Maternal Undernutrition September 23, 2006 1. What is the topic of the paper and what is known about this so far? The topic of this paper is maternal undernutrition during different stages of pregnancy and its effect in later life on the offspring. Through studies all over the world, we learned that "cardiovascular disease and its biological risk factors" have a direct link to low birth weight. Maternal diet during pregnancy can have significant effects on offspring health in later life. Studies in animal models have shown that diseases in later life, such as cardiovascular disease, originate from impaired development in the womb, triggered by maternal undernutrition. 2. What is the research's stated purpose? Why do they want to do this particular study? The purpose of this research paper is to "study the effects of a short but severe period of maternal undernutrition during different stages of gestation on the offspring." There is well-founded evidence that maternal diet during pregnancy can trigger permanent change in the fetus. However, not enough studies show clearly how maternal undernutrition effects human children. The researchers hope to change that with this particular study of "the effects of maternal undernutrition during gestation on later life from the Dutch Famine birth cohort." 3. Based on the methods section, how was the study done? What study design was used? Justify your answer. The study was done after following a thorough selection process of the candidates: - To be eligible for the study of the Dutch famine birth cohort, the baby had to be born after 259 days gestation at the Wilhelmina Gasthuis between November 1st 1943 and February 28th 1947. Based on this requirement, 2414 babies were eligible to be included in the study. However, they could only trace 2155 (89%) of the eligible babies' medical records. - Out of the 2155 babies, 164 weren't willing to participate, 199 had migrated, and 265 were deceased. Subtracting those, 1018 participated in the study. This research paper used both experimental and observational methods to collect data. The researchers interviewed 912 people to collect data on socio-economical factors, lifestyle, and medical history. However, they also collected data from the candidates using several testing and analytical methods such as glucose testing, analysis of plasma lipids and clotting parameters, etc. The eligible babies were divided into three groups. The control group consisted of babies born before the famine (born between November 1st 1943 and January 6th 1945) and babies conceived after the famine (born between December 9th 1945 and February 28th 1947). Three groups were babies exposed to the famine in late gestation (born between January 7th and April 28th 1945), mid gestation (born between April 29th and August 18th 1945), and early gestation (born between August 19th and December 8th 1945). 4. Briefly, summarize the results The results showed the following findings: - Women exposed to famine in late gestation gained no weight in the third trimester. - Babies exposed during late or mid gestation were lighter, shorter, thinner, and had smaller head circumference than babies not exposed to famine. - Babies exposed to famine in early gestation were slightly heavier and larger than babies that had not been exposed to famine. - Babies exposed to famine in late gestation had impaired glucose tolerance compared to babies that had not been exposed to famine. - Babies of the mid gestation group had more risk of having obstructive airway disease and microalbuminuria. - Subjects exposed in early gestation had a higher percentage of coronary heart disease, atherogenic lipid profile, obesity, levels of plasma fibrinogen, and decreased levels of factor VII. - Low birth weight was linked to raised blood pressure in the later life. 5. What are the limitations of the research design? The limitations of the research design are that the study was done on healthy subjects of a particular ethnic background. Perhaps maternal undernutrition might have different effects on people from other ethnic backgrounds. Also, the researchers were limited to using only non-invasive testing methods. Therefore, their findings were based only on non-invasive data. Third, perhaps famine is not a good model for undernutrition because it also causes economic, social, and political stresses. The famine was at the end of World Wat II, so many factors might have affected the babies. Fourth, it is not clear if the babies had similar social classes or other special circumstances. Fifth, famine lowers all protein, fat, carbohydrate, vitamin, and mineral levels, so the importance of various nutritional factors cannot be controlled or judged. 6. What are the implications of this study? To what population(s) can we generalize the application of the results? The implications of this study are that maternal undernutrition has significant effects on physical and mental health in later life. It indicates that the early stage of pregnancy is the most important to determine the heath of the offspring in later life. The effects of famine on fetuses are not of various types but follow distinct patterns. We can probably generalize the results to native European peoples and perhaps to white children, people with essentially the same genetic make-up as the test subjects in this study. Famine is drastic, so perhaps we can relate the results to all people around the world. However, it is possible that people have genes to deal with food shortage, so it's unclear that babies from different regions and environmental backgrounds exposed to famine during gestation would have the same effects. Perhaps women at different economic levels, educational levels, health care levels, and women's rights levels would affect their children in different ways. 7. What would be the next logical (in your mind) step to study? The next logical step might be to check the results of famine in different countries. Famine still occurs in various parts of the world, but often in war so it is hard to study. Places where selective nutritional problems occur might be good to study. For example, places with a low vitamin, mineral, or protein level. Maybe it would be good to study women on various diets in western countries. People can also study babies with similar symptoms as the babies in this study and see what factors caused their problems by gathering histories and doing tests like those in the article. Also, genetic studies can be done to gain more knowledge and possibly pinpoint the genes that are involved during prenatal famine exposure. 8. Do you think this is a well-researched and well reported article? You personal response to the article: Did you like it? Was it easy to follow? Did it increase your knowledge of the topic? Any other comments on the study? my opinion, this is a well-researched and well-reported article about an important subject. The language and the organization of the article are very easy to follow, so that I could see the issues clearly. The article has a short and clear background about the topic of health effects in later life of offspring who were exposed to famine during gestation. This helped me to connect current knowledge about the topic with the study in this research. The purpose, the subjects and methods, and the findings of the study were written so that I could understand. I also got a desire to find out more about the topic after reading the article. I liked this article because it's one of the most well written and well informed articles I've ever read and I wanted to know about its topic.