Reproductive Health in the 21st Century

As a clinical geneticist, Dr. Judith Hall, professor of pediatrics and medical genetics at the University of British Columbia, strives to take new developments in genetics and apply them to families to provide options for reproduction and prenatal diagnosis care detection: "Clinical genetics is based on the principle that families have a right to this information so they can make the right decisions for them."

Hall's primary interest is congenital anomalies (or birth defects), and she informs the audience that one in every twenty children is born with a major anomaly. "The recent advances in developmental biology have given a major insight into what happens to the fetus and that what happens to the fetus does determine adult health," Hall states. She emphasizes the fact that there are transgenerational effects involved in birth defects, and in the interest of survival, we naturally program certain biochemical reactions which establish themselves when we are fetuses.

There have been three major advances in our understanding of birth defects, the first concerning Fetal Maternal Micro-chimerism. When attempting to extract baby cells from a mother's blood, doctors realized that the mother's blood also contains cells from all of her previous pregnancies, miscarriages, and abortions. Some of these cells are fetal stem cells that are different from the individual. However, they are also potentially dangerous because they have an increased level of autoimmune disease. Scientists have yet to determine the purpose of these cells.

The second advance has been in our understanding of the importance of nutrition during pregnancy. For instance, folic acid intake has resulted in a thirty percent decrease in neural tube defects. The transgenerational effects of nutrition are also important: "The egg that made you was being formed when your mom was a six-week old embryo. So it was actually your grandma's diet that established your DNA in a good, solid form." Women's diets today will affect the next two generations.

Finally, there is now a deeper understanding of Interuterine Growth Retardation (IGR) and how it affects children's lives. There is a strong link between IGR and an increased risk of cardiovascular disease, hypertension, and diabetes. "What's happening to the baby in utero is setting a pattern for diseases that might come later," states Hall. The information transmitted between the mother and child sets a pattern for the child's future health, and doctors should consider this when treating hypertension and diabetes associated with IGR. The mother's environment programs the baby "in a way that has longstanding effects for several generations."