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The Endowment for Human Development
The Endowment for Human Development
Improving lifelong health one pregnancy at a time.
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When Health and Disease Begin

A steady stream of research has shown that diseases such as diabetes,1 heart disease,2 stroke,3 osteoporosis,4 and high blood pressure5 originate from impaired growth during pregnancy and infancy.6 Prenatal factors contributing to premature birth,7 obesity,8 ADHD,9 conduct disorder,10 asthma,11 lung disease,12 and other conditions are also emerging.

Nutrition before and during pregnancy and during infancy greatly influences how babies grow. Babies who grow normally are relatively protected from future disease13 while low birth weight babies and babies born thin or short are at risk.14

Prenatal Conditions Determine Risk

During early development, body systems go through critical phases when rapid growth occurs and vital functions are established.15 An embryo or fetus lacking essential nutrients or oxygen, or exposed to harmful substances such as tobacco and alcohol, may have to adapt by limiting the size and altering the function of some organs. These adaptations may increase the risk of certain diseases later in life.16

For example, the filtration units of the kidneys, called nephrons, stop forming around 33 weeks after fertilization.17 Undernutrition prior to that time may limit the number of nephrons and increase the future risk of high blood pressure.18

Lifelong Nutrition Matters!

A pregnant woman’s ability to provide a healthy prenatal environment for her baby depends in part on her overall health, whether she uses harmful substances such as tobacco and alcohol, and of course, her diet during pregnancy.19 It also depends on her lifelong nutritional history, which helps determine her muscle mass, bone mass, and vital stores of fat, vitamins, and minerals.20 All of these elements are crucial for the growing embryo and fetus—and the breastfeeding infant.

Prevention Begins with Prenatal Education

This research is revolutionizing our understanding about the ways a woman’s lifelong health and nutrition influence prenatal growth, and shape every child’s lifelong health and cognitive ability.

The way to dramatically enhance public health is now clear. Improve the health and nutrition of girls and young women before, during, and after pregnancy. Protect the embryo, fetus, and infant from harmful substances. Encourage breastfeeding. Improve infant and child nutrition.

Shaping the future begins with prenatal education.

“If we protect the health and nutrition of girls and young women, we can make an end of heart disease and diabetes.”
David J. P. Barker, M.D., Ph.D. From Nutrition in the Womb, The Barker Foundation, 2008.

1 Ong KK, Dunger DB, 2002. 202; International Diabetes Federation website, 2002. e-article.
2 Barker, Winter, et al., 1989. 579; Barker DJ, 1999. 305.
3 Eriksson JG et al., 2000. 873.
4 Cooper C et al., 2005. 2730S; Javaid MK et al., 2006. 36.
5 Leon DA et al., 1996. 405.
6 Hyppönen E et al., 2001. 1502; Barker DJP, 2008. 36.
7 Bukowski R et al., 2009. 6.
8 Dubois and Girard, 2006. 610.
9 Linnet KM et al., 2003. 1028; Braun JM et al., 2006. 1904; Millichap JG, 2008. e360.
10 Wakschlag LS et al., 1997. 670; Fergusson DM et al., 1998. 726; Langley K et al., 2007. e-article.
11 Devereux G et al., 2006. 502; Litonjua AA et al., 2006. 853.
12 Coming Soon, 2010. 100.
13 Barker DJP, 2008. 36.
14 Barker DJP, 2008. 141-155.
15 Barker DJ, Clark PM, 1997. 105; Barker DJP, 1998a. 85.
16 Barker DJP, 1998a. 13-15, 18-19; Gillman MW, 2005. 1848; Godfrey KM, Barker DJ, 2000. 1344S.
17 Moore and Persaud, 2008. 244.
18 Barker DJP, 2008. 44;
19 Barker DJP, 2008. v.
20 Barker DJP, 2008. 80-81, 148.

When Health Begins brochure/poster, Page 2   Back to Top


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Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ. 1989. Weight in infancy and death from ischaemic heart disease. Lancet. 2:577-580.
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Godfrey KM, Barker DJ. 2000. Fetal nutrition and adult disease. Am J Clin Nutr. May;71(5 Suppl):1344S-52S.
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Barker DJ, Clark PM. 1997. Fetal undernutrition and disease in later life. Rev Reprod. May;2(2):105-12.
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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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Eriksson JG, Forsen T, Tuomilehto J, Osmond C, Barker DJ. 2000. Early growth, adult income, and risk of stroke. Stroke. Apr;31(4):869-74.
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Barker DJ. 1999. Early growth and cardiovascular disease. Arch Dis Child. Apr;80(4):305-7.
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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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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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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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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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Millichap JG. 2008. Etiologic classification of attention-deficit/hyperactivity disorder. Pediatrics. Feb;121(2):e358-65.
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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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International Diabetes Federation. 2002. Experts reach consensus on causes of Type 2 diabetes. International Diabetes Federation Website. International Diabetes Federation.
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Braun JM, Kahn RS, Froehlich T, Auinger P, Lanphear BP. 2006. Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children. Environ Health Perspect. Dec;114(12):1904-9.
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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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Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. 2001. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. Nov 3;358(9292):1500-3.
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Barker DJP. 1998. Mothers, babies and health in later life, Second edition. Churchill Livingstone.
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Gillman MW. 2005. Developmental origins of health and disease. N Engl J Med. Oct 27;353(17):1848-50.
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