcoen A. 2004. High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8- and 9-year-olds. Child Dev. Jul-Aug;75(4):1085-97.
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Chong DS, Yip PS, Karlberg J. 2004. Maternal smoking: an increasing unique risk factor for sudden infant death syndrome in Sweden. Acta Paediatr. Apr;93(4):471-8.
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Cnattingius S, Granath F, Petersson G, Harlow BL. 1999. The influence of gestational age and smoking habits on the risk of subsequent preterm deliveries. N Engl J Med. Sep 23;341(13):943-8.
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Cornelius MD, Leech SL, Goldschmidt L, Day NL. 2000. Prenatal tobacco exposure: is it a risk factor for early tobacco experimentation? Nicotine Tob Res. Feb;2(1):45-52.
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Devereux G, Turner SW, Craig LC, McNeill G, Martindale S, Harbour PJ, Helms PJ, Seaton A. 2006. Low maternal vitamin E intake during pregnancy is associated with asthma in 5-year-old children. Am J Respir Crit Care Med. Sep 1;174(5):499-507.
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Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ, Arden NK, Godfrey KM, Cooper C; Princess Anne Hospital Study Group. 2006. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet. Jan 7;367(9504):36-43.
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Bukowski R, Malone FD, Porter FT, Nyberg DA, Comstock CH, Hankins GD, Eddleman K, Gross SJ, Dugoff L, Craigo SD, Timor-Tritsch IE, Carr SR, Wolfe HM, D'Alton ME. 2009. Preconceptional folate supplementation and the risk of spontaneous preterm birth: a cohort study. PLoS Med. May 5;6(5):e1000061.
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Coming Soon. 2010. Coming Soon.
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