tag:theconversation.com,2011:/us/topics/fetal-development-4793/articlesFetal development – The Conversation2021-10-06T16:30:18Ztag:theconversation.com,2011:article/1638632021-10-06T16:30:18Z2021-10-06T16:30:18ZUnderstanding the early-life origins of suicide: Vulnerability may begin even before birth<figure><img src="https://images.theconversation.com/files/424824/original/file-20211005-19-1cjc5q8.jpg?ixlib=rb-1.1.0&rect=219%2C323%2C4365%2C3120&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vulnerability to suicide may build up throughout the course of life, and may start with events occurring in the perinatal period and infancy.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Suicide is a tragic event. Unfortunately, <a href="https://www.who.int/news/item/09-09-2019-suicide-one-person-dies-every-40-seconds">every 40 seconds, a person dies by suicide</a>. Beyond the premature loss of an individual’s life, <a href="https://doi.org/10.1111/sltb.12450">more that 100 people may be affected</a> by each suicide, including family, friends and community members. </p>
<p>People considering their own death have often gone through long periods of intense suffering and internal struggles. They may have endured mental illness and experienced a range of adverse life events. Helping people suffering from a mental disorder and/or going through a difficult time is therefore of the utmost importance to preventing suicide. </p>
<p>However, evidence from research conducted in the past two decades has highlighted that suicide is not only the result of such contributing factors around the time of death. Instead, vulnerability to suicide may build up throughout the course of life. It may start with events occurring very early in life, in the perinatal period and infancy, that have long-lasting influences on suicide in adulthood.</p>
<h2>The developmental origins of health and diseases</h2>
<p>In the 1990s, British epidemiologist David Barker noticed that children born with low birth weight (less than 2.5 kilograms) or preterm (before 37 weeks) were more likely to develop chronic conditions such as <a href="https://doi.org/10.1056/NEJMra0708473">cardiovascular or metabolic diseases</a> as adults. These observations served as the foundation of the <a href="https://doi.org/10.1093/inthealth/ihy006">developmental origins of health and diseases</a> (or DOHaD) hypothesis. </p>
<p>The DOHaD hypothesis suggests that exposure to environmental influences during the critical period of fetal development could have significant consequences on an individual’s short- and long-term health. This knowledge promoted <a href="http://www.project-earlynutrition.eu/eneu/">early-life interventions</a> such as prenatal and infant nutrition to improve long-term outcomes. It also supported <a href="https://www.who.int/news-room/fact-sheets/detail/preterm-birth">guidelines to promote quality care</a> before, between and during pregnancies.</p>
<p>As such, the DOHaD hypothesis has increased scientific interest in understanding how early-life events influence the risk of other health problems, including suicide.</p>
<h2>Early-life origins of suicide</h2>
<figure class="align-right ">
<img alt="Illustration of a fetus and a network of interconnected dots." src="https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=485&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=485&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=485&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">When the fetus is exposed to adversity, it may adapt to survive a harsh environment in utero.</span>
<span class="attribution"><span class="source">(Pixabay/Canva)</span></span>
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</figure>
<p>As researchers with the <a href="http://www.lifespanproject.net/">LIFESPAN research project</a>, our goal is to better understand whether early-life factors influence the risk of suicide later in life, and how. If early life factors are associated with suicide, suicide prevention strategies need to be implemented early in life.</p>
<p>Within the LIFESPAN project, we recently conducted a <a href="https://doi.org/10.1016/S2215-0366(19)30077-X">meta-analysis</a> looking at 42 articles from 21 longitudinal cohort studies from Europe, North America, South America and Asia. It examined associations of 14 early-life factors in the prenatal and perinatal periods — including low birth weight, obstetric complications, impoverished socio-economic conditions of the family at childbirth and young parental age — with later suicide. </p>
<p>Out of the 14 factors investigated, seven were associated with suicide in adulthood, providing support for the DOHaD hypothesis. The strongest early-life influences on later suicide were parental characteristics such as low parental education, low family socio-economic conditions and young maternal age, as well as restricted fetal growth, including <a href="https://doi.org/10.1192/bjp.2021.15">low birth weight</a>.</p>
<p>For example, researchers found that children born with a lower birth weight or <a href="https://doi.org/10.1093/ije/dyab038">who were premature</a> were more likely to die by suicide than children born with normal birth weight. They also found that children of <a href="https://doi.org/10.1016/S0140-6736(04)17099-2">teenage parents</a> were more likely to die by suicide than children of older parents, and that children born to parents with <a href="https://doi.org/10.1093/aje/kwt014">lower levels of education</a> were more likely to die by suicide than children born to parents with higher levels of education. </p>
<p>It is important to note that these are epidemiological findings that should not be directly applied to the single individual, but rather they should be applied to the population. We cannot consider a prematurely born baby as being at risk of suicide, but in a given population, babies born prematurely are, on average, at higher risk of dying by suicide than children born at term.</p>
<h2>How early-life risk factors increase suicide risk</h2>
<figure class="align-center ">
<img alt="Illustration of a person's silhouette in a sad posture" src="https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If early life factors are associated with suicide, suicide prevention strategies need to be implemented early in life.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>An important followup question is to understand <a href="https://doi.org/10.1017/S0033291720002974">why factors occurring very early in life may influence behaviour happening decades later</a>. A first theory implicates social mechanisms. Socio-economic factors (such as poverty or lower education levels) are key determinants of health and tend to be <a href="https://doi.org/10.1007/s13524-012-0120-1">transmitted from one generation to another</a>. </p>
<p>Children born to a family with low financial resources may have restricted access to quality education, health care and life opportunities. This may increase their chances of being confronted with financial and social problems in adulthood, which may in turn increase suicide risk. In other words, social and economic problems that increase suicide risk in adulthood may be, in part, the continuation of the socioeconomic conditions of the family into which a child was born. </p>
<p>This is also true for non-monetary indicators of socio-economic position, such as <a href="https://doi.org/10.1177/0002716217729471">parental education</a>. Parents who are young and less educated may not have the material and emotional resources to provide their children with the best start in life. Providing resources to young parents from low socio-economic conditions may therefore be an opportunity to improve their child’s health in adulthood, and consequently decreasing suicide risk.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of a blue human silhouette with clouds and rain in its head" src="https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=799&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=799&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=799&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1004&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1004&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1004&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The capacity to cope with life stress, also known as resilience, is a key protective factor for suicide and mental health problems in general.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>A second theory implicates <a href="https://doi.org/10.1073/pnas.2023598118">brain development</a>. The DOHaD hypothesis states that when the fetus is exposed to adversity, it reacts with adaptations to survive a harsh environment in utero. These adaptations may result in impairments in brain development, which are in turn associated with decreased cognitive skills that may further reduce a person’s capacity to deal with stressful events later in life. The capacity to cope with life stress, also known as resilience, is a key protective factor for suicide and mental health problems in general. </p>
<p>Reducing risk factors that may determine <a href="https://doi.org/10.1056/NEJMra0708473">low birth weight or fetal suffering</a>, such as poor nutrition, infections, exposure to chemicals or hormonal perturbations, is important for the health of the offspring. However, interventions to boost resilience among children who have experienced adversity during the fetal period may also be a promising avenue for preventing later problems, including suicide.</p>
<h2>Suicide prevention from an early-life perspective</h2>
<p>Early prevention is universally recognized as a leading way to <a href="https://doi.org/10.1542/peds.2017-3174">reduce health problems</a> while <a href="https://heckmanequation.org/resource/invest-in-early-childhood-development-reduce-deficits-strengthen-the-economy/">minimizing societal costs</a>. Early prevention often means removing or reducing risk factors in a population before a health problem manifests. </p>
<p>In this perspective, research on the early-life origins of suicide invites us to integrate interventions at the individual level with prevention at the population level. It supports the need to think about suicide prevention as a long-term, rather than uniquely a short-term, endeavour with the goal of reducing vulnerability to suicide during the life course. </p>
<p>Public health policy providing the best environment for children to grow up may have the potential to build resilience and reduce the long-term vulnerability to suicide.</p>
<p><em>If you or someone you know is thinking about suicide, call 911 for emergency services. For support, call Canada Suicide Prevention Service at 1-866-277-3553 (from Québec) or 1-833-456-4566 (other provinces), or send a text to 45645. Visit <a href="https://www.crisisservicescanada.ca/en/">Crisis Services Canada</a> for more resources.</em></p><img src="https://counter.theconversation.com/content/163863/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement no. 793396 (awarded to Massimiliano Orri).
Massimiliano Orri is affiliated with the Bordeaux Population Health Research Centre, INSERM U1219, University of Bordeaux</span></em></p><p class="fine-print"><em><span>Marie-Claude Geoffroy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Early life influences have been linked to higher risk of suicide later in life. Reducing those risks, and boosting resilience in children exposed to them, may help reduce suicide rates.Massimiliano Orri, Assistant Professor, McGill Group for Suicide Studies, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill UniversityMarie-Claude Geoffroy, Assistant Professor, Department of Educational and Counselling Psychology and Canada Research Chair in Youth Suicide Prevention, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1688202021-10-01T19:17:35Z2021-10-01T19:17:35ZTylenol could be risky for pregnant women – a new review of 25 years of research finds acetaminophen may contribute to ADHD and other developmental disorders in children<figure><img src="https://images.theconversation.com/files/424065/original/file-20210930-22-wgb0x.jpg?ixlib=rb-1.1.0&rect=123%2C22%2C1993%2C1387&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nearly 100 scholars and health care professionals are urging women to limit their use of acetaminophen during pregnancy. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/midsection-of-pregnant-woman-holding-her-belly-royalty-free-image/1310443783?adppopup=true"> Oscar Wong/Moment via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>A mounting body of evidence shows that the use of acetaminophen - widely known by its brand name Tylenol - during pregnancy may pose risks to the fetus and to early childhood development. That was the conclusion of a <a href="https://doi.org/10.1038/s41574-021-00553-7">new review study</a> on which I was a lead author. </p>
<p>Acetaminophen, which has the chemical name paracetamol, is a go-to over-the-counter medication that is widely recommended by doctors to relieve pain and reduce fever.</p>
<p>Our study, based on an assessment of 25 years of research in the areas of human epidemiology, animal and in-vitro studies, concludes that prenatal acetaminophen exposure may increase the risks of reproductive organs developing improperly. We identified a heightened risk of <a href="https://doi.org/10.1111/ppe.12632">neurodevelopmental disorders</a>, primarily attention deficit hyperactivity disorder and related behaviors, but also autism spectrum disorder, as well as language delays and decreased IQ. </p>
<p>In our consensus statement – a broad agreement by our multidisciplinary international panel of experts – published in Nature Reviews Endocrinology in September 2021, 91 clinicians and researchers are calling for caution and additional research.</p>
<h2>Why it matters</h2>
<p>Acetaminophen is an active ingredient in <a href="https://www.chpa.org/our-issues/otc-medicines/acetaminophen">over 600 prescription and over-the-counter medications</a>, including Tylenol. It is used by more than <a href="https://doi.org/10.1002/aur.1591">50% of pregnant women</a> worldwide and at least <a href="https://doi.org/10.1016/j.ajog.2005.02.100">65% of pregnant women</a> in the U.S. Research suggests that acetaminophen is an endocrine disruptor and may interfere with the hormones essential for healthy neurological and <a href="https://doi.org/10.1289/EHP2478">reproductive development</a>.</p>
<p>A spokeswoman for Johnson & Johnson, which makes Tylenol, <a href="https://www.cnn.com/2021/09/23/health/acetaminophen-pregnancy-wellness/index.html">told CNN</a> in September that the product label tells women who are pregnant or breastfeeding to ask a health care professional before using it.</p>
<p>Current <a href="https://mothertobaby.org/fact-sheets/acetaminophen-pregnancy/">guidance recommends</a> acetaminophen as the pain reliever of choice during pregnancy, as <a href="https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/aspirin-during-pregnancy/faq-20058167">other pain relievers</a> such as <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic">ibuprofen and aspirin are not considered safe</a> after <a href="https://mothertobaby.org/fact-sheets/ibuprofen-pregnancy/">midpregnancy</a>.</p>
<p>Rates of <a href="https://doi.org/10.1152/physrev.00017.2015">reproductive disorders</a> and neurodevelopmental disorders, <a href="https://www.cdc.gov/ncbddd/adhd/timeline.html">such as ADHD</a> and <a href="https://autismsciencefoundation.org/what-is-autism/how-common-is-autism/">autism spectrum disorder</a>, have <a href="https://doi.org/10.1542/peds.2019-0811">been increasing</a> over the last 40 years. </p>
<p>Over the same time period, the use of acetaminophen during pregnancy <a href="https://doi.org/10.1016/j.ajog.2005.02.100">has gone up</a>. We conclude that because <a href="https://doi.org/10.1016/j.annepidem.2017.09.003">acetaminophen is so commonly taken during pregnancy</a>, if its use is responsible for even a small increase in individual risk, it could contribute substantially to these disorders in the <a href="https://doi.org/10.1136/bmj.k757">overall population</a>.</p>
<h2>What still isn’t known</h2>
<p>It’s unethical to do experiments that could harm a human life, so to gain a better understanding of the direct effects of acetaminophen during pregnancy, we must rely on human observational and experimental studies to assess the possibility of causal connections. But to really get at these questions, we need human cohort studies that can precisely capture when and why acetaminophen is taken during pregnancy. Additionally, we would like to see research that gives us a better understanding of the biologic pathways. </p>
<p>Notably, acetaminophen is also the medication <a href="https://doi.org/10.1542/peds.2008-2869">most commonly</a> <a href="https://doi.org/10.1016/j.jped.2014.03.004">given to infants</a>. More research is needed to determine whether this practice is safe for the developing brain. </p>
<h2>What’s next</h2>
<p>The current near-ubiquitous use of acetaminophen during pregnancy is due in part to the <a href="https://doi.org/10.2174/1381612825666190321110420">widespread perception</a> – even among doctors – that it has limited side effects and negligible risk. But a growing body of research suggests that the <a href="https://doi.org/10.1016/j.yhbeh.2018.01.003">indiscriminate use</a> of acetaminophen during pregnancy – especially for conditions such as <a href="https://doi.org/10.1111/bcpt.12527">chronic pain</a>, <a href="https://doi.org/10.1002/14651858.CD012230">low back pain</a> and <a href="https://doi.org/10.1002/14651858.CD011889.pub2">headaches</a> – may be unwarranted and unsafe.</p>
<p>In our consensus statement, we urge education of health professionals and pregnant women about the risks and benefits of acetaminophen use during pregnancy.</p>
<p>Based on our extensive review of the evidence – and the recognition that there are limited alternatives for the necessary treatment of high fever and severe pain – we recommend that pregnant women refrain from using acetaminophen unless it is medically recommended by a doctor. Women should also minimize risk to the fetus by using the lowest effective dose for the shortest possible time.</p>
<p><em>This article was updated on Oct. 4, 2021, to include a statement from Johnson & Johnson.</em></p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/168820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ann Z. Bauer does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tylenol has long been considered a go-to medication for low to moderate pain and for fever reduction, even during pregnancy. But mounting evidence suggests that it is unsafe for fetal development.Ann Z. Bauer, Postdoctoral Fellow in Epidemiology, UMass LowellLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1687472021-09-28T06:54:57Z2021-09-28T06:54:57ZTake care with paracetamol when pregnant — but don’t let pain or fever go unchecked<figure><img src="https://images.theconversation.com/files/423465/original/file-20210928-13-6txwri.jpg?ixlib=rb-1.1.0&rect=19%2C6%2C4219%2C2815&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/pregnancy-people-health-care-concept-260nw-1015659301.jpg">Shutterstock</a></span></figcaption></figure><p>Pregnancy comes with aches and pains and heightened anxiety about what we put into the body. </p>
<p>A new article published in <a href="https://www.nature.com/articles/s41574-021-00553-7">Nature Reviews Endocrinology</a> has urged caution around taking paracetamol during pregnancy. The paper is a “consensus statement” that brings together analysis by a panel of experts who looked at evidence from human and animal studies of paracetamol use in pregnancy. </p>
<p>Paracetamol use during pregnancy may alter fetal development, say the authors, with long-lasting effects on child health. The authors call for improved education for health-care professionals and patients, less paracetamol use during pregnancy and further research.</p>
<h2>Alert but not alarmed</h2>
<p>At first glance, calls to minimise paracetamol use during pregnancy are alarming. For those who have taken paracetamol (commonly marketed in Australia as Panadol, Herron Paracetamol, Panamax, Chemist Own or Dymadon) during pregnancy, this could cause anxiety. </p>
<p>This new consensus statement calls for caution, but not concern. The proposed recommendations are largely consistent with <a href="https://www.nps.org.au/australian-prescriber/articles/analgesics-and-pain-relief-in-pregnancy-and-breastfeeding-1">current advice</a> provided to pregnant women in Australia. </p>
<p>With any medication in pregnancy, there needs to be a careful balance between treating a maternal condition and protecting the unborn. A trusted health care provider can help reach an informed decision. Paracetamol is no different. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423469/original/file-20210928-19-r1l55t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="pill packet" src="https://images.theconversation.com/files/423469/original/file-20210928-19-r1l55t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423469/original/file-20210928-19-r1l55t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423469/original/file-20210928-19-r1l55t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423469/original/file-20210928-19-r1l55t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423469/original/file-20210928-19-r1l55t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423469/original/file-20210928-19-r1l55t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423469/original/file-20210928-19-r1l55t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Paracetamol is the active ingredient in hundreds of prescription and non-prescription medications.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/siegen-north-rhinewestphaliagermany-01-02-260nw-1633257661.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<h2>What are the concerns?</h2>
<p>Worldwide, <a href="https://academic.oup.com/ije/article/45/6/2009/2724482">more than 50% of pregnant women</a> use paracetamol to treat pain and/or fever. Paracetamol is the active ingredient in hundreds of prescription and non-prescription products. It has been widely regarded for many years as safe to use during pregnancy.</p>
<p>Some, but not all, observational studies in humans suggest paracetamol use during pregnancy may <a href="https://pubmed.ncbi.nlm.nih.gov/25851072/">alter fetal development</a>. The new statement notes that paracetamol has been linked to increased risk of certain <a href="https://www.nature.com/articles/%20s41574-021-00553-7">neurodevelopmental, reproductive and urogenital disorders</a>.</p>
<p>But these studies have limitations. Researchers have found it hard to distinguish the effects of paracetamol from the effects of underlying illness. And there are potential inaccuracies in recording the amount and timing of paracetamol use across an entire pregnancy as are highlighted in the accompanying <a href="https://www.nature.com/articles/s41574-021-00567-1">editorial</a>.</p>
<p>Possible risks of paracetamol use in pregnancy are supported by a number of animal studies, the authors say. For this reason, caution regarding paracetamol use has been advised until a definitive link can be proven or disproven.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1441082949965795336"}"></div></p>
<p>It’s worth noting the available evidence suggests any possible harms of paracetamol are likely to be dose-related. As highlighted by the review article, most increased risks have been linked with use in pregnancy for <a href="https://www.nature.com/articles/s41574-021-00553-7">more than two or four weeks</a>. Current evidence suggests limited risks to unborn babies when paracetamol is taken short term. </p>
<p>Timing is also important. Taking paracetamol during the first trimester has been linked to an increased risk of reproductive and urogenital disorders. Neurodevelopmental disorders have been linked to use in the second or third trimester. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/domperidone-can-boost-breast-milk-supply-heres-what-you-need-know-88648">Domperidone can boost breast milk supply – here's what you need know</a>
</strong>
</em>
</p>
<hr>
<h2>When the benefits outweigh the risks</h2>
<p>The potential benefits of taking medication need to be weighed against any possible risks. Paracetamol is recognised as an important medication for treating pain and fever during pregnancy. </p>
<p>If left untreated, these conditions could harm the fetus or the pregnant person (the Nature <a href="https://www.nature.com/articles/s41574-021-00567-1">editorial</a> and <a href="https://www.nature.com/articles/s41574-021-00553-7">statement</a> say the expert advice is “relevant for all people who wish to become pregnant, including transgender individuals, non-binary people and intersex people”). </p>
<p>The review authors recognise the <a href="https://www.nature.com/articles/s41574-021-00553-7">potential benefits of paracetamol use</a> and note untreated pain has been linked to increased risks of depression or anxiety as well as hypertension during pregnancy. Fever in pregnancy is a risk factor for multiple neonatal and childhood disorders, including certain birth defects and miscarriage. There is evidence to suggest that use of paracetamol may reduce these risks. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/using-cannabis-during-pregnancy-could-be-bad-news-for-your-baby-new-research-140443">Using cannabis during pregnancy could be bad news for your baby: new research</a>
</strong>
</em>
</p>
<hr>
<h2>What are the alternatives?</h2>
<p>The optimal management of pain or fever during pregnancy has not been well studied and treatment options remain limited. </p>
<p>Non-steroidal anti-inflammatory medications (such as ibuprofen) have been linked to <a href="https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.15510">miscarriage</a> when used in the first trimester, whereas use after 30 weeks’ gestation can negatively impact <a href="https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.15510">kidney and heart/lung function</a> in the fetus. For this reason non-steroidal anti-inflammatory medications are <a href="https://www.medicinesinpregnancy.org/Medicine--pregnancy/Ibuprofen/">best avoided</a> unless advised by a healthcare professional. The same goes for strong pain medications such as opioids, which should be <a href="https://www.nps.org.au/australian-prescriber/articles/analgesics-and-pain-relief-in-pregnancy-and-breastfeeding-1">reserved for the management of severe pain</a>. Paracetamol remains the best choice for the short-term treatment of pain and/or fever during pregnancy. </p>
<p>It is also important to identify the cause of the pain or fever, particularly during pregnancy. Discussions about paracetamol use can lead to further investigation, recommendations for non-medication treatments or the need for different medications. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423468/original/file-20210928-26-1vj7zne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="pregnant woman with sore back" src="https://images.theconversation.com/files/423468/original/file-20210928-26-1vj7zne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423468/original/file-20210928-26-1vj7zne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423468/original/file-20210928-26-1vj7zne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423468/original/file-20210928-26-1vj7zne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423468/original/file-20210928-26-1vj7zne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423468/original/file-20210928-26-1vj7zne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423468/original/file-20210928-26-1vj7zne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Safe options for pain management during pregnancy are limited.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/pregnant-woman-suffering-lower-back-260nw-786703240.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weight-gain-during-pregnancy-how-much-is-too-much-89016">Weight gain during pregnancy: how much is too much?</a>
</strong>
</em>
</p>
<hr>
<h2>The bottom line</h2>
<p>The new consensus statement does not alter existing recommendations regarding paracetamol use during pregnancy. But it does highlight the importance of thinking carefully before using any medications during pregnancy and raises greater awareness about how challenging making informed decisions about medication use can be. </p>
<p>Better evidence is needed to support decision-making during pregnancy and reduce unnecessary anxiety and concern.</p>
<p>Paracetamol use during pregnancy should be discussed with a health-care professional and used at the lowest effective dose for the shortest possible duration. Non-medication therapies for treating pain or fever should be tried before or in addition to paracetamol. When indicated, short-term use of paracetamol remains the safest medication for the treatment of pain and/or fever during pregnancy.</p><img src="https://counter.theconversation.com/content/168747/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Luke Grzeskowiak receives funding from the Channel 7 Children's Research Foundation, The Hospital Research Foundation, and National Health and Medical Research Foundation</span></em></p><p class="fine-print"><em><span>Debra Kennedy is affiliated with MotherSafe, the NSW Statewide Medications in Pregnancy and Lactation Advisory Service at the Royal Hospital for Women. </span></em></p>A panel of experts has urged caution regarding paracetamol during pregnancy. But that doesn’t change current advice to discuss pain relief with your doctor or pharmacist.Luke Grzeskowiak, Channel 7 Children's Research Foundation Fellow in Medicines Use and Safety - Flinders University & South Australian Health & Medical Research Institute, Flinders UniversityDebra Kennedy, Senior lecturer, School of Women's and Children's Health, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1655142021-09-01T23:18:07Z2021-09-01T23:18:07ZDefining when human life begins is not a question science can answer – it’s a question of politics and ethical values<figure><img src="https://images.theconversation.com/files/418958/original/file-20210901-21-5hg6d6.jpg?ixlib=rb-1.1.0&rect=25%2C33%2C5572%2C4154&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Science can observe these various phases of fetal development but cannot determine when human life begins.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/pregnancy-ultrasound-royalty-free-image/168415756">UrsaHoogle/E+ via Getty Images</a></span></figcaption></figure><p>Now that the U.S. Supreme Court has <a href="https://theconversation.com/a-revolutionary-ruling-and-not-just-for-abortion-a-supreme-court-scholar-explains-the-impact-of-dobbs-185823">given states final say</a> over if and when abortions are legal, the <a href="https://www.cnn.com/2022/06/27/media/supreme-court-abortion-reliable-sources/index.html">political debates over abortion rights</a> will intensify in legislatures and <a href="https://theconversation.com/state-courts-from-oregon-to-georgia-will-now-decide-who-if-anyone-can-get-an-abortion-under-50-different-state-constitutions-184298">courthouses</a> around the nation. Many of those discussions will hinge on the question of when, exactly, is the beginning of a human life that could – or should – be protected by law.</p>
<p>A <a href="https://www.supremecourt.gov/DocketPDF/19/19-1392/185346/20210729162737297_19-1392%20BRIEF%20OF%20BIOLOGISTS%20AS%20AMICI%20CURIAE%20IN%20SUPPORT%20OF%20NEITHER%20PARTY.pdf">friend of the court filing</a> in the Supreme Court case implicitly claimed that biology – and therefore biologists – can tell when human life begins. The filing then went on to claim explicitly that a vast majority of biologists agree on which particular point in fetal development actually marks the beginning of a human life.</p>
<p>Neither of those claims is true.</p>
<h2>The role of science</h2>
<p>As a <a href="https://scholar.google.com/citations?user=wQsQxFoAAAAJ&hl=en&oi=ao">biologist and philosopher</a>, I have been watching players in the national abortion debate make claims about biology for many years. </p>
<p>Abortion rights opponents know that Americans have widely differing values and religious beliefs about abortion and the protection of human life. So they <a href="https://www.nytimes.com/2019/01/22/opinion/abortion-roe-science.html">seek to use science as an absolute standard</a> in any discussion of abortion’s constitutionality, setting a definition of human life that they hope will be immune to any counterargument.</p>
<p>While possibly well-intentioned, this appeal to scientific authority and evidence over discussions of people’s values is based on faulty reasoning. Philosophers such as the late <a href="https://plato.stanford.edu/entries/williams-bernard/">Bernard Williams</a> have long pointed out that understanding what it is to be human <a href="https://philpapers.org/rec/WILMSO">requires a lot more than biology</a>. And <a href="https://cup.columbia.edu/book/fear-wonder-and-science-in-the-new-age-of-reproductive-biotechnology/9780231170949">scientists can’t establish</a> when a fertilized cell or embryo or fetus becomes a human being.</p>
<iframe width="100%" height="480" frameborder="0" allowfullscreen="" src="https://archive.org/embed/COM_20121113_070000_The_Daily_Show_With_Jon_Stewart?start=1370&end=1412.2" webkitallowfullscreen="true" mozallowfullscreen="true"></iframe>
<h2>Political claims about science</h2>
<p>Public figures have, in recent years, prominently claimed that scientific knowledge on the topic of human life is definitive.</p>
<p>In 2012, for instance, former Arkansas Gov. Mike Huckabee, who was running for president, claimed on “The Daily Show with Jon Stewart: ”<a href="https://lincmad.blogspot.com/2012/11/transcript-huckabee-on-daily-show.html">Biologically, life begins at conception</a>. That’s irrefutable from a biological standpoint.“</p>
<p>Similarly, in his 2015 presidential bid, Florida Sen. Marco Rubio declared, ”<a href="https://www.cnn.com/2015/08/07/politics/marco-rubio-abortion-republican-debate-gop/index.html">I believe that science is clear</a> … when there is conception that that is a human life in the early stages of its development.“</p>
<p>The most recent high-profile example of this claim is in that <a href="https://www.supremecourt.gov/DocketPDF/19/19-1392/185346/20210729162737297_19-1392%20BRIEF%20OF%20BIOLOGISTS%20AS%20AMICI%20CURIAE%20IN%20SUPPORT%20OF%20NEITHER%20PARTY.pdf">amicus brief filed with the Supreme Court</a> in the Mississippi case.</p>
<p>The brief, coordinated by a University of Chicago graduate student in comparative human development, Steven Andrew Jacobs, is based on a problematic piece of research Jacobs conducted. He now seeks to enter it into the public record to influence U.S. law.</p>
<p>First, Jacobs carried out a survey, supposedly representative of all Americans, by seeking potential participants on the <a href="https://doi.org/10.1177%2F1948550619875149">Amazon Mechanical Turk crowdsourcing marketplace</a> and accepting all 2,979 respondents who agreed to participate. He found that <a href="https://papers.ssrn.com/sol3/papers.Cfm?Abstract_id=3211703">most of these respondents trust biologists over others</a> – including religious leaders, voters, philosophers and Supreme Court justices – to determine when human life begins.</p>
<p>Then, he sent 62,469 biologists who could be identified from institutional faculty and researcher lists a separate survey, offering several options for when, biologically, human life might begin. He got 5,502 responses; 95% of those self-selected respondents said that life began at fertilization, when a sperm and egg merge to form a single-celled zygote. </p>
<p>That result is not a proper survey method and does not carry any statistical or scientific weight. It is like asking 100 people about their favorite sport, finding out that only the <a href="https://news.gallup.com/poll/4735/sports.aspx">37 football fans</a> bothered to answer, and declaring that 100% of Americans love football.</p>
<p>In the end, just 70 of those 60,000-plus biologists supported Jacobs’ legal argument enough to sign the amicus brief, which makes a companion argument to the main case. That may well be because there is neither scientific consensus on the matter of when human life actually begins nor agreement that it is a question that biologists can answer using their science.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/418960/original/file-20210901-15-10pj2s7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An image of a fetus" src="https://images.theconversation.com/files/418960/original/file-20210901-15-10pj2s7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/418960/original/file-20210901-15-10pj2s7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418960/original/file-20210901-15-10pj2s7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418960/original/file-20210901-15-10pj2s7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418960/original/file-20210901-15-10pj2s7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418960/original/file-20210901-15-10pj2s7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418960/original/file-20210901-15-10pj2s7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A human fetus at six to seven weeks of gestation.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/lunarcaustic/3233482244">lunarcaustic via Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Several possible options</h2>
<p><a href="https://www.swarthmore.edu/profile/scott-gilbert">Scott Gilbert</a>, the Howard A. Schneiderman Professor of Biology emeritus at Swarthmore College, is the author of the <a href="https://global.oup.com/ushe/product/developmental-biology-9781605358246?cc=us&lang=en&">standard textbook</a> of developmental biology. He has identified <a href="https://www.swarthmore.edu/news-events/when-does-personhood-begin">as many as five developmental stages</a> that, from a biological perspective, are all plausible beginning points for human life. Biology, as science knows it now, can tell these stages apart, but cannot determine at which one of these stages life begins.</p>
<p>The first of these stages is fertilization in the egg duct, when a zygote is
formed with the full human genetic material. But <a href="https://www.nytimes.com/2018/05/21/science/mosaicism-dna-genome-cancer.html">almost every cell in everyone’s body contains that person’s complete DNA sequence</a>. If genetic material alone makes a potential human being, then when we shed skin cells – as we do all the time – we are severing potential human beings.</p>
<p>The second plausible stage is called gastrulation, which happens about two weeks after fertilization. At that point, <a href="https://dx.doi.org/10.1187%2Flse.7.1.cbe12">the embryo loses the ability to form identical twins</a> – or triplets or more. The embryo therefore becomes a biological individual but not necessarily a human individual. </p>
<p>The third possible stage is at 24 to 27 weeks of pregnancy, when the characteristic <a href="https://doi.org/10.7312/gilb17094">human-specific brain-wave pattern emerges in the fetus’s brain</a>. Disappearance of this pattern is part of <a href="https://dx.doi.org/10.1007%2Fs11571-008-9047-z">the legal standard for human death</a>; by symmetry, perhaps its appearance could be taken to mark the beginning of human life.</p>
<p>The fourth possible stage, which is <a href="https://www.worldcat.org/title/abortion-medicine-and-the-law/oclc/563961118">the one endorsed in the Roe v. Wade decision</a> legalizing abortion in the United States, is viability, when a fetus typically becomes viable outside the uterus with the help of available medical technology. With the technology that we have today, <a href="https://www.rcog.org.uk/en/guidelines-research-services/guidelines/sip41/">that stage is reached at about 24 weeks</a>.</p>
<p>The final possibility is birth itself.</p>
<p>[<em>Over 100,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>The overall point is that biology does not determine when human life begins. It is a question that can only be answered by appealing to our values, examining what we take to be human. </p>
<p>Perhaps biologists of the future will learn more. Until then, when human life begins during fetal developments is a question for philosophers and theologians. And policies based on an answer to that question will remain up to politicians – and judges.</p>
<p><em>This is an updated version of an article originally published Sept. 1, 2021.</em></p><img src="https://counter.theconversation.com/content/165514/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sahotra Sarkar does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some people seeking to influence public opinion about abortion rights claim the science is clear. It’s not, and that means abortion remains a political question – not a biological one.Sahotra Sarkar, Professor of Philosophy and Integrative Biology, The University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1283912020-02-13T14:04:32Z2020-02-13T14:04:32ZHow did I get my own unique set of fingerprints?<figure><img src="https://images.theconversation.com/files/314900/original/file-20200212-61925-1j04rei.jpg?ixlib=rb-1.1.0&rect=778%2C14%2C3824%2C2679&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even identical twins have different fingerprints.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/multiple-colored-hand-prints-on-orange-93461938">El Greco/Shutterstock.com</a></span></figcaption></figure><figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em><a href="https://theconversation.com/us/topics/curious-kids-us-74795">Curious Kids</a> is a series for children of all ages. If you have a question you’d like an expert to answer, send it to <a href="mailto:curiouskidsus@theconversation.com">CuriousKidsUS@theconversation.com</a>.</em></p>
<hr>
<blockquote>
<p><strong>How do we get the fingerprints we have? – Oscar V., age 8, Somerville, Massachusetts</strong></p>
</blockquote>
<hr>
<p>Fingerprints are those little ridges on the tips of your fingers. They’re essentially folds of the outer layer of skin, the epidermis. The “prints” themselves are the patterns of skin oils or dirt these ridges leave behind on a surface you’ve touched.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/314901/original/file-20200212-61925-1etqs37.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/314901/original/file-20200212-61925-1etqs37.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/314901/original/file-20200212-61925-1etqs37.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/314901/original/file-20200212-61925-1etqs37.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/314901/original/file-20200212-61925-1etqs37.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/314901/original/file-20200212-61925-1etqs37.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/314901/original/file-20200212-61925-1etqs37.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/314901/original/file-20200212-61925-1etqs37.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A careful closeup look will show you your fingerprint’s ridges and valleys.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/finger-close-757162741">Fotosr52/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Your fingerprints began to form before you were born. When a fetus starts to grow, the outside layer of its skin is smooth. But after about 10 weeks, a deeper layer of skin, called the basal layer, starts growing faster than the layers above it, <a href="https://doi.org/10.1016/j.jtbi.2004.12.020">which makes it “buckle” and fold</a>. The expanding lower layer ends up scrunched and bunched beneath the outside layer.</p>
<p>These folds eventually cause the surface layers of the skin to fold too, and by the time a fetus is 17 weeks old – about halfway through a pregnancy – <a href="https://doi.org/10.1016/j.jtbi.2004.12.020">its fingerprints are set</a>.</p>
<p>Although this folding process might sound random, the overall size and shape of fingerprints are <a href="https://ghr.nlm.nih.gov/primer/traits/fingerprints">influenced by the genes you get from your parents.</a> So you probably share some fingerprint patterns with your family members.</p>
<p>But the details of your fingerprints are influenced by many other factors besides genes. For example, the shape and size of the blood vessels in your skin, how fast the different layers of skin are growing, and the chemical environment inside the womb all play a part. No two people end up with exactly the same fingerprints, <a href="https://doi.org/10.1109/BTAS.2016.7791176">even identical twins</a>.</p>
<p>It was only in 2015 that a big long-term study showed that <a href="https://doi.org/10.1073/pnas.1410272112">fingerprints are stable</a> over a person’s lifetime. The ridges of a fingerprint are visible on the skin’s surface layer, but the pattern is actually “encoded” below that. Even if you have a major skin injury, your prints will come back when the outer layer heals – though you might have a scar, too.</p>
<p>So your fingerprints are totally unique to you and have been since before you were born. No matter how much you change as you grow up, you’ll always have the set you have now, no matter how long you live.</p>
<h2>What’s a fingerprint’s point?</h2>
<p>Surprisingly, nobody really knows what fingerprints are for.</p>
<p>People have long thought that fingerprints provide the friction that helps our hands grip objects. This makes sense because the other animals besides human beings that have fingerprints – including many other primates like apes and monkeys, <a href="https://www.livescience.com/14007-koalas-human-fingerprints.html">and koalas</a> – are all tree climbers.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"723344536051810306"}"></div></p>
<p>But sometimes what makes sense isn’t true, and a recent study found that fingerprints <a href="https://doi.org/10.1242/jeb.028977">don’t really help people hold onto things</a> – at least, not things with smooth surfaces.</p>
<p>Other possibilities are that fingerprints improve your sense of touch or help protect your fingers from injury. But scientists don’t know for sure yet.</p>
<h2>Making use of your prints</h2>
<p>Police have been using fingerprints and their <a href="http://www.forensicsciencesimplified.org/prints/principles.html">unique loop, whorl and arch shapes</a> to help catch criminals for more than 2,000 years, <a href="https://www.ncjrs.gov/pdffiles1/nij/225321.pdf">starting in ancient China</a>.</p>
<p>Fingerprints are now used for many other things as well, all based on the fact that each person’s fingerprints are different. You can use that unique code to unlock your phone or enter a restricted area, for example. In Malawi, fingerprints have been used to <a href="https://doi.org/10.1257/aer.102.6.2923">identify farmers who have taken out loans</a>. They can even be <a href="https://doi.org/10.1109/TIFS.2016.2639346">taken from babies</a> and used throughout the person’s life to <a href="https://www.futurity.org/babies-fingerprints-keep-immunizations-track/">access their immunization records</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/314902/original/file-20200212-61925-icgh7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/314902/original/file-20200212-61925-icgh7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/314902/original/file-20200212-61925-icgh7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/314902/original/file-20200212-61925-icgh7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/314902/original/file-20200212-61925-icgh7a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/314902/original/file-20200212-61925-icgh7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/314902/original/file-20200212-61925-icgh7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/314902/original/file-20200212-61925-icgh7a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Do your prints match those left at the scene of a crime?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fingerprint-record-sheet-top-view-criminal-1340084930">New Africa/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Police forces are still finding new uses for fingerprints, too. As fingerprint detection and study methods have improved, detectives can even use them to see <a href="https://doi.org/10.1111/1556-4029.12438">who threw a particular stone</a>. Those little ridges can hide tiny amounts of substances too – which means they could be used to <a href="https://doi.org/10.1021/acs.analchem.5b01060">detect the use of illegal drugs like cocaine and heroin</a>. And now forensic scientists can detect decades-old fingerprints, too – maybe allowing detectives to solve really old crimes – with a <a href="https://doi.org/10.1038/ncomms4736">new technique that uses a color-changing chemical</a> to map the sweat glands within your fingerprints.</p>
<hr>
<p><em>Hello, curious kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to <a href="mailto:curiouskidsus@theconversation.com">CuriousKidsUS@theconversation.com</a>. Please tell us your name, age and the city where you live.</em></p>
<p><em>And since curiosity has no age limit – adults, let us know what you’re wondering, too. We won’t be able to answer every question, but we will do our best.</em></p><img src="https://counter.theconversation.com/content/128391/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Leupen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>You’ve had your own personal set of fingerprints since before you were born, and they’ll be with you throughout your whole life.Sarah Leupen, Senior Lecturer in Biological Sciences, University of Maryland, Baltimore CountyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1301812020-01-23T18:46:54Z2020-01-23T18:46:54ZJoaquin Phoenix’s lips are not like Napoleon’s − here’s what everyone should know about cleft lip<figure><img src="https://images.theconversation.com/files/311185/original/file-20200121-117933-16v4fic.jpg?ixlib=rb-1.1.0&rect=122%2C47%2C3176%2C2227&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Joaquin Phoenix won the award for outstanding performance by a male actor in a leading role for 'Joker' at the 26th annual Screen Actors Guild Awards. </span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/26thAnnualSAGAwards-PressRoom/6f4e297798694088b9f9603784f48604">Jordan Strauss/Invision via AP</a></span></figcaption></figure><p>Starring in the <a href="https://collider.com/napoleon-global-box-office-78-million/">November 2023 film “Napoleon,”</a> Joaquin Phoenix is back in the limelight, along with the prominent scar on his upper lip. You may recall in 2020, after discussing Phoenix’s appearance on her talk show, Wendy Williams received near universal <a href="https://www.today.com/health/wendy-williams-blasted-mocking-joaquin-phoenix-s-cleft-palate-scar-t171887">condemnation</a> for mocking those affected with cleft lip – a common birth defect in which the upper lip does not form completely while still an embryo. Note that it is also unclear whether Phoenix has a cleft lip or simply a scar. To her credit, Williams was quick to apologize. Regardless, this renewed attention to Phoenix’s scar offers another opportunity to highlight how people with facial differences (and their families) often feel stigmatized and can face discrimination and <a href="https://doi.org/10.4103/2231-0746.200336">social isolation</a>. </p>
<p>We have each devoted major portions of our professional lives to understanding what causes clefts and to the treatment and advocacy of those affected. <a href="https://scholar.google.com/citations?user=2Nq1fLsAAAAJ&hl=en">We are</a> <a href="https://scholar.google.com/citations?user=GYMrNdIAAAAJ&hl=en">geneticists</a> and a <a href="https://www.dental.pitt.edu/people/bernard-j-costello-dmd-md">pediatric craniomaxillofacial surgeon</a>. The three of us felt this was an opportunity to explain how clefts form and how clefts affect the people who live with them. And what, if anything, can be done to prevent them?</p>
<h2>The ABCs of clefting</h2>
<p>There are several different types of facial clefts. The most common are cleft lip, when the upper lip does not form properly, leaving a gap, and cleft palate, when the roof of the mouth does not close while a baby is developing in utero.</p>
<p>These birth defects arise very early during development when the embryo is about the size of a grain of rice. At this stage, the face is merely a collection of swellings rapidly growing toward one another in order to <a href="https://doi.org/10.1038/nrg2933">fuse together</a> and form the lips, nose and palate. Thus, in a way, everyone starts out with clefts of the lip and palate.</p>
<p>In most cases, these swellings fuse before the end of the first trimester of pregnancy, forming an intact lip and palate. When this fails to happen, a child is born with a cleft of the lip, the palate or both. Worldwide, facial clefts are estimated to occur in <a href="https://doi.org/10.4103/2231-0746.200336">1 in 700 births</a>, making it one of the most common birth defects. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/311628/original/file-20200123-162240-i0s4a3.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration showing before and after depictions of cleft lip and cleft lip palate repair" src="https://images.theconversation.com/files/311628/original/file-20200123-162240-i0s4a3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/311628/original/file-20200123-162240-i0s4a3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=245&fit=crop&dpr=1 600w, https://images.theconversation.com/files/311628/original/file-20200123-162240-i0s4a3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=245&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/311628/original/file-20200123-162240-i0s4a3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=245&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/311628/original/file-20200123-162240-i0s4a3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=308&fit=crop&dpr=1 754w, https://images.theconversation.com/files/311628/original/file-20200123-162240-i0s4a3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=308&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/311628/original/file-20200123-162240-i0s4a3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=308&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cleft lip and palate are two of the most common birth defects worldwide.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/0/09/Cleft_Lip_%26_Cleft_Palate_Repair.png">BruceBlaus/Wikimedia</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>How clefts harm quality of life</h2>
<p>People with cleft lip and palate, as well as their families, face many issues associated with these birth defects. Although clefts may seem like cosmetic problems, they adversely affect basic functions like eating and speaking. Children with clefts must endure multiple corrective surgeries, often beginning when they are only a few months old. However, the surgeries are often just the beginning. </p>
<p>Many years of intensive orthodontic treatment and speech therapy are routinely needed. The <a href="https://doi.org/10.1111/j.1601-0825.2009.01588.x">total lifetime treatment cost</a> is estimated to be at least US$200,000 per individual. Beyond immediate medical care, individuals born with a cleft also tend to <a href="https://doi.org/10.1136/archdischild-2017-313777">experience more learning difficulties</a>, <a href="https://doi.org/10.1136/archdischild-2017-313777">higher mortality rates</a> at all stages of life and <a href="https://doi.org/10.1093/aje/kwi132">higher risk for other disorders</a>, such as breast, brain and colon cancers. </p>
<p>Children born in the U.S. with these conditions are lucky to have these supports, given the myriad challenges cleft lips and palates present. There are superb teams dedicated to <a href="https://acpa-cpf.org/">advocacy</a>, to their <a href="https://acpacares.org">care</a> and <a href="https://www.smiletrain.org/">support</a>, and <a href="https://www.asha.org/advocacy/">who work</a> to address the needs of the children and their families.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/311207/original/file-20200121-117907-1ydz595.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person holding baby with cleft lip next to another person holding a clipboard" src="https://images.theconversation.com/files/311207/original/file-20200121-117907-1ydz595.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/311207/original/file-20200121-117907-1ydz595.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/311207/original/file-20200121-117907-1ydz595.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/311207/original/file-20200121-117907-1ydz595.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/311207/original/file-20200121-117907-1ydz595.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/311207/original/file-20200121-117907-1ydz595.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/311207/original/file-20200121-117907-1ydz595.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In China, orphanages mostly house children abandoned by their families because of serious medical issues, including cleft lip.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Emptying-The-Orphanages/badb3d4b1c0f4a89a3d7b8f16f3c3bb4/2/0">AP Photo/Ng Han Guan</a></span>
</figcaption>
</figure>
<h2>Multiple factors cause clefts</h2>
<p>Facial clefts have likely been around for as long as people have. An early example is the pharaoh Tutankhamun, better known as King Tut, who suffered from a <a href="https://doi.org/10.1001/jama.2010.121">partial cleft palate</a>.</p>
<p>Because clefts are often externally visible features, many have tried to explain their occurrence. An early hypothesis suggested that the mother was pregnant during an <a href="https://doi.org/10.1597/06-113.1">eclipse</a>, while <a href="http://www.opensourceshakespeare.org/views/plays/play_view.php?WorkID=midsummer&Act=5&Scene=1&Scope=scene&LineHighlight=2252#2252">Shakespeare</a> attributed the feature to an intervention by mischievous sprites. Many cultures also believed that clefts were “<a href="https://doi.org/10.1146/annurev-genom-090711-163729">in the blood</a>,” or familial, which aligns with current understanding.</p>
<p>Our group at the University of Pittsburgh has spent many years trying to understand the causes of clefts, with some notable successes.</p>
<p>Clefts are considered “complex” by those who study birth defects, meaning that they result from a combination of environmental factors during pregnancy and family genetics. Some of the environmental causes include taking certain <a href="https://doi.org/10.1186/s12916-017-0845-1">prescription medications</a> and <a href="https://doi.org/10.1080/15459624.2018.1484127">exposure to some toxins</a> during pregnancy. </p>
<p>The completion of the <a href="https://doi.org/10.1080/15459624.2018.1484127">Human Genome Project</a> in the late 1990s and early 2000s provided important scientific tools for us to tease out the genetic factors leading to complex traits such as facial clefts. To date, scientists have identified at least <a href="https://doi.org/10.12688/f1000research.9503.1">30 possible genetic regions</a> increasing the risk of facial clefts, and we suspect that there are still many more regions to discover. </p>
<p>However, population-level studies such as the ones that identified those 30 genetic regions can tell us only so much. Researchers still face a major challenge identifying the specific genes that confer risk to specific individuals and families. There are other mysteries as well, such as why cleft palate alone is more common in girls, but when cleft palate is combined with cleft lip, it is <a href="https://doi.org/10.1016/S0140-6736(09)60695-4">more common in boys</a>.</p>
<h2>Are clefts preventable?</h2>
<p>Parents who have a child with a cleft sometimes blame themselves. This is unfortunate, because there are still no known measures parents can take that will definitively prevent a facial cleft.</p>
<p>Doctors do know that <a href="https://doi.org/10.1016/j.annepidem.2016.11.009">smoking</a> and <a href="https://doi.org/10.1001/archpediatrics.2011.185">poor nutrition</a> during pregnancy can increase the chances of having a baby with a cleft. There is also some evidence that <a href="https://doi.org/10.1097/SCS.0000000000004488">supplementation with folic acid</a> before and during pregnancy may provide some protection. </p>
<p>As scientists learn more about the genetic and environmental risk factors for clefting, new actionable evidence will hopefully emerge that will bolster prevention efforts. Our most important task, however, is to work toward improving the quality of life for those affected. That starts with understanding.</p>
<p><em>This article was updated on Nov. 27, 2023 to note Joaquin Phoenix’s role in the film “Napoleon.”</em></p><img src="https://counter.theconversation.com/content/130181/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary L. Marazita receives funding from the National Institutes of Health, primarily the National Institute of Dental and Craniofaical Research. </span></em></p><p class="fine-print"><em><span>Bernard J Costello is affiliated with the AACMFS and ACPA. Past-president of the American Academy of Craniomaxillofacial Surgeons and Past-President of the American Cleft Palate-Craniofacial Association. </span></em></p><p class="fine-print"><em><span>Seth M. Weinberg receives funding from the National Institutes of Health. </span></em></p>Joaquin Phoenix has previously been mocked for a facial scar that some have assumed is a cleft lip. Two geneticists and a surgeon explain what causes this common birth defect.Mary L. Marazita, Director, Center for Craniofacial and Dental Genetics; Professor of Oral Biology and of Human Genetics, University of PittsburghBernard J. Costello, Associate Vice Chancellor and Professor, University of PittsburghSeth M. Weinberg, Professor of Oral and Craniofacial Sciences and Human Genetics, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1268222019-12-02T16:11:02Z2019-12-02T16:11:02ZPregnant women have a higher risk of delivering early on unseasonably hot days<figure><img src="https://images.theconversation.com/files/303649/original/file-20191126-112504-1eot3q7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Around 10 states in the U.S. have hit over 120 degrees Fahrenheit on their hottest days this year.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/heat-thermometer-shows-temperature-hot-sky-692692216">VladisChern/Shutterstock.com</a></span></figcaption></figure><p>About a quarter of children in the United States are born <a href="https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_05.pdf">two to three weeks before their due date</a>, which qualifies them as “early term.” Pregnancies typically last 40 weeks, so you might think that being born two to three weeks early wouldn’t matter. But, children born just two or three weeks early are at <a href="https://doi.org/10.1002/ppul.23529">slightly higher risks of respiratory problems</a>, like asthma, later in childhood. About 1 in 10 children in the U.S. are born more than three weeks before their due date, which qualifies them as “preterm” and <a href="https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm">puts them at higher risks for much worse outcomes</a>. </p>
<p>Hot weather is one potential risk factor in early deliveries because heat exposure can increase the mother’s level of <a href="https://doi.org/10.1126/science.6278592">oxytocin, a hormone that regulates delivery</a>. Despite the plausible link, questions remain about the number of deliveries affected by hot weather every year in the U.S. or if hot weather accelerates the timing of delivery by hours, days or weeks. </p>
<p><a href="https://www.ioes.ucla.edu/person/alan-barreca">I’m an economist</a> who has spent much of my decadelong career investigating how weather affects human health, with a focus on child and maternal health. I got started down this career path in 2008 because I wanted to understand why <a href="https://www.cdc.gov/nchs/pressroom/sosmap/lbw_births/lbw.htm">infant health is much worse today in hotter parts of the U.S., like Louisiana</a>. Now, I work on these issues to help identify unknown health-related threats from climate change.</p>
<p><iframe id="P6rml" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/P6rml/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>New evidence on temperature and delivery risk</h2>
<p>My latest work with <a href="https://www.cmc.edu/academic/faculty/profile/jessamyn-schaller">Jessamyn Schaller at Claremont McKenna</a>, published in the Dec. 2, 2019 issue of <a href="https://www.nature.com/articles/s41558-019-0632-4">Nature Climate Change</a>, focuses on the effect of hot weather on early deliveries. We compiled 56 million birth records from the United States over the 1969-1988 time period. We then matched the recorded county of birth to daily weather data to see if hot weather does, in fact, lead to earlier deliveries.</p>
<p>But, there were two data challenges we needed to overcome. </p>
<p>First, hotter places have other problems, many of which aren’t related to the climate. <a href="https://www.census.gov/library/stories/2019/11/state-by-state-health-insurance-coverage-2018.html">More people in Mississippi, for example, do not have health insurance</a>. </p>
<p>To get around this challenge, we analyzed time periods with unpredictably hot weather, which we define as an excess of days with maximum temperatures of 90 degrees Fahrenheit (32 degrees Celsius) or higher for a given county and time of year. This approach controls for slow-moving societal changes that affect infant health independent of the weather, like access to health care.</p>
<p>Second, measuring pregnancy duration (or what obstetricians call gestational length) is difficult. Pregnancies technically begin on the start of the last menstrual period prior to conception. Some mothers might recall this date, but the data suggest that there’s a lot of guessing going on, either on the hospital’s or the mother’s side.</p>
<p>Here’s where our study gets creative. We tested for shifts in the timing of deliveries. Take a hypothetical example: We might observe 10 more births than average in DeKalb County, Georgia, one of many counties in our data, on an unusually hot day for that time of year. Supposing the hot weather caused those births to occur two days early, we should observe 10 fewer births than average for DeKalb County two days later after the hot weather subsides. With this approach, we only need data on weather and birth dates, and not the start date of the pregnancy.</p>
<p>Our estimates imply that about 5% more children are born on unpredictably hot 90 degree-plus Fahrenheit days than would be expected. In total, hot weather caused about 25,000 babies each year to be born earlier than they would have otherwise in the United States. The average loss is about six days of gestation. But, the losses were potentially as large as two weeks for some births. </p>
<p><iframe id="OYdhG" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/OYdhG/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Lessons for climate change</h2>
<p>This isn’t the first study to consider how <a href="https://doi.org/10.1257/aer.99.2.211">weather might influence fetal health</a>. <a href="https://doi.org/10.1186/s12940-017-0209-5">A number of studies</a> <a href="https://doi.org/10.1016/j.envres.2011.01.023">look at preterm delivery</a> (less than 37 weeks gestation), although using very small samples. Our creative approach and large dataset enabled us to calculate weather-related reductions in gestational lengths across the entire U.S. </p>
<p>Unfortunately, we can’t give the specific reason why hot weather causes earlier deliveries. It may or may not be because hot weather increases oxytocin and induces labor. And, it’s not clear how much worse off these children will be as they grow into adulthood for being born a little early, especially since we can’t tell whether the births qualify as preterm or early term. But, one recent study did find that <a href="https://doi.org/10.1073/pnas.1702436114">fetal exposure to hot weather has lasting impacts into adulthood</a>. </p>
<p>The risks for women delivering early are likely to increase in the coming years with climate change. Of course, the exact reductions in gestational length are difficult to predict because it’s unclear what our future world is going to look like once 90 degree-plus F (32 degree-plus C) days become much more frequent.</p>
<p>But, to give you a sense of the magnitude, we predicted that more hot weather from climate change would induce about 42,000 additional deliveries annually in the United States by the end of century. That’s more than 1 in every 100 births. </p>
<p>Air conditioning is likely to be an important solution, and is something we see in our data. But, without using <a href="https://doi.org/10.1126/science.aat5331">greener air conditioners</a> and renewable energy sources it will make climate change worse.</p>
<p>Given air conditioning is costly, climate change is likely to not only be a threat to child health, but would also <a href="https://www.federalreserve.gov/publications/2018-economic-well-being-of-us-households-in-2017-dealing-with-unexpected-expenses.htm">put a financial strain on many households’ tight budgets</a>. </p>
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<p class="fine-print"><em><span>Alan Barreca received funding to conduct this research from the California Strategic Growth Council. </span></em></p>More places around the world are experiencing days with record high temperatures. These prolonged hot spells may have unanticipated impacts on pregnant women, triggering early deliveries.Alan Barreca, Associate Professor of Environmental Economics, University of California, Los AngelesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/948852018-05-21T12:58:32Z2018-05-21T12:58:32ZWhen does a foetus have moral status?<figure><img src="https://images.theconversation.com/files/218305/original/file-20180509-34009-6vsel.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/home">via shutterstock.com</a></span></figcaption></figure><p>Those who argue that the UK’s legal limit on abortion should be lowered below 24 weeks often do so on the basis of supposed improvements in foetal “viability” – the ability of foetuses born prematurely to survive outside the womb. </p>
<p>In early March, the MP Maria Caulfield, the Conservative party’s vice-chair for women, called for a “debate” on changing the law on abortion. She <a href="https://www.politicshome.com/news/uk/political-parties/conservative-party/house/house-magazine/93251/maria-caulfield-">said</a>:</p>
<blockquote>
<p>We’ve got babies born now at 18, 19 weeks. I think it’s something like 50% of babies after 22 weeks are viable and yet abortion is still freely available up to 24 weeks. </p>
</blockquote>
<p>Caulfield’s Conservative colleague Fiona Bruce had also <a href="http://www.dailymail.co.uk/news/article-4430822/Calls-lower-abortion-time-limit-survival-rates-rise.html">advocated</a> a reduction in the abortion cut-off in 2017. And in 2012 another Conservative MP, Nadine Dorries, secured a <a href="http://www.bbc.co.uk/news/uk-politics-20079031">Commons debate</a> on reducing the limit to 20 weeks – again on grounds of foetal viability.</p>
<p>While the most recent interjection from Caulfield stimulated heated discussion, her critics largely focused on <a href="https://www.politicshome.com/news/uk/health-and-care/nhs/opinion/house-commons/93407/diana-johnson-mp-maria-caulfields-%E2%80%98baseless">disputing</a> her claims about where the threshold of viability now lies. Yet, irrespective of the medical facts about the point at which a foetus could survive, it’s worth questioning the assumption that the morality of abortion is closely linked to those facts.</p>
<p>This assumption is common, among both those who want to reduce, and those who want to retain, the current abortion time limit. And it’s also prevalent elsewhere – notably in the US, where, as a result of the Supreme Court’s successive rulings in <a href="https://edition.cnn.com/2013/11/04/us/roe-v-wade-fast-facts/index.html">Roe v. Wade</a> and <a href="https://www.law.cornell.edu/supremecourt/text/505/833">Planned Parenthood v. Casey</a>, significant governmental interference with a woman’s choice of an abortion prior to the point of the viability of the foetus is unconstitutional. </p>
<p>But morally speaking, it’s hard to see how foetal viability could have such deep significance.</p>
<h2>Moral status</h2>
<p>It’s rare for those who believe foetal viability should determine abortion limits to make their reasoning explicit. When they do so, however, they often seem to share the view of a midwife quoted in a <a href="http://www.dailymail.co.uk/news/article-4430822/Calls-lower-abortion-time-limit-survival-rates-rise.html">Daily Mail article</a> in 2017 in support of reducing the abortion cut-off. She said: “Women should be made aware that if they want a termination at 24 weeks, their baby is now viable. It is not a thing in them – it is a human being.”</p>
<p>These words suggest the view that, when a foetus is capable – with medical help – of surviving outside the womb, it acquires what philosophers call “<a href="http://philosophybites.com/2012/04/jeff-mcmahan-on-moral-status.html">moral status</a>”. To have moral status is to matter morally in your own right, and so for there to be moral constraints on what may be done to you. Understanding the moral status of the foetus, and how this might develop over time, is a key part of what the philosophical problem of abortion is all about.</p>
<p>But the idea that foetuses acquire significant moral status when they become capable of surviving outside the womb is difficult to sustain. This is largely because whether a foetus could survive depends on variable features of the world around it, such as the available medical technology. Yet it’s strange to suppose that how much individuals matter morally could rest on something so subject to chance. We are used to thinking that our moral status is due to our intrinsic nature, such as our abilities to think, feel or reason, rather than arbitrary circumstances such as how advanced our society is.</p>
<h2>Alternative futures</h2>
<p>Probably the clearest way to confirm this is to imagine a world in which artificial wombs exist. As it happens, scientists have been working on these for some years, and have had <a href="https://www.theguardian.com/science/2017/apr/25/artificial-womb-for-premature-babies-successful-in-animal-trials-biobag">recent successes incubating sheep foetuses</a>. If an embryo after conception could be transferred to an artificial womb, all embryos and foetuses would be viable. But it would be absurd to conclude that abortion should then be banned. Neither defenders nor opponents of abortion are likely to be persuaded that embryos will suddenly acquire a new, higher moral status, on the day artificial wombs become available.</p>
<p>Infant survival rates can go down as well as up. Imagine that in the future air quality deteriorates so that foetuses born before 28 weeks almost never survive. Or suppose that viability declines because, following a financial crisis, funding for neonatal care services is unavoidably slashed. If moral status depends on whether or not a foetus could survive outside the womb, the abortion limit should presumably be raised under these circumstances. But again, this seems too arbitrary to accept.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/218308/original/file-20180509-34015-1hy1nqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/218308/original/file-20180509-34015-1hy1nqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/218308/original/file-20180509-34015-1hy1nqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/218308/original/file-20180509-34015-1hy1nqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/218308/original/file-20180509-34015-1hy1nqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/218308/original/file-20180509-34015-1hy1nqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/218308/original/file-20180509-34015-1hy1nqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Advances in technology don’t determine our moral status.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTUyNTkwMzMzMSwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfNzU3NTQ1ODU5IiwiayI6InBob3RvLzc1NzU0NTg1OS9tZWRpdW0uanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJnWVBIbFF3bjBuMFRzajg1a01ISVVwRk1QMjAiXQ%2Fshutterstock_757545859.jpg&pi=33421636&m=757545859&src=okynsGvIEi8z2VurlPy-gA-1-0">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Infant survival also depends not only on gestational age but on factors such as birth weight and sex. Heavier infants, and girls, are <a href="https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_41.pdf">apparently</a> more likely to survive. Nobody, however, is likely to think that a foetus’s moral status, rather than its medical prognosis, might depend on its mere weight or gender.</p>
<p>If a foetus’s survivability doesn’t determine its moral status, we still need to ask what does. This is a huge topic, which philosophers <a href="https://stanford.library.sydney.edu.au/entries/grounds-moral-status/#JustGrouMoraStat">are still grappling with</a>. But we should stress that attributing significant moral status to a foetus doesn’t mean that abortion should be banned, since women may have moral claims to decide what to do with their bodies that trump this status. </p>
<p>Wherever one thinks the truth lies, however, the debate on abortion would be enhanced by abandoning the idea that a moral transformation takes place in the foetus at the point when it is able to survive outside of the womb.</p><img src="https://counter.theconversation.com/content/94885/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even if survival rates for very premature infants have improved, it’s dubious that there is a moral reason to lower the abortion limit.Jonathan Parry, Lecturer in Global Ethics in the Philosophy Department, University of BirminghamJeremy Williams, Lecturer in Global Ethics, Department of Philosophy, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/865952017-12-02T08:11:26Z2017-12-02T08:11:26ZFrom fireworks to iodine and IQ: the perchlorate connection<figure><img src="https://images.theconversation.com/files/195249/original/file-20171117-19269-92mbul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">"Remember, remember the fifth of November"...</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/andywilkes/2999025703/in/photolist-5z1MRH-aCbJGQ-aC93UB-8dB8Fa-9YqFGx-aC94Dp-crT21N-HiUxBN-qkHvQv-cHTykU-aCbHHQ-JLrPqN-2799SR-cQzwaj-TaGKjN-cQzx2N-cQzBDE-52buvj-crSWy7-279aAc-27dC9u-6C4Wu5-8gFFfa-527gb4-cQzy5W-52buVo-NWkXAF-sCEhSj-cM7oAG-fkazHg-4NDrL-6Wn5jE-ZiuxmN-dnyuXc-BWFuoC-7g3ExK-WyvWcL-uH6eF-cWzaBW-8vsCQR-RCpSw3-8vw2Hj-b5qeRz-D7uWAo-8RUi72-GAD3Z-8vwgeL-21eh9zY-q48Jxg-8vtyRx">Andy Wilkes/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Fireworks are a key part of a wide number of public celebrations around the world, including Australia Day (January 26), the Festival of Sant Joan in Genoa, Italy (June 24), US Independence Day (July 4), Bastille Day (July 14), National Day in Signapore (August 9), Diwali in India (October), Guy Fawkes Night in the United Kingdom (November 5) and New Year’s Eve in Jakarta, Indonesia (December 31). But while they are a visual delight, fireworks are anything but innocuous. Research has shown that they can cause <a href="https://theconversation.com/our-prettiest-pollutant-just-how-bad-are-fireworks-for-the-environment-52451">significant air pollution</a> and the residues they leave behind – including <a href="http://www.sciencedirect.com/science/article/pii/S0304389410009672">strontium, barium, cobalt and lead</a> – can be highly dangerous.</p>
<p>A less-known fact is that fireworks contain significant amounts of <a href="http://pubs.acs.org/doi/abs/10.1021/es0700698">perchlorate</a>, a chemical of particular concern because of its potential effects on foetal brain development. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/25057878">2014 study</a> published in <em>Journal of Clinical Endocrinology & Metabolism</em> examined data from more than 21,000 pregnant women in the United Kingdom and Italy. All of tested positive for perchlorate, and many also had low iodine levels. Children born to women with the highest levels of perchlorate and the lowest levels of iodine were found to be at greater risk of significant IQ loss. So what’s the connection between perchlorate, iodine and IQ?</p>
<h2>Perchlorate and thyroids</h2>
<p>The answer is that perchlorate blocks iodine uptake by the body’s thyroid glands, reducing their ability to produce sufficient levels of thyroid hormone. This hormone (and hence iodine) is needed for normal brain development. Since the 1970s most children world-wide are tested at birth to ensure they have enough thyroid hormone. If not they are given thyroid supplementation. Thyroid hormone is needed before birth as well, and it was recently demonstrated that a pregnant women’s thyroid hormone levels are vital for her <a href="https://www.ncbi.nlm.nih.gov/pubmed/26497402">child’s future IQ and brain structure</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/195639/original/file-20171121-6061-ngve35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/195639/original/file-20171121-6061-ngve35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/195639/original/file-20171121-6061-ngve35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=629&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195639/original/file-20171121-6061-ngve35.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=629&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195639/original/file-20171121-6061-ngve35.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=629&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195639/original/file-20171121-6061-ngve35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=791&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195639/original/file-20171121-6061-ngve35.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=791&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195639/original/file-20171121-6061-ngve35.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=791&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Structure of the chemical compound perchlorate.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Perchlorate">Wikipedia</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>As a consequence, too much perchlorate or other factors that interfere with thyroid function are bad news for pregnant women. In the United States, the Environment Protection Agency has estimated that up to 16 million people could be drinking <a href="https://www.epa.gov/sites/production/files/2015-08/documents/epa815f11003.pdf">perchlorate-contaminated water</a>. Worse, because perchlorate is highly soluble in water as well as colourless, tasteless and odourless, people won’t know if their water is safe without it tested.</p>
<p>Perchlorate is thus a problem for human health because it interferes with production of thyroid hormone, something we all need. The condition of not having enough is called <a href="https://en.wikipedia.org/wiki/Hypothyroidism">hypothyroidism</a>, and can cause us to become tired, depressed and overweight. So essential is thyroid hormone that some doctors have referred to it as the “fire of life”.</p>
<p>The importance of thyroid hormone for pregnant women and young children cannot be understated: The lack of either iodine or thyroid hormone during early development, especially the foetal and perinatal periods, results in lower IQ as well as an increased risk of neurodevelopmental disease such as <a href="https://en.wikipedia.org/wiki/Autism_spectrum">autism spectrum disorder</a> (ASD) or <a href="https://en.wikipedia.org/wiki/Adult_attention_deficit_hyperactivity_disorder">attention deficit hyperactivity disorders</a> (AD/HD). It has been estimated that neurodevelopmental disorders affect <a href="https://ehp.niehs.nih.gov/ehp358/">1 in 6 American children today</a>. In the United Kingdom, it is estimated that <a href="http://bjp.rcpsych.org/content/194/6/500">1 in 100 children are diagnosed with ASD</a>, while in the US the rate is approximately 1 in 68. There was an unprecedented and worrying increase in ASD incidence between 2000 and 2014, and given that human DNA has been relatively stable over that time period, genetics are unlikely to explain this increase.</p>
<h2>Endocrine-disrupting chemicals</h2>
<p>An increasing number of scientists and health professionals, including paediatricians and psychiatrists, are focusing on the multitude of chemicals to which we are exposed on a daily basis that can affect brain development. Of particular concern are chemicals that disrupt hormones – <a href="https://theconversation.com/everyday-chemicals-may-affect-brain-development-including-foetal-iq-75897">endocrine-disrupting chemicals</a> as they are called. When thinking of brain development and neurodevelopmental disorders, experts immediately think of the main hormone needed for brain development: thyroid hormone. Hence the concern over perchlorate, which is notorious for interfering with our bodies’ capacity to make this hormone.</p>
<p>Fireworks are by no means the only source of perchlorate in our environment. Because it’s highly soluble in water and stable, perchlorate can contaminate croplands and be taken up by vegetables and fruits grown there. Foods with the highest documented levels of perchlorate include melons, dairy and leafy vegetables such as spinach and lettuce. Given the vulnerability of the rapidly growing brains of babies, another particularly unfortunate source is breast milk and <a href="https://www.nature.com/articles/jes200918">infant formula</a>. New-borns are particular vulnerable, not only because their brains are growing quickly, but they also absorb more food and water for their body weight. But both cows-milk and soy-based infant formulas have been found to contain significant levels of perchlorate as well. Yet soy products are not at option, as they contain yet another compound that interferes with thyroid hormone production, <a href="https://en.wikipedia.org/wiki/Genistein">genistein</a>. So, soy-fed infants and children are doubly at risk.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/195247/original/file-20171117-19256-wut8mk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/195247/original/file-20171117-19256-wut8mk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195247/original/file-20171117-19256-wut8mk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195247/original/file-20171117-19256-wut8mk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195247/original/file-20171117-19256-wut8mk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195247/original/file-20171117-19256-wut8mk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195247/original/file-20171117-19256-wut8mk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Perchlorate has been found in infant formula.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/jar0d/5210381038/in/photolist-8WqyKQ-afSLWn-7iC395-hfoPc3-5MpAP9-74JdxA-npGxaH-8jvNSf-4Zd2xa-63ciJk-9UEsSC-8GCTVh-97EuXJ-aCJcxU-83TkS4-eAJYH4-4ofkhB-8HxQU8-fGsD6o-89XJGq-nSnTvy-q4xLNW-5N1dM3-bDrVAq-63s3Qu-L6bj8-G4idSs-gZqyzW-qQFizY-2sBXeA-hpsHQ1-o6Ufj3-nbAGzz-85fzGt-8gtHi7-PA1GN-9SxjMu-j1hPUK-p2oLsT-QPqYun-h6fFDM-njYPFp-stGeAT-oULHMR-dYibRp-bCEz7L-9Go18u-57kkRH-q772t-bRzk1R">Sander van der Wel/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>In the United States, perchlorate can even be used in food packaging. Despite well-founded objections from a <a href="http://www.packaginglaw.com/news/ngos-request-hearing-fda%E2%80%99s-denial-their-perchlorate-food-additive-petition">number of NGOs</a>, the US Food and Drug Administration (FDA) recently <a href="http://www.packaginglaw.com/news/fda-removes-clearance-potassium-perchlorate-sealing-gaskets-based-abandonment">upheld their 2005 decision</a> to allow perchlorate to be used as an anti-static or sealing agent.</p>
<p>Ironically, the same administration reported that levels of perchlorate in the American diet had <a href="https://chemicalwatch.com/52040/us-fda-amount-of-perchlorate-increasing-in-food-products">increased significantly</a> since this decision was taken. Comparing results from two surveys made between 2003-2006 and 2008-2012, revealed significant increases in perchlorate content in various foods, with packaged foods such as salami showing increases of 150-fold. Certain samples of infant food also showed an increase of more than 100-fold. Overall it was estimated that the perchlorate content of the food eaten by infants and toddlers had increased by 34 and 23 % since the FDA decision.</p>
<p>In Europe, perchlorate can also be found on food, as indicated in a 2017 study, <a href="https://www.efsa.europa.eu/en/efsajournal/pub/5043">“Dietary exposure assessment to perchlorate in the European population”</a>. In toddlers and children – the most vulnerable populations along with pregnant and nursing women – maximum levels were ten times as high as in adults. Food is thus a significant source of perchlorate both sides of the Atlantic.</p>
<p>Finally, perchlorate is not the only chemical that affects thyroid hormone production. Others include pesticides, per-fluorinated compounds, flame retardants and plasticizers. Because multiple thyroid-hormone disrupting chemicals are found in human amniotic fluid, babies are exposed during their entire development in their mother’s womb. My team recomposed a mixture of chemicals commonly found in human amniotic fluid, including perchlorate. They were used at exactly the same concentrations in amniotic fluid as measured by epidemiological studies, and we found that the mixture affected not only thyroid hormone signalling but also <a href="https://www.ncbi.nlm.nih.gov/pubmed/28266608">brain development, brain gene expression, numbers of neurons in the brain and behaviour</a>.</p>
<h2>So what can be done?</h2>
<p>What can be done if governmental agencies continue to fail to regulate perchlorate and other thyroid disrupting chemicals? First, try to limit the effects of perchlorate:</p>
<ul>
<li><p>If you’re pregnant or nursing, use iodized salt. <a href="https://www.ncbi.nlm.nih.gov/pubmed/22335882">Studies show</a> that women increase the iodine content of their breast milk when using iodized salt.</p></li>
<li><p>Take vitamin and mineral supplements that contain 150µg iodine per tablet per day, especially if pregnant or breast feeding. This meets half of the <a href="http://www.who.int/elena/titles/guidance_summaries/iodine_pregnancy/en/">WHO recommendations for iodine intake in pregnancy</a>; the remaining half will come from a balanced diet.</p></li>
<li><p>Eat as much fresh, preferably organically grown, produce as possible. Organically grown produce will have lower pesticide levels. Certain pesticides can act as <a href="https://www.efsa.europa.eu/fr/efsajournal/pub/3293">thyroid disruptors at high levels</a>.</p></li>
<li><p>Reduced the use of packaged foods. In addition to perchlorate, packaging can contaminate food with other thyroid disruptors, <a href="https://www.ncbi.nlm.nih.gov/pubmed/28651165">such as phthalates</a>.</p></li>
</ul>
<p>And, of course, skip the fireworks displays. They may be beautiful, but the consequences of perchlorate exposure for you and your infant’s health could be serious.</p><img src="https://counter.theconversation.com/content/86595/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Barbara Demeneix a reçu des financements de Europe (H2020), Agence National de la Recherche, France). Barbara Demeneix is a co-founder of Watchfrog (<a href="https://www.watchfrog.fr/">https://www.watchfrog.fr/</a>) but receives no financial compensation from this company. </span></em></p>A chemical found in products as diverse as fireworks and food packaging, perchlorate can interfere with thyroid function as well as foetal brain development.Barbara Demeneix, Professor Physiology/ Endocrinology, Muséum national d’histoire naturelle (MNHN)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/765392017-04-26T01:05:48Z2017-04-26T01:05:48ZCutting EPA budget puts babies at risk – and makes little economic sense<p>President Donald Trump recently ordered an air strike on Syria, fueled in part by <a href="http://www.telegraph.co.uk/news/2017/04/10/ivanka-trump-influenced-father-launch-air-strikes-against-assad/">moral outrage</a> at images of babies being injured and killed by airborne toxins.</p>
<p>American babies are under threat as well. In this case, the culprit is the Trump administration’s <a href="https://www.nytimes.com/2017/04/10/climate/trump-epa-budget-cuts.html">proposal to slash the Environmental Protection Agency’s budget</a> by 31 percent, including cuts to the enforcement division, Targeted Air Shed Grants and the Clean Power Plan. </p>
<p>These reductions degrade the protections needed to reduce airborne toxins and maintain the nation’s air quality. Expectant mothers will face greater exposure to air pollution, which causes more preterm births, infant illnesses and deaths. </p>
<p>As an economist who studies the link between health and socioeconomic status, I’ve explored the extensive research demonstrating the importance of a clean environment to the well-being of children. By improving health outcomes, the EPA’s efforts to reduce pollution reduces health care costs and can benefit the economy. </p>
<h2>Dirty air and baby health</h2>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/21112090">link</a> between fetal and infant health and exposure to air pollution <a href="https://www.ncbi.nlm.nih.gov/pubmed/22726801">has been well-established</a> by <a href="https://www.ncbi.nlm.nih.gov/pubmed/15811825">many experts</a> using a variety of methods and data sets over decades. </p>
<p>This large body of work clearly shows that prenatal exposure to airborne pollutants significantly raises the risk of preterm birth, low birth weight, and infant respiratory and cardiovascular illness as well as developmental problems, like autism. </p>
<p><a href="https://e-zpassiag.com/about-us">Adoption of the E-Z Pass system</a> on the New Jersey and Pennsylvania turnpikes in the late 1980s provided a natural experiment and illustrates the connection between air pollution and fetal health. </p>
<p>Turnpike authorities adopted E-Z Pass in order to reduce the time drivers spent in toll plazas. And it worked; traffic congestion fell by 85 percent. Because vehicles spent less time at the toll plazas, EZ Pass also reduced vehicle emissions and improved local air quality. </p>
<p>Economists Janet Currie and Reed Walker <a href="https://www.aeaweb.org/articles?id=10.1257/app.3.1.65">found</a> that within three years of the introduction of E-Z Pass in these two states, the number of premature births and low birth weight babies born to mothers living within two kilometers of toll plazas dropped by roughly 8 percent and 10 percent, respectively. </p>
<p>Because babies born prematurely or with low birth weight suffer more health problems, reducing these adverse birth outcomes reduces infant illness and deaths. </p>
<h2>The economic case</h2>
<p>And from an economic perspective, healthy babies save money. </p>
<p>Currie and Walker estimate the drop in adverse birth outcomes in the neighborhoods near the toll plazas saved US$10 million to $13 million in health care costs. Generalizing their results suggests that reducing traffic congestion nationwide would reduce preterm births by 8,600 and save $444 million in health care costs annually. </p>
<p>Molecular epidemiologist Frederica Perera and her colleagues <a href="https://www.ncbi.nlm.nih.gov/pubmed/24804951">found</a> that a modest reduction in the amount of toxins known as polycyclic aromatic hydrocarbons in the air in New York City would raise low-income infants’ IQ, increasing their lifetime earnings by $43 million to $215 million. </p>
<p>And to add the national perspective, pediatrician Leonardo Transande and his research team <a href="http://dx.doi.org/10.1289/ehp.1510810">projected</a> that reducing air pollution nationwide would save billions of dollars in medical costs and lost economic productivity over the lifetimes of exposed infants. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/166706/original/file-20170425-13408-1hnsuxq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Prenatal exposure to airborne pollutants significantly raises the risk of complications like preterm birth and infant respiratory and cardiovascular illness.</span>
<span class="attribution"><span class="source">Pregnant woman via www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>A great return</h2>
<p>Now let’s consider the <a href="https://www.epa.gov/clean-air-act-overview/1990-clean-air-act-amendment-summary">Clean Air Act Amendments of 1990</a>, which garnered bipartisan support and was signed into law by President George H.W. Bush. </p>
<p>EPA <a href="https://www.epa.gov/sites/production/files/2015-07/documents/fullrept.pdf">cost-benefit analysis</a> of this legislation indicates that it generated $4 of benefits per dollar of cost incurred, where benefits were defined as reduced health costs and greater labor productivity. That’s a good return. </p>
<p>The EPA’s nearly 25-year effort to remove lead from gasoline <a href="https://yosemite.epa.gov/ee/epa/eerm.nsf/vwan/ee-0034-1.pdf/$file/ee-0034-1.pdf">generated even more impressive results</a>. This policy lowered Americans’ average blood lead levels by 75 percent.</p>
<p>Lower lead levels in children reduced infant mortality and improved children’s physical health, raised IQs and reduced aggressive behaviors. When these children matured into adults they were more economically productive and less likely to commit crimes. This policy <a href="https://yosemite.epa.gov/ee/epa/eerm.nsf/vwan/ee-0034-1.pdf/$file/ee-0034-1.pdf">saved an estimated</a> $10 for every dollar spent on getting the lead out of gasoline. That’s a great return.</p>
<p>The health and economic benefits of the Clean Air Act Amendments and the transition to unleaded gasoline show that not all environmental policies waste taxpayer money. In fact, the <a href="https://www.gop.com/the-2016-republican-party-platform/">Republican Party 2016 platform</a> states that “human health and safety are the proper measures of a policy’s success.” By that standard, the EPA’s work with on the Clean Air Act Amendments and the elimination of leaded gasoline constitute great successes. </p>
<p>The EPA’s efforts to preserve air quality protects babies (and the rest of us) from damage caused by airborne toxins. It also saves a lot of money. Whether you care about economics or children’s health, cutting the EPA’s budget is not a good deal in the long run.</p><img src="https://counter.theconversation.com/content/76539/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patricia Smith does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An extensive amount of research has shown a direct link between air quality and fetal and infant health. Cleaner air has saved lives – and money.Patricia Smith, Professor of Economics, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/494352015-10-21T23:51:34Z2015-10-21T23:51:34ZBetter care and communication can cut stillbirth rates and avoid unnecessary trauma<figure><img src="https://images.theconversation.com/files/99128/original/image-20151021-15451-1izl8gu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The death of an unborn baby is a devastating and traumatic event</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>An unusually high number of stillbirths and infant deaths at a Victorian regional hospital has stirred up a grim topic often hidden from public view. <a href="http://www.abc.net.au/news/2015-10-20/bacchus-marsh-hospital-midwives-reading-ultrasound-manual/6868426">A review of ten of these deaths</a> occurring in 2013 and 2014 found that seven may have been avoidable.</p>
<p>The death of an unborn baby is a devastating and traumatic event, with long-lasting <a href="http://www.biomedcentral.com/1471-2393/15/188/">psychological, social and economic impacts</a> on parents, families and society. In Australia, around <a href="http://www.aihw.gov.au/publication-detail/?id=60129550033">2,225</a> stillbirths occur each year.</p>
<p>The majority of these deaths are not fully, diagnostically investigated, while some remain unexplained despite thorough investigation. Although there are beliefs stillbirth is “nature’s way” and therefore “meant to be”, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=stillbirths+the+vision+for+2020">many stillbirths are preventable</a> with improved health and quality care. </p>
<h2>Causes and risk factors</h2>
<p>In Australia, <a href="http://www.health.vic.gov.au/ccopmm/about/mortality.htm">stillbirth is defined</a> as the death of a baby of at least 20 weeks’ gestation or 400 grams in weight. Most stillbirths occur in the antenatal period.</p>
<p><a href="http://www.aihw.gov.au/publication-detail/?id=60129550033">Causes of death</a> can include infection, the mother’s health, haemorrhage, spontaneous preterm birth and congenital abnormality. </p>
<p>In high-income countries, no definitive cause is found in around <a href="http://www.ncbi.nlm.nih.gov/pubmed/21496907">30%</a> of stillbirth cases. But <a href="http://www.ncbi.nlm.nih.gov/pubmed/21496916">mothers most at risk</a> include those who are older, smokers, those with obesity and diabetes, and women with a past history of stillbirth. </p>
<p>Problems with the placenta that restrict blood and nutrient flow from the mother to the baby, called <a href="http://www.ncbi.nlm.nih.gov/pubmed/24953162">placental insufficiency</a>, are strongly linked with stillbirth. Fetal growth restriction, twin or multiple pregnancy, ethnicity and social disadvantage, can also play a part.</p>
<p>However, many women who have a stillborn baby have no identifiable risk factors. And in a some cases, substandard care can be to blame.</p>
<h2>Substandard care</h2>
<p>Substandard care appears to more commonly contribute to stillbirths during labour and birth. A Dutch <a href="http://www.sciencedirect.com/science/article/pii/S0301211599001359">study showed inadequate care</a> may have played a part in around 30% of stillbirths. </p>
<p>A 2010 <a href="http://www.pi.nhs.uk/pnm/clinicaloutcomereviews/index.htm">confidential enquiry</a> in the United Kingdom found the majority of reviewed infant deaths at birth had “contributing factors”, some of which may have lead directly to the death of the baby. While in New Zealand, adequate care <a href="http://www.hqsc.govt.nz/publications-and-resources/publication/2123/">could have prevented</a> 19% of stillbirths in 2013. </p>
<p>Concerns about care in the UK report included failures to identify signs of poor health (such as poor growth of the baby), misinterpretation of the fetal heart rate, failure to consult senior staff, and poor communication between care providers or with the mother.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/99131/original/image-20151021-15440-wmj1of.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/99131/original/image-20151021-15440-wmj1of.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/99131/original/image-20151021-15440-wmj1of.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/99131/original/image-20151021-15440-wmj1of.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/99131/original/image-20151021-15440-wmj1of.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/99131/original/image-20151021-15440-wmj1of.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/99131/original/image-20151021-15440-wmj1of.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Not following clinical guidelines can contribute to stillbirths and infant deaths.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Failure to follow clinical practice guidelines and poor communication is <a href="http://www.ncbi.nlm.nih.gov/pubmed/2149690">most common</a> in substandard care. Low antenatal care attendance and poor management of the mother’s health conditions, such as diabetes, are also instances of inadequate care.</p>
<h2>Coronial inquests</h2>
<p>There are a number of ways to investigate the causes of stillbirth. As the gold standard, it is <a href="http://www.ncbi.nlm.nih.gov/pubmed/21496907">recommended</a> all parents be offered an autopsy of the baby and examination of placental tissue to look for abnormalities that may weaken placental function.</p>
<p>But <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2012.03357.x/full">some parents don’t consent to an autopsy</a>, while others are not approached at all about the possibility. Some are not appropriately counselled to help them make an informed decision about whether to have the autopsy.</p>
<p>Tests such as these are also limited in availability due to high costs as well as access to equipment and expertise. </p>
<p>Several rights and legal groups <a href="http://www.mauriceblackburn.com.au/about/media-centre/newsletters/medical-law/autumn-2012/legal-rights-of-infants-and-parents/">are advocating to incorporate</a> stillbirths into states’ Coroner’s Acts for their cause to be determined through a Coronial inquest.</p>
<p>But this is not the most appropriate way of investigating stillbirths, for a number of reasons. </p>
<p>First, the purpose of the Coroner is to determine whether the cause of a death is natural or caused by accident or injury. Because the majority of stillbirths aren’t a result of the latter, and have an obvious cause, they wouldn’t fulfil the requirement of this determination.</p>
<p>Further, a Coronial inquest would mean the autopsy would generally be performed by a forensic pathologist rather than a more suitable, skilled perinatal pathologist.</p>
<p>And most importantly, there are significant disadvantages for women and their families. The major limiting factor to autopsy being performed in the case of a stillbirth is parental consent, as many don’t wish their child to undergo this procedure. </p>
<p>The inquest – which would have the bereaved family separated from the child immediately after birth – would take the choice away from parents and surely add to their emotional turmoil. </p>
<p>And while autopsy is the gold standard test (along with placental pathology) there are alternatives to autopsy which are often helpful in understanding why the baby died.</p>
<h2>Recommended investigation</h2>
<p>The Perinatal Society of Australia and New Zealand <a href="http://www.stillbirthalliance.org.au/guideline1.htm">sets out recommendations</a> for maternity services to investigate and clinically audit stillbirths and neonatal deaths. </p>
<p>These audits should be conducted by the health service responsible, with an external expert panel doing an in-depth review. This review must be underpinned by comprehensive information about the death. </p>
<p>Victoria is currently introducing a state-wide perinatal autopsy service to ensure high-level advice on the appropriate investigations is given and appropriate support and counselling can be set in place for families. </p>
<p>For the cases of unexpected stillbirths in late pregnancy, there will be a requirement under the regulations of the Act that governs the <a href="http://www.health.vic.gov.au/ccopmm/">Consultative Council on Obstetric and Paediatric Mortality and Morbidity</a>, that these deaths are notified within 48 hours.</p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0412.2003.00224.x/abstract">Norway</a> introduced perinatal mortality audits such as these, which have been associated with improved care and less perinatal deaths.</p>
<p>In 2011 the <a href="http://www.thelancet.com/series/stillbirth">Lancet’s stillbirths series</a> urged all high-income countries to implement routine perinatal mortality audits, governed at the national level. Despite this call, only a handful of countries have such programs in operation.</p><img src="https://counter.theconversation.com/content/49435/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vicki Flenady receives funding from Stillbirth Foundation Australia, the NHMRC and Queensland Health.</span></em></p><p class="fine-print"><em><span>Aleena Wojcieszek has received funding from Stillbirth Foundation Australia. </span></em></p><p class="fine-print"><em><span>David Ellwood receives funding from NHMRC and Stillbirth Foundation Australia. He is a past-Chair of the International Stillbirth Alliance.</span></em></p>The death of a baby, whether born or unborn, is a devastating and traumatic event. More than 2,000 stillbirths occur every year in Australia. But a large number of them can be prevented.Vicki Flenady, Associate Professor, School of Medicine, School of Population Health, and School of Nursing and Midwifery, The University of QueenslandAleena Wojcieszek, Research Officer, Stillbirth Prevention Group, Mater Research Institute, The University of QueenslandDavid Ellwood, Professor of Obstetrics & Gynaecology, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/360542015-01-27T11:08:15Z2015-01-27T11:08:15ZDiscrimination is bad for your health – and your kids too<figure><img src="https://images.theconversation.com/files/69815/original/image-20150122-12100-r2aqb6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Racial discrimination may have biological impacts lasting across generations. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-131169620/stock-photo-father-and-son-to-the-sea-at-sunset.html?src=Hv7kOdNUpkTefDLNwSUeFA-1-14&ws=1">Orange-studio/Shutterstock</a></span></figcaption></figure><p>Think about the last time you left the house. Did strangers on the street acknowledge your presence with a smile or avert their glance? Chances are that the answer depended on your age, gender and, of course, your race.</p>
<p>There is no shortage of evidence that racism persists. Despite the fact that science has demonstrated that <a href="http://aaronhood.net/wp-content/SocialConstructionRace.pdf">racial groups are defined by society rather than biology</a>, an individual’s experience from the moment they are born is colored by the color of their skin.</p>
<p>Recently, high-profile incidents have focused attention on how people can be treated differently by authority figures, such as police officers, because of their race. However the majority of discrimination experiences are much <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1751-9004.2009.00183.x/full">more subtle</a>. </p>
<p>In fact, subtle bias <a href="http://gpi.sagepub.com/content/early/2012/12/04/1368430212468170">may actually be more mentally damaging than overt bias</a>. This is because overt bias can be more easily dismissed as ignorant. However subtle bias is able to “get under the skin” to influence physical health. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/69704/original/image-20150122-29842-1kpeakj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/69704/original/image-20150122-29842-1kpeakj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/69704/original/image-20150122-29842-1kpeakj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/69704/original/image-20150122-29842-1kpeakj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/69704/original/image-20150122-29842-1kpeakj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/69704/original/image-20150122-29842-1kpeakj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/69704/original/image-20150122-29842-1kpeakj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our experiences, and our health, can be influenced by discrimination.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-113588890/stock-photo-a-crowd-moving-against-a-background-of-an-urban-landscape-young-people.html?src=5CMXcZfRoowtOMDSH65Apg-3-67&ws=0">Crowd via Artens/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Racism affects physical health</h2>
<p>In recent years, there has been a growing amount of research highlighting the effects of racial discrimination on not only mental health but <a href="http://www.annualreviews.org/doi/abs/10.1146/annurev-clinpsy-032814-112728?journalCode=clinpsy">also physical health</a>. Discrimination may influence physical health through <a href="http://informahealthcare.com/doi/abs/10.3109/10253890.2014.989204?journalCode=sts">changes</a> in stress physiology functioning. </p>
<p>As an example, in African-Americans experiencing racism has been associated with <a href="http://www.sciencedirect.com/science/article/pii/S0306453011001648">higher evening cortisol levels</a>, which are considered unhealthy. Similarly, a study among <a href="http://www.sciencedirect.com/science/article/pii/S0018506X12000311">Hispanic youth</a> found that racism experience was associated with higher cortisol levels across the day.</p>
<p>Cortisol and other hormones in the stress physiology system are important for <a href="http://www.jstor.org/discover/10.2307/25064859?sid=21105079897301&uid=2&uid=4">maintaining immune, reproductive and cardiovascular health</a>. Therefore changes in this system as a result of discrimination experience can adversely affect everything from your body’s ability to fight infection to your ability to become pregnant.</p>
<p>The quantity of evidence supporting the relationship between discrimination and physical health is staggering. And yet discrimination may have even greater impacts than was initially recognized.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/69781/original/image-20150122-12117-ita96y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/69781/original/image-20150122-12117-ita96y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/69781/original/image-20150122-12117-ita96y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/69781/original/image-20150122-12117-ita96y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/69781/original/image-20150122-12117-ita96y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/69781/original/image-20150122-12117-ita96y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/69781/original/image-20150122-12117-ita96y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Maternal health can influence offspring.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-144901300/stock-photo-row-of-multiethnic-babies-sitting-side-by-side-looking-away-isolated-on-gray-background.html?src=pp-photo-144900970-8BOrQ46Pr6xycTnzefZ3xQ-1&ws=1">Babies via bikeriderlondon/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Racism can affect health across generations</h2>
<p>It is increasingly accepted that a woman’s mental and physical health in pregnancy <a href="https://theconversation.com/moms-prenatal-hardship-turns-babys-genes-on-and-off-32353">influences</a> her baby. Maternal health may influence offspring through exposure to hormones in pregnancy.</p>
<p>For example, women with high stress hormones give birth to infants with <a href="http://repositorium.sdum.uminho.pt/bitstream/1822/4718/1/prenatal%20cortisol.pdf?origin=publicationDetail">lower birth weight</a>. Since being born small increases risk for developing poor health in adulthood, factors impacting maternal stress hormones in pregnancy could also affect long term offspring health.</p>
<p>While racial discrimination has well known impacts on adult health, less research has focused on the potential for racial discrimination to influence health in the next generation. However the studies that have been done suggest that there can be very important effects. </p>
<p>For example, racial discrimination has been associated with <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.94.12.2132">lower birth weight</a>. One <a href="http://www.rwj.harvard.edu/papers/Lauderdale.pdf">particularly interesting study</a>, reported a decrease in birth weight among children of California women with Arab sounding names in the year following 9/11. The author attributed this finding to an increase in racial discrimination experience among these women.</p>
<p>I recently published <a href="http://www.sciencedirect.com/science/article/pii/S0277953615000040">an article</a> that evaluated whether racial discrimination influences maternal and offspring stress physiology among a socioeconomically and ethnically diverse sample of women from Auckland, New Zealand. Auckland is an interesting cultural context to explore the effects of discrimination on health because it is very ethnically diverse; <a href="http://www.stats.govt.nz/browse_for_stats/population/Migration/international-travel-and-migration-articles/international-migration-to-from-auckland.aspx">39% of all residents were born overseas</a>. </p>
<p>I tracked women who were in the late stages of their pregnancy. What I found was that women who experienced discrimination had higher evening stress hormone levels in late pregnancy, consistent with a pattern of chronic stress. </p>
<p>When I followed up their infants at six weeks of age, I found that their children had elevated stress response to vaccination. These findings suggest that experience of racial discrimination may actually have biological impacts lasting across generations. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/69778/original/image-20150122-12071-1i1m0w1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/69778/original/image-20150122-12071-1i1m0w1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/69778/original/image-20150122-12071-1i1m0w1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/69778/original/image-20150122-12071-1i1m0w1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/69778/original/image-20150122-12071-1i1m0w1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/69778/original/image-20150122-12071-1i1m0w1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/69778/original/image-20150122-12071-1i1m0w1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">caption.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-143144314/stock-photo-discrimination-dictionary-definition-single-word-with-soft-focus.html?src=2RmAV5cnV063sVaBBrLqMA-1-9&ws=1">chris2766/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What do we do about it?</h2>
<p>Understanding the link between discrimination experience and poor health is an important first step towards raising awareness of this issue. But something obviously needs to be done in order to improve the health and well being of all members of society. Continuing to identify and call out the institutional and interpersonal experiences of discrimination is a necessary first step. </p>
<p>Interventions aimed at increasing <a href="http://jcc.sagepub.com/content/37/3/293.short">social support</a> and <a href="http://onlinelibrary.wiley.com/doi/10.1111/jasp.12192/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false">ethnic identity</a> will likely increase resilience to discrimination experience. Efforts should not focus solely on these “buffering” interventions, however, as this effectively translates into placing responsibility on the victim rather than on the perpetrators of discrimination. </p>
<p>Tools, such as the <a href="https://implicit.harvard.edu/implicit/selectatest.html">implicit bias test</a>, exist to help people identify their own biases that they may be unaware of. Recognizing the potential for subtle bias is necessary before anything can be done to address it.</p><img src="https://counter.theconversation.com/content/36054/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zaneta Thayer receives funding from National Science Foundation, Wenner Gren Foundation, and the National Institute for Minority Health & Health Disparities.</span></em></p>Think about the last time you left the house. Did strangers on the street acknowledge your presence with a smile or avert their glance? Chances are that the answer depended on your age, gender and, of…Zaneta Thayer, Assistant professor , University of Colorado DenverLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/323532014-10-29T09:34:19Z2014-10-29T09:34:19ZMom’s prenatal hardship turns baby’s genes on and off<p>In January 1998 five days of freezing rain collapsed the electrical grid of the Canadian province of Québec. The <a href="http://en.wikipedia.org/wiki/North_American_Ice_Storm_of_1998">storm</a> left more than 3 million people <a href="http://people.uwec.edu/jolhm/EH4/Ice%20Storms/Ice%20Storms/Ice%20Storms_Final.pdf">without electricity</a> for anywhere from a few hours to 45 days – one of the worst natural disasters in Canadian history.</p>
<p>As devastating as the ice storm and its effects were, these challenging conditions also provided an unusual research opportunity.</p>
<p>As a professor of psychiatry, I’ve long been interested in stress during pregnancy. Usually we’re forced to study prenatal stress <em>retrospectively</em>. Researchers have relied on databases of birth, death, and health information to conclude that exposure to major events during pregnancy, like <a href="http://bjp.rcpsych.org/content/172/4/324.short">war</a> or <a href="http://humrep.oxfordjournals.org/content/24/2/429.short">death of a relative</a>, increases health risks in the unborn child. Interviewing mothers many years later about stressful events that might have occurred during their pregnancies is another retrospective way to examine the question. But it still doesn’t get at what it was about the stressful event that influenced the fetus’s development.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/61078/original/4yphm3j9-1412705205.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/61078/original/4yphm3j9-1412705205.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=609&fit=crop&dpr=1 600w, https://images.theconversation.com/files/61078/original/4yphm3j9-1412705205.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=609&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/61078/original/4yphm3j9-1412705205.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=609&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/61078/original/4yphm3j9-1412705205.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=766&fit=crop&dpr=1 754w, https://images.theconversation.com/files/61078/original/4yphm3j9-1412705205.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=766&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/61078/original/4yphm3j9-1412705205.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=766&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">How would the ice storm affect unborn babies?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-121804579/photo-a-beautiful-outdoor-pregnant-woman-portrait-in-snowy-nature.html?src=DlhDD12Bu-lplBokVX-gHA-1-3">Pregnancy image via www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>The challenging conditions left in the ice storm’s wake provided the unusual opportunity to study prenatal stress <em>prospectively</em>. Living without electricity in the middle of the Canadian winter would stress plenty of pregnant women. Instead of looking backwards, we could track effects of stress going forward in time.</p>
<p>So in June 1998 we recruited nearly 200 women who were pregnant during the ice storm. We sent them questionnaires to measure the objective severity of the hardship they experienced (days without electricity, financial loss, injuries, moving house and so on), and also how much subjective distress they were still feeling from the disaster. </p>
<p>Since then, we have seen that a mother’s level of objective hardship predicts many outcomes: the more days she was without electricity, for example, the <a href="http://www.nature.com/pr/journal/v56/n3/abs/pr2004225a.html">lower</a> the <a href="http://www.tandfonline.com/doi/abs/10.1080/15250000701298741#.VDRT4FboYUs">child</a>’s <a href="http://www.sciencedirect.com/science/article/pii/S0890856708600829">IQ</a>, the greater the child’s risk of <a href="http://www.nature.com/pr/journal/v71/n1/abs/pr201118a.html">becoming obese</a>, and the <a href="http://www.sciencedirect.com/science/article/pii/S0378378213001448">more insulin the child secreted</a> in a glucose tolerance test, which might set him up to develop diabetes later in life. </p>
<p>The big surprise was that the mother’s subjective experience of distress had no effect on any of these outcomes. The theory had been that prenatal maternal distress could affect the fetus’ development via the mother’s stress. Distress would trigger a cascade of stress hormones in her body that would then pass through the placenta to disrupt normal development of the baby. There was no room in that theory for objective hardship to have an effect on the baby without going through the mother’s level of distress and her resulting stress hormones.</p>
<p>We were perplexed: how is it that a child whose mother stayed calm and collected during the ice storm despite losing power for weeks could have worse outcomes than one whose mother was clearly distraught by the ice storm but never lost power? Our study showed it was happening, but how could objective maternal hardship – independent of subjective stress – affect these biological mechanisms? To investigate, my colleague Dr. Moshe Szyf and I started to look at the epigenetics of the ice storm kids.</p>
<p>To understand <a href="https://theconversation.com/explainer-what-is-epigenetics-13877">epigenetics</a>, imagine that your genetic makeup is a printed sheet of music, the product of the DNA from your mother and father. Every human being has a different song printed on their score, and no one can change what has been printed.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/61075/original/8jk8vvk3-1412704077.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/61075/original/8jk8vvk3-1412704077.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/61075/original/8jk8vvk3-1412704077.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/61075/original/8jk8vvk3-1412704077.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/61075/original/8jk8vvk3-1412704077.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/61075/original/8jk8vvk3-1412704077.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/61075/original/8jk8vvk3-1412704077.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">How fast or slow is the song in your DNA played?</span>
<span class="attribution"><a class="source" href="http://pixabay.com/en/music-classical-sheet-music-piano-277278/">Rebecca Jasso</a></span>
</figcaption>
</figure>
<p>On the other hand, any song can be played in different ways: a little faster here, a little slower there; a little louder here, but softer there. These nuances may be written on the printed score. And so it is with our DNA, which cannot be changed, but can take on different forms according to markings made on it by the environment.</p>
<p><a href="http://en.wikipedia.org/wiki/DNA_methylation">Methylation</a> is one way those markings are made on the score of DNA. Imagine that your DNA has thousands of little switches, like dimmers on lights, which slide up and down to increase or decrease the expression of those genes. The process of adding biochemicals called methyl groups to those little switches is methylation. Where these methyl groups are attached to your DNA helps determine which genes in your genome are actually expressed.</p>
<p>We wanted to know if mothers’ objective hardship or subjective distress from the ice storm changed the way in which the babies’ DNA was methylated. In 2011, 34 of the children, then 12 or 13 years old, gave blood samples. Our post-doctoral fellow Dr. Lei Cao <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0107653">found</a> that the women’s objective level of hardship from the ice storm predicted the children’s epigenetic profile, while their level of distress from the storm didn’t predict any effect. For instance, the more times the family changed house during the crisis predicted more methylation in certain genes – regardless of the mom’s subjective feeling of stress during the ice storm. As in our earlier work, the changes in the kids weren’t due to their mothers’ degree of emotional distress following the ice storm, but rather to factors outside of the moms’ control, such as the number of days without electricity.</p>
<p>Though small, our study showed the 1998 ice storm created sufficient hardship for pregnant women that it caused epigenetic changes in their unborn children that have lasted at least 13 years – that’s pretty permanent! No other study had previously shown epigenetic effects linked to objective hardship rather than subjective distress.</p>
<p>The objective severity of the mothers’ hardship most affected the methylation of two kinds of genes in the ice storm kids: immune system genes, which might increase risk for asthma and allergies, and metabolism genes, which might affect risk of obesity or diabetes. Our next challenge is to figure out how these epigenetic changes actually affect the children’s health. And a remaining big question is how did the mothers’ experiences produce these altered patterns of gene expression?</p><img src="https://counter.theconversation.com/content/32353/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Suzanne King, Ph.D. receives funding from The Canadian Institutes of Health Research (CIHR).</span></em></p>In January 1998 five days of freezing rain collapsed the electrical grid of the Canadian province of Québec. The storm left more than 3 million people without electricity for anywhere from a few hours…Suzanne King, Full Professor of Psychiatry, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/248172014-04-28T09:44:30Z2014-04-28T09:44:30ZLate-stage unborn babies can learn and remember nursery rhymes<figure><img src="https://images.theconversation.com/files/46849/original/9wjpcd3n-1398179817.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Repeat after me: Humpty Dumpty sat on a wall ...</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-124072051/stock-photo-medical-auscultation-the-belly-of-a-pregnant-woman.html?src=mW1r-xgTbeyhncaahhcLZQ-3-48">Pregnant woman via Shutterstock</a></span></figcaption></figure><p>As technology advances so does our ability to monitor unborn babies. Now it’s even possible to track how a very young fetus, still in its mother’s womb, learns and remembers basic speech. </p>
<p>As a labour and delivery nurse in the 1980s, the limits and potential value of monitoring a fetus always intrigued me. The <a href="http://www.psych.yorku.ca/adler/courses/4010/Articles/DeCasper%20et%20al%201994.pdf">research of Anthony DeCasper</a> a decade later really caught my interest – demonstrating early learning and memory capabilities. </p>
<p>In a <a href="http://www.sciencedirect.com/science/article/pii/S0163638313001185">recent piece of research</a>, my team and I decided to use a fetal monitor similar to those used in traditional labour and delivery units to record a fetus’s heart rate in response to a recording of a passage of speech. We did this to help us understand more about how early a fetus could learn a passage of speech and, if learned, whether the passage could be remembered as long as four weeks later. </p>
<p>Because the fetus cannot speak to us, we used a small change in heart rate called the “cardiac orienting response” to determine when and for how long the fetus could remember. The <a href="http://www.ncbi.nlm.nih.gov/pubmed/6831983">conventional interpretation</a> of this kind of response is that it shows the heart-rate decelerating because of a stimulus. Researchers <a href="http://www.sciencedirect.com/science/article/pii/S0163638398900534">have used</a> this response for decades in newborns and some hypothesise that it indicates familiarity with a stimulus or learning.</p>
<h2>Poetry recital</h2>
<p>In our study, from 28 to 34 weeks of pregnancy, mothers spoke a passage or nursery rhyme out loud twice a day and then came in for testing at 28, 32, 33, and 34 weeks gestational age. The nursery rhyme was untitled and it was therefore unlikely for mothers to have heard it before. </p>
<p>During testing, we decided to make things a bit more difficult for the fetus. Rather than play back a recording of the mother speaking the rhyme, instead, we played a recording of a female stranger speaking the same rhyme. We believed this would help us determine whether the fetus was responding simply to its mother’s voice or to a familiar pattern of speech – a more difficult task. </p>
<p>At 34 weeks gestational age, we asked mothers to stop speaking the passage out loud so that we could then see how long the fetus could remember the pattern of speech.</p>
<p>Interestingly, the fetus’ heart rate began to respond by 34 weeks gestational age – or once the mother had spoken the rhyme out loud for six weeks. The fetuses in this study continued to respond in the same way for as long as four more weeks after the mother had stopped saying the rhyme, or until 38 weeks gestational age – just before birth.</p>
<p>This should not be entirely surprising, because a mother’s voice is a predominant source of sensory stimulation for her developing fetus and, while speaking, not only does her fetus hear but, it also feels her vertebral column and diaphragm gently vibrate and move in sync with her speech.</p>
<p>So our findings should not be used to suggest alterations in the typical ways mothers interact with their unborn baby. But they do highlight just how sophisticated the third trimester fetus really is and suggest that a mother’s voice can be involved in the development of early learning and memory capabilities. </p><img src="https://counter.theconversation.com/content/24817/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlene Ann Krueger receives funding from the National Science Foundation. She is affiliated with the University of Florida.</span></em></p>As technology advances so does our ability to monitor unborn babies. Now it’s even possible to track how a very young fetus, still in its mother’s womb, learns and remembers basic speech. As a labour and…Charlene Ann Krueger, Associate professor, College of Nursing, University of FloridaLicensed as Creative Commons – attribution, no derivatives.