Neonatal health care can reduce adult heart, stroke and diabetes incidence: Health begins at conception and continues to adulthood

The health of the pregnant mother is critical to the health of the baby. Doctors have known that for a long time. More recent research shows that the mother’s health can affect that baby long after development, into childhood and in some cases as a mature adult. Finding the answers to what, how and why there is such an impact is important.

Dr. Robert Gagnon, Chair of the Fetal and Newborn Health Program at CHRI, and his team of scientists are working hard to discover those answers. Their group is part of the Canadian Institutes of Health Research (CIHR) Group in Fetal and Neonatal Health and Development. The group is recognized worldwide as one of the strongest prenatal research groups internationally.

“A common problem, is that until recently, there was little understanding that to identify factors early after birth can help identify high risk in adulthood,” says Dr. Gagnon. Early intervention can reduce the risk. It could be more important than the family history, smoking and cholesterol factors.

“One marker we have looked at is the onset of hypertension in the baby before birth from placenta insufficiency. We’ve also found the heart is thicker and heavier – something we usually see in adults who have had hypertension for years. We can now identify in utero if the placenta shows premature aging using ultrasound imaging.”

Dr. Gagnon has a new grant to study the effects of placenta premature aging on growth restriction. When this premature aging occurs, the placenta reduces the oxygen and nutrients available to the baby, so it slows its growth to survive in the uterus.

“The potential for long-term consequences is higher risk of cardiovascular disease later in life. We are now seeing this may have some origin in the uterus. Also Type 2 diabetes,” says Dr. Gagnon. “Original studies were on full-term babies, but now we are studying the evidence of undernourishment in utero. After birth, the babies try to catch up too much and gain too much weight, putting themselves at greater risk.”

The results of such studies can influence lifestyle for mothers and children. Adult health is linked to prenatal and postnatal lifestyles. For example, obese women don’t necessarily eat well. “Their nutrition status is not good,” says Dr. Gagnon. So when pregnant, their babies are also not receiving proper nutrition. Improved lifestyle before and during pregnancy is important. Once the placenta is not working properly, there is only so much that can be done nutritionally with the mother.

Dr. Gagnon learned the technique of non-invasive ultrasound elsewhere and brought it to London when he came. Using umbilical artery Doppler, it can measure the amount of blood flowing to the placenta. If this blood flow is reduced, insufficiencies result in the placenta. Dr. Gagnon wrote guidelines for this technique “which has changed the practice and delivery of babies that are high risk.”

Future research involves looking at the stages after birth. “Most studies now focus on the fetus,” says Dr. Gagnon. “We know if you don’t improve the function of the placenta, the fetus will die. The best strategy is for fetal gene therapy to improve placenta development structure.

“We know these children also have more learning disabilities, so what is the effect of the placenta on brain development? We must develop a strategy to further improve the following growth of the baby.

“We have tried pharmacological treatment. For example, you can infuse nitroglycerin to dilute the blood vessels and increase oxygen to the placenta, but when this is stopped, the situation is worse. The next step is targeted gene therapy. For example, injecting a virus into the placenta to improve function. But you need to determine which gene to target.”

Dr. Gagnon and his team are looking at how the neonatal brain develops; how important the fetal cardio development promotes better brain development. They are identifying non-invasive markers to look at the cardiovascular system of the fetus and newborn to prevent diseases later. They are examining the main markers now for myocardial hypertrophy, or the thickening of the walls of the heart.

“Over the next five years, we will be able to identify earlier a group of women who are carrying babies at higher risk and could do early intervention, either before the baby is born or soon after.”

The impact of such early intervention is reduction of three of the biggest health problems in the country: heart, stroke and diabetes. This has an impact across the entire health care system. Dr. Gagnon believes more health care money should be channeled to such prevention of illness, instead of treatment. Much more money should be spent on this critical time of development for the best return on investment on early development.

“What you are born with, is what you have,” says Dr. Gagnon. “Early embryo and fetal development have an effect on long-term health. Research now shows they affect how well you grow and reach your growth potential, your brain and organ development.

“The failure to grow properly in utero (resulting in small for their age) or the failure to meet full growth potential in utero, puts a person at much higher risk of developing disease later. Health is continuous from conception to later adulthood.”