Fetal or Developmental Programming:“…biological systems adapt to input from the environment during especially sensitive periods of development; furthermore, the malleability of biological systems to adjust to environmental input is developmentally constrained, so that systems that adapt to environments early in life do not readapt to subsequent changes in the environment…” p. 674, O’Connor, 2003
Consider the nightmare of the “Hungerwinter” of 1944 • Dutch under German occupation • Sudden starvation • 20,000 people die • What happens to pregnant women?http://www.pnas.org/content/107/39/16757.full.pdf+html
Dutch Famine Study 1944-5Periconception 1st Trimester 3rd Trimester Schizophrenia
Fetal Nutrient demand Maternoplacental nutrient supply • Nutrient availability • Placental function and transfer • Uteroplacental blood flowFetal adaptations (e.g., re-programming) If demand is > maternoplacental supply Then alterations how key organs function Disease and Disability—YEARS later!
Anne Murphy Paul @ TED What we learn before we’re bornhttp://www.ted.com/talks/annie_murphy_paul_what_we_learn_before_we_re_born.html
The Adverse Childhood Experiences (ACEs) Study • The largest study of its kind ever done: ~18,000 participants. • Examined the health and social effects of adverse childhood experiences over the lifespan. • Conducted by a group at Kaiser Permanente, a large HMOFor more on the Adverse Childhood Experiences Study, see:http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=DetailsSearch&term=adverse+childhood+experiences+study
Abuse Physical 10.6% Sexual 28.3% Emotional 20.7%
Adverse Childhood Experiences and Adult Depression Odds Ratio Adverse Events Chapman et al, 2004
Adverse Childhood Events and Adult Substance Abuse Self-Report: Alcoholism Self-Report: Illicit Drug Use Dube et al, 2002, 2005
Cumulative ACEs Increase the Risk of Negative Outcomes 14 Attempted suicide 12 Injected drug use Alcohol problem 10 Illicit drug use Depressed 8 Chronic bronchitis 50+ sex partners 6 STDs Poor Self-rated health 4 Current Smoker Cancer 2 Severe obesity 0 0 1 2 3 4+
ACE Studies Summary of Findings• Adverse Childhood Experiences are very common.• ACEs are strong predictors of later health risks.
ACE Studies Summary of FindingsThis combination makes ACEs one of theleading, if not the leading, determinant of thehealth and social well-being of our nation.
Felitti’s General Model-Trauma Effects Early Death Disease & Disability Adoption of Health Risk Behavior Social, Emotional, & Cognitive Impairment Adverse Childhood Experienced
James Heckman and the Question of When to Intervene….• Nobel prize winning economist who teaches at U-Chicago• Focus is on human capital and on policy that promotes this commodity• See: www.heckmanequation.org