The XX Factor

How Does “Fetal Programming” Sound to You?

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The phrase “fetal programming” has to be one of the skeeviest terms I’ve heard used to describe legitimate, and even laudable, scientific research in a long time. The headline of the Wall Street Journal’s article yesterday about a new British research study that hopes to use medication taken by obese pregnant women to lower the risk of obesity in their children, “Programming a Fetus for a Healthier Life,” and all the language surrounding the theory behind the study may be a politically correct attempt to avoid blaming mothers for their children’s health problems, but the result takes those mothers, and the choices they’re making to have healthier babies, right out of the equation.

The research itself is fascinating. Because the bodies of obese women produce more glucose, particularly during pregnancy, when many women tend to have higher blood sugar, more glucose passes through the placenta to the fetus. The fetus, expecting the glucose, produces higher levels of insulin to deal with the sugar—and continues to do so once the baby is born. The higher rate of glucose production by the mother “programs” the child’s insulin production which, once set, doesn’t change. Researchers hope that if the mothers take Metformin, a drug used to treat type-2 diabetes, during their pregnancy to lower their blood sugar, their babies will be smaller at birth and “have metabolisms that don’t come out churning insulin and aren’t predisposed towards obesity.”

The researchers note an ethical problem with asking pregnant women to take a drug (even one considered safe during pregnancy) that they themselves don’t need, but that’s really a specific research study ethics question. If the research is successful, adding Metformin to the possible arsenal of prenatal care choices available to pregnant women, who regularly change habits, take particular vitamins, and even endanger their own health (for example, by stopping antidepressant use or postponing cancer treatment) on behalf of their fetuses does not, for me, raise any red flags. But calling it “fetal programming” and referring abstractly to “womb conditions that are less than optimal” does.

In the same vein, reporting yesterday on research that suggests that a fetus’ time in its mother’s womb is “at least as important as genes in causing autism” and supporting the suspected link between a mother’s use of S.S.R.I. antidepressants and an elevated risk of autism barely uses the word “mother” at all. The studies were called “game changers,” but what interested me most was the change in how mothers were referred to. In an effort, again, to avoid any implication of blame or responsibility, the researchers repeatedly referred to “environmental factors” rather than a woman’s prenatal care. A cursory glance at the New York Times’ headline (New Study Implicates Environmental Factors in Autism) suggests that global warming has added to its list of planetary crimes.

How women treat our bodies during pregnancy obviously affects our children, but those bodies remain our bodies. Phrases like “fetal programming” and “environmental factors” slice women rather neatly out of the picture. It may be well-intentioned, and it may also reflect that to some extent, we’re no longer able to control the “conditions” in our own wombs (the placenta is permeable by pollutants and toxins like BPA, mercury, lead, and pesiticides). But we still are, and want to be, responsible for the things we do control, like the choice to take antidepressants or Metformin. Referring to that choice only by its effect on our children could encourage people to believe it’s something they could ethically impose or pressure women into. It could also discourage women from taking other steps (like changing diet and exercise habits) to protect the health of their babies by suggesting that “fetal environment” is best handled by doctors and scientists rather than by individual women. But the “fetal environment” is women. Language can’t change that truth. But it does risk changing the way we think about it.