Embryo Project Encyclopedia

Fetal programming, or prenatal programming, is a concept that suggests certain events occurring during critical points of pregnancy may cause permanent effects on the fetus and the infant long after birth. The concept of fetal programming stemmed from the fetal origins hypothesis, also known as Barker’s hypothesis, that David Barker proposed in 1995 at the University of Southampton in Southampton, England. The fetal origins hypothesis states that undernutrition in the womb during middle to late pregnancy causes improper fetal growth, which in turn, causes a predisposition to certain diseases in adulthood. In addition to nutritional impacts, researchers have studied the fetal programming effects of many factors, such as maternal anxiety or violence during pregnancy. Researchers proposing the concept of fetal programming established a new area of research into the developmental causes of disease, pointing towards the in utero environment and its critical role in healthy human development.

In the 2014 case Burwell v. Hobby Lobby, the US Supreme Court ruled that the contraceptive mandate promulgated under the Patient Protection and Affordable Care Act violated privately held, for-profit corporations’ right to religious freedom. The contraception mandate, issued in 2012 by the US Department of Health and Human Services, required that employer-provided health insurance plans offer their beneficiaries certain contraceptive methods free of charge. In a five to four decision, the US Supreme Court maintained that the mandate, in cases of privately held, for-profit organizations like Hobby Lobby Inc., violated the Religious Freedom Restoration Act of 1993. Although the Court did not decide on the constitutionality of the mandate, their ruling enabled privately held, for-profit corporations that objected to the contraceptive mandate on religious grounds to be exempt from it.

Dorothy Andersen studied cystic fibrosis in the United States during the early 1900s. In 1935, Andersen discovered lesions in the pancreas of an infant during an autopsy, which led her to classify a condition she named cystic fibrosis of the pancreas. In 1938, Andersen became the first to thoroughly describe symptoms of the medical condition cystic fibrosis. Commonly mistaken for celiac disease prior to the 1900s, Andersen defined cystic fibrosis as the build-up of pancreatic fluid in the body caused by the blockage of pancreatic ducts, and she determined that the two conditions were symptomatically different. Andersen developed an early method for
diagnosing cystic fibrosis. By conceptualizing cystic fibrosis and
defining its symptoms, Andersen laid the foundation for treatments that
enabled infants diagnosed with the disease to survive into adulthood.

Better babies contests were competitions held in state fairs throughout the US during the early twentieth century in which babies between the ages of 6 and 48 months were judged for their health. In 1908, social activist Mary de Garmo established and held the first better babies contest at the Louisiana State Fair in Shreveport, Louisiana. The contests, mirroring theories established in the US’s eugenics movement of the twentieth century, aimed to establish standards for judging infant health. Nurses and physicians judged infants participating in the contest on mental health, physical health, and physical appearance. In 1913, the Woman’s Home Companion (WHC) magazine cosponsored de Garmo’s better babies contests and introduced the competition to state fairs throughout the US. Better babies contests helped promote routine health assessments of children by medical professionals.

Better babies contests were competitions held in state fairs throughout the US during the early twentieth century in which babies between the ages of 6 and 48 months were judged for their health. In 1908, social activist Mary de Garmo established and held the first better babies contest at the Louisiana State Fair in Shreveport, Louisiana. The contests, mirroring theories established in the US’s eugenics movement of the twentieth century, aimed to establish standards for judging infant health. Nurses and physicians judged infants participating in the contest on mental health, physical health, and physical appearance. In 1913, the Woman’s Home Companion (WHC) magazine cosponsored de Garmo’s better babies contests and introduced the competition to state fairs throughout the US. Better babies contests helped promote routine health assessments of children by medical professionals.

On 30 June 1980, in a five to four decision, the US Supreme Court ruled in the Case Harris v. McRae that the Hyde Amendment of 1976 did not violate the US Constitution. The Hyde Amendment banned the use of federal funding to pay for any abortion services. The US Supreme Court's decision in Harris v. McRae overturned the decision of McRae v. Califano (1980), in which the US District Court for the Eastern District of New York had ruled that the funding restrictions established by the Hyde Amendment violated the US Constitution. After the US Supreme Court's ruling in Harris v. McRae, the Hyde Amendment continued to prohibit federal Medicaid funding for abortion services, limiting the funds available for low-income women seeking abortions.

In the 2012 case Texas Medical Providers Performing Abortion Services v. David Lakey, a US appeals court ruled as constitutional a Texas law that required abortion providers in the state to show women receiving abortions the ultrasound images of their fetuses. The law also required providers to describe the sounds of the fetuses' nascent hearts. In doing so, the court set precedent that ultrasound readings are necessary medical information for pregnant women seeking abortions, increasing the wait-period for women seeking abortions. The decision fueled debates in the early twenty-first century US abouts women's rights to abortions.

In 1976, the US Congress passed the Hyde Amendment, which banned the use of federal funding to pay for abortions through Medicaid. In 1976, Illinois Congressman Henry J. Hyde proposed the amendment to the Departments of Labor and Health, Education, and Welfare, Appropriation Act of 1977. In 1980, the US Supreme Court in Harris v. McRae (1980) upheld the constitutionality of the Hyde Amendment. Included annually in every Congressional appropriation act after the one passed in 1976, amended versions of the Hyde Amendment have restricted federal funding of abortion services for women participating in Medicaid.

In 2011, Sarah McMahon and colleagues published “The Impact of Emotional and Physical Violence During Pregnancy on Maternal and Child Health at One Year Post-partum,” hereafter, “The Impact,” in the journal, Child and Youth Services Review. While existing studies had indicated negative chronic effects resulting from intimate partner violence, or IPV, such as miscarriage and premature labor, there was little research specifically analyzing the separate and joint effects of psychological and physical abuse on pregnant women and fetuses. The authors reported that both physical and emotional IPV had negative impacts on the woman and child at one-year after birth, including worse overall health and increased likelihood of depression. In “The Impact,” the researchers analyzed the effects of partner abuse during pregnancy, distinguishing between the effects of emotional abuse and physical abuse on health outcomes for a pregnant woman and her offspring.

In 2001, Kevin M. Godfrey and David J.P. Barker published the article “Fetal Programming and Adult Health” in Public Health Nutrition, where they identified the significance of maternal nutrition during pregnancy to healthy offspring development. The authors describe the effects of maternal nutrition on fetal programming of cardiovascular disease. Fetal programming is when a specific event during pregnancy has effects on the fetus long after birth. The authors argue that fetuses may adapt to varying shifts in their environment in utero, such as slowed fetal growth in response to malnutrition. While those adaptations can be helpful in utero, the authors assert they may persist into adolescence and adulthood, causing conditions such as high blood pressure or diabetes. Godfrey and Barker assert that fetal adaptations to maternal malnutrition may be implicated in the development of cardiovascular disease in adulthood, and called for future research investigating additional fetal programming variables.