The Nine Months That Made You Horizon


The Nine Months That Made You

Series exploring topical scientific issues. The programme examines how the nine months you spend in the womb could have more lasting effects than lifestyle or genes.


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Transcript


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Across the world, tens of thousands of people

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have been part of a truly remarkable scientific project.

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It's altering our understanding of what made you the way you are today.

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Scientists think they have discovered in these people's lives

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the secret of a healthy, happy, long life...

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for all of us.

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Studying our journeys from baby to adulthood

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is revealing the most important part of your life,

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maybe one you can't even remember.

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The nine months before you were born.

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When we think of what makes us unique,

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we don't tend to think of life before birth,

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but we're finding out that life before birth

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is actually shaping who we are and who we become.

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The importance of those crucial months before birth

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has become one of the most powerful and provocative new ideas in science.

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The whole idea was extremely controversial.

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It blew me away, actually.

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It was an incredible idea, a real paradigm shift.

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Understanding what happened to us in the mysterious world of the womb

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holds the promise of living not just longer lives,

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but healthier and happier ones.

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This is the story of one man's struggle to unravel our destiny.

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It begins in Britain over 20 years ago.

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Professor David Barker

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had spent much of his life as a practising doctor,

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and he thought he'd discovered

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a way to predict the future of each and every one of us.

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He began to test this idea on the people in this room.

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They're not part of a scientific research group or a hi-tech lab.

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They are simply people who happen to be born in Hertfordshire.

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Very evocative.

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This reminds me of the way I used to go to school.

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I used to walk along a road past a ford every day,

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and then in the summer we would play in it just like these children do.

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He believed from the moment they were born,

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scientific predictions could be made about these people's lives.

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I think their destiny is in large part already wrought.

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Much of their lifetime's well-being

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and ability - mental ability, physical ability and health -

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is already determined.

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How long they would live.

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How healthy they would be.

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Whether they would have a happy and fulfilled old age.

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Well, these people are clearly fit.

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If you're still able to run and win cups at 70,

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you had a strong constitution.

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He believed he could make these predictions

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using only the information contained in these books -

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the birth records of the county of Hertfordshire.

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The books record the birth weights

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and the weights at one of these men and women,

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and in those measurements

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lie a description of the life that lies ahead of them,

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in terms of health.

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David Barker believed that in these records

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he had found a simple and powerful link

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between a low weight at birth and heart disease in later life.

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The babies who go on to develop coronary heart disease

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were not abnormal in any way.

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When they were born, their arrival was greeted with the usual enthusiasm.

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But they were already marked.

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The idea that future health was linked to birth weight became known as the Barker theory,

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and it sounded too simple to be true.

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That's the first time I've actually heard that,

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that your weight at birth determines what health risk

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you're going to have later on in life. That's weird.

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Really? No.

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No, I haven't, no.

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I would not think that

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that had any relation to a disease later in your life.

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I think it's more to do with lifestyle factors and things as you grow old,

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so that your weight when you're a child I can't imagine

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would have a big impact on those kind of factors when you're older.

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Critics of the Barker theory

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thought there were other explanations for our health

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and well-being in later life.

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Conventional wisdom said we turned out the way we did

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because of what we ate as children,

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or the lifestyle choices we made as adults.

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From diet to exercise,

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we were encouraged to take control of our own destiny,

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and that a long and happy life would be the result.

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But David Barker believed birth weight

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was more important than lifestyle when it came to future health.

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His task was to turn conventional wisdom on its head.

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To silence his critics, David embarked on a worldwide search.

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He has travelled to the four corners of the globe

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to find crucial evidence to back up his provocative theory.

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Because to prove this theory,

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he needed to show that his ideas held true

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on every continent and for each and every one of us.

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We're trying to establish really core truths

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which would apply anywhere in the world,

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and no-one is going to think that findings

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that are based on a southern county in England

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represent the globe,

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and the only thing you can do to offset that reasonable criticism

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is to go out and do it.

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In 1995, one of the key pieces of evidence for the Barker theory

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emerged from one of the most crowded countries in the world.

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By a quirk of fate, the people here

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followed every piece of healthy living advice you can think of.

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According to conventional wisdom, these Indian villagers

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had made all the right choices to lead a long and healthy life.

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And yet they were getting diseases

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normally seen in unhealthy, overweight people.

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This was a real puzzle for us.

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They are thin, they are eating the vegetables they grow in their farms.

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They walk long distances, they work in the farms,

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and that's the puzzle.

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These people are anything but overweight and obese.

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Professor Ranjan Yajnik is a world-renowned diabetes specialist.

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And he's facing a diabetes epidemic in India.

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In the Western world,

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type-2 diabetes is seen as a disease of lifestyle.

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It's associated with being overweight,

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a lack of exercise and an unhealthy diet.

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But Ranjan's patients didn't fit that pattern.

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The Western textbooks I read as a medical student

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told me that diabetic patients were fat and overweight,

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but you come to the clinic in the rural hospital

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and these are the people who fill up our clinics.

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They have a lot of diabetes and heart disease.

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The lifestyle of Ranjan's patients

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should have given them a long and healthy old age.

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It couldn't explain why so many of them

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were falling victim to type-2 diabetes.

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But for one person, lifestyle was clearly not the answer.

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According to David Barker, a low weight at birth

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could be linked to later health problems like diabetes.

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BABY CRIES

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And in India, there was no shortage of low birth weight children.

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Was the key to the disease already there in these tiny babies?

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Ranjan and his colleagues decided to find out if the Barker theory

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might explain what they were seeing.

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Well, there was a lot of scepticism at that stage

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because we had learnt as paediatricians at that time

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that low birth weight is associated with poverty and malnutrition,

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whereas diabetes and hypertension are diseases of affluence,

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diseases of lifestyle.

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So how were the two going together?

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I was trained as an adult diabetes specialist

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and I was even more sceptical of this idea

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because we equated diabetes with over-nutrition.

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So David Barker was describing the other end of the spectrum.

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We do have a large number of low birth weights

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and we are having a large number of diabetics.

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So we are probably in a good position to test his hypothesis,

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so why not try it?

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Ranjan and his colleagues began to follow a group of babies

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to see if their birth weight could be linked to later diabetes.

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Babies were measured when they were born,

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then at four years of age, and again at eight years.

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The scientists were looking for early signs of diabetes -

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for instance, a resistance to insulin.

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The first step was to show

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that birth weight was related to insulin resistance.

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And we did tests by studying 200 children born in our hospital.

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The children from that original study are now 21.

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The scientists have records of their growth from the day they were born,

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as well as a library of blood samples.

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It is these blood samples

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that allowed the scientists to find an early indicator of diabetes.

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A low birth weight seemed to be linked to a resistance to insulin.

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So children whom we had found to be low birth weight,

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they are more insulin-resistant at four years.

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They were more insulin-resistant at eight years,

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and they are still insulin-resistant at 21 years.

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With passage of years, their blood glucose has started rising.

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There are other changes we can observe in the blood

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which tell us that their risk of getting diabetes is now much higher

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than their colleagues who were not low birth weight.

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Ranjan was beginning to be converted to David Barker's

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seemingly strange idea

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that what happens to you in the womb affects your destiny.

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So David's idea that part of your destiny

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was sealed before you are born

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was difficult to understand for Westerners, but not for me.

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As an Indian, I believed that what happened in your earlier life,

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what your parents did,

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actually had a bearing on what happens to you in your life.

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This is the theory of karma.

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This study was a crucial piece of evidence

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to support David Barker's theory.

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But the real power of the Barker theory

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was that it didn't just apply to very tiny babies.

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The predictive power of birth weight applies to us all.

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What was surprising about these early data

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was that there was a graded relationship

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across a whole normal range of birth weight,

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so it was better to be a seven-pound baby than a six-pound baby,

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and better to be an eight than a seven and better to be a nine than an eight-pound baby,

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and that is profound.

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What this suggested was that there was an element of destiny

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to the future health of each and every one of us.

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Look, look around you.

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Clearly there are people on very unhealthy lifestyles,

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who live long lives and have good constitutions,

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and for them healthy lifestyles may not matter so much.

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But there are other people who are highly vulnerable,

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who have poor constitutions,

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and for them the lifestyle is the way forward.

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That is what will protect them.

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An idea that began in Hertfordshire was starting to

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reveal universal truths about how our future health

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was determined before we were even born,

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and what's true of health may extend to our personality.

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Oh, my goodness, for each of them?

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I have two children and from day one their personalities came out.

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I have three children. My oldest is very outgoing,

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my middle child is very wild and adventurous

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and my youngest is the easy-going, carefree child.

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Only a fortune-teller

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would attempt to predict the person we will become

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well before we were even born.

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Before we could speak.

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Before we'd even met our mother face to face.

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Yet many pregnant women think they can.

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I have one child

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and she was just a diva from before she was even born.

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While they were in the womb, they were very different.

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This one's definitely calm like my first,

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but strong like my second.

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Janet DiPietro is putting this mother's intuition to the test.

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She's a mother of three and a developmental psychologist.

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She wants to discover how much of our future character is formed

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before we've even experienced the world.

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Her work begins by trying to give what is, in effect,

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a personality test to an unborn baby.

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So in adults and young people and children,

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when we want to look at individual differences,

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what we often do is put them in a new situation to see how they react

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because how people react to things

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is a big component of what makes them unique.

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To unpick the personality question,

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Janet needed a way to test the reactions of unborn babies.

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She started by looking at the way these tests

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were conducted in children.

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Some of the 900 babies that have passed through her lab

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are now five years old, and they're back

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to undergo more testing.

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Right here.

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It's just telling us about how your body's working, OK?

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The experiments put the children

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in unusual situations to see how they react.

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-Woof.

-Good.

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Asking them to miaow when they see a dog.

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Or getting them to share with adults, who start to behave

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like greedy children.

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..Give you one, and then I'll take two.

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One, two.

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At five, differences in personality begin to show

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in the way children respond to these unusual circumstances.

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You can see it in their behaviour

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and in their heart rates and stress levels.

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But I really like these candies, so I'm going to take two. One, two.

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I like them, too!

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You do?

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I'm going to give you one, but I'll take four more.

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-No! You're taking all of it!

-One, two, three, four.

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'That little boy was almost a little bit more intellectual.'

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He was adamant when he had his expectations about sharing...

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broken, and so he said "no" immediately,

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'and then he sort of moved on and he watched what was happening

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'with the investigator, but he was really more adamant.'

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What do you think about that?

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No.

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'Whereas if we look at the first little boy...'

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What do you think about that, if I take all of them?

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..you can see that he really feels what's going on,

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so he'll experience that very differently in his body, too.

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I really like them, but I think I'll get a stomach ache

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if I eat them all.

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Some of us react very emotionally to changes in circumstances.

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Our heart rates and stress levels soar.

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While others seem to have no trouble keeping their body under control.

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The characteristics that distinguish all of us

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are how we react to things

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and then how we recover after something happens.

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Those are called the core features of temperament.

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We can see them in six-month-olds, we can see them in five-year-olds,

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and in adults it's a more refined set of traits,

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but the core is reactivity and recovery irregulation.

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Janet can even see these core responses,

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how extreme our reaction to a new situation is and how quickly we recover,

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in the heart rate and stress levels of six-month-olds.

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If they were already there at six months,

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could these core personality traits

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start even earlier, back in the womb?

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Janet's experiments allow her to see how babies react to

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a change in circumstances, even before they're born.

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First, she provokes strong emotions in the pregnant mother

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by showing her a video about childbirth.

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As the mother's heart rate and stress levels change,

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Janet watches to see how the baby responds.

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Or she can take a simpler approach, and surprise the babies directly.

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The mum is wearing the spa mask and the headphones.

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She's listening to music, so she can't hear the stimulus,

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but the foetus can.

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OK, are you ready?

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I'm ready.

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All right. Go.

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I could see her abdomen jump, in fact.

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You see a very quiet actograph and then just that discrete little jump.

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The foetus is startled at things, just like babies.

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Some babies, to that response,

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startle so much that they wake up and they continue to move.

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Some babies don't really react at all.

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And then some babies, like this one, moved.

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Looks like they gave a very specific response to it,

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and then they went back to their own business.

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Even one month before birth,

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Janet can begin to see distinctive responses from the babies.

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The core elements of our future personality.

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It feels great to me as a mom to sort of validate moms everywhere,

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that they didn't cause their child to behave this way,

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that their child was already that way at birth.

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But moms have to accept the good and the bad, right?

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So if your child turns out a pleasant, happy child,

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it's not... It's not your doing,

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in the same way that if your child turns out to be

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a very difficult, unhappy child, it's not your doing.

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From the moment you're born, parts of your future health,

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happiness and personality could already be determined.

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But there may be a very simple explanation for this.

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It could all be down to the genes we inherited from our parents.

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David Barker needed to show it was your nine months in the womb

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and not just your genes that made you...you.

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Over ten years ago,

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he began a collaboration with Dutch scientists.

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It was already clear that in animals, manipulating

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the environment in the womb altered the health of future generations.

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It would be impossible to experiment on pregnant women in this way,

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but sometimes history creates an experiment for you.

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Holland, 1944.

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The Nazis were retreating and leaving devastation in their wake.

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All possible food had been commandeered.

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The result, a country-wide famine which lasted five months.

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Well, the Dutch famine occurred when the Germans

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banned all food transport,

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and suddenly rations dropped dramatically.

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It was really an acute period of famine

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that struck an entire population.

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Biologist Tessa Roseboom saw an opportunity

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to find out if our experience in the womb

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was every bit as important as our genes.

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There was hardly any food available

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and we know from the records in Amsterdam that people ate

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two slices of bread, two potatoes

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and half a sugarbeet for the entire day.

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So that's around 400 calories,

0:25:250:25:28

and we need about 2,000 to 2,500 a day.

0:25:280:25:31

Tessa began with the birth records of one Amsterdam hospital.

0:25:350:25:39

After two years of painstaking research,

0:25:390:25:42

she tracked down the people who had been born in the famine.

0:25:420:25:46

We have birth records of 2,414 babies,

0:25:460:25:51

who were all born in this hospital in Amsterdam.

0:25:510:25:55

We traced people and we interviewed lots of people in their homes

0:25:550:25:59

and then invited them to come to the clinic

0:25:590:26:01

for measurements, and then do obviously a lot of statistics behind the computer.

0:26:010:26:07

Tessa found that whatever genes they carried,

0:26:100:26:13

those exposed to the famine in the womb had more heart disease,

0:26:130:26:17

high blood pressure, raised cholesterol, diabetes and breast cancer.

0:26:170:26:22

And those who were conceived after the famine...didn't.

0:26:220:26:26

We did indeed find the brothers and sisters

0:26:270:26:30

of the people who were exposed to famine.

0:26:300:26:34

They had the same genes from the parents,

0:26:340:26:35

they had the same post-natal environment, they grew up

0:26:350:26:39

in the same family, but the ones who were exposed to the famine

0:26:390:26:43

while in the womb were actually less healthy.

0:26:430:26:46

The later ill-health was connected to the famine,

0:26:480:26:50

to what happened to these people in the womb.

0:26:500:26:54

And the famine even had an effect

0:26:590:27:01

when it only lasted for the first 12 weeks of a pregnancy.

0:27:010:27:05

Well, as a biologist, it seems quite logical

0:27:050:27:07

that in the first 12 weeks in which you lay down your brain,

0:27:070:27:10

your heart, your lungs, your kidneys, all the essential organs,

0:27:100:27:13

if the quality of the building blocks is poor

0:27:130:27:16

then the organs aren't as healthy,

0:27:160:27:19

or aren't as good as one would have had with appropriate nutrition.

0:27:190:27:24

Because of the way our bodies grow,

0:27:310:27:33

the nine months that made you will also have made your children.

0:27:330:27:38

At the time of the Dutch famine, Tessa's grandmother was pregnant.

0:27:410:27:45

The egg that Tessa grew from was already there,

0:27:470:27:51

created inside Tessa's mother's body

0:27:510:27:54

when she was an unborn baby inside Tessa's grandmother.

0:27:540:27:57

So the egg that created Tessa

0:28:030:28:05

was also permanently altered by the Dutch famine.

0:28:050:28:08

Well, genes can't be changed by the food we eat,

0:28:120:28:15

but we know that food can actually change whether genes

0:28:150:28:19

are switched on or off.

0:28:190:28:20

So famine may have affected the switches on the genes in the egg

0:28:200:28:26

and therefore they may have affected

0:28:260:28:29

all the cells in the entire body of the next generation as well.

0:28:290:28:33

So of the grandchildren

0:28:330:28:35

of women who were pregnant at the time of the famine.

0:28:350:28:38

Tessa's work was powerful support for the argument

0:28:400:28:44

that our life in the womb, and not just our genes,

0:28:440:28:47

makes us more resilient to future disease.

0:28:470:28:52

The picture that's emerging

0:28:520:28:54

is that your early development sets up your constitution

0:28:540:28:59

and therefore sets up how vulnerable you are

0:28:590:29:03

to negative things that you may encounter through your life.

0:29:030:29:07

We've hitherto tried to answer that question by assuming that

0:29:070:29:11

there must be genes which explain it, but those genes have not come forward

0:29:110:29:15

and there isn't any particular reason why they will.

0:29:150:29:18

Why would such genes exist?

0:29:180:29:20

The theory was that the quality of nutrition you received in the womb

0:29:250:29:29

determined the quality of your growth before birth.

0:29:290:29:33

This development shapes your birth weight,

0:29:340:29:37

your life as a child and your health to the present day.

0:29:370:29:41

But one question remained-

0:29:450:29:47

what exactly was happening inside our bodies

0:29:470:29:50

in those crucial nine months that could shape our destiny?

0:29:500:29:54

Back in India,

0:30:070:30:09

Professor Ranjan Yaznik was asking himself the same question.

0:30:090:30:13

He had discovered low birth weight babies

0:30:140:30:17

were more likely to end up as diabetes patients in his clinic.

0:30:170:30:20

And the bad health went further.

0:30:230:30:26

At 21, some of them were already showing signs of plaque

0:30:260:30:30

forming in their arteries, an early indicator of heart disease.

0:30:300:30:34

Although these patients looked thin,

0:30:360:30:39

they were getting diseases normally seen in overweight and obese people.

0:30:390:30:44

There was something strange going on.

0:30:530:30:54

Why were these apparently thin people's bodies

0:30:570:31:00

behaving as if they were fat?

0:31:000:31:03

To find out, Ranjan did another study to measure the amount of body fat

0:31:080:31:12

these low birth weight babies were carrying.

0:31:120:31:15

The babies here were born at 2.7 kilograms,

0:31:210:31:25

but when we measured their body fat with special techniques,

0:31:250:31:29

we realised that they have body fat

0:31:290:31:32

which is as high as that of an English baby,

0:31:320:31:35

a baby weighing 3.5 kg.

0:31:350:31:37

Almost 800 grams heavier.

0:31:370:31:40

They appear very thin, but they are fat.

0:31:400:31:43

We found the same thing at four years.

0:31:450:31:47

They were thin and fat. At eight years again,

0:31:470:31:50

they were thin and fat, and at 21 years they're again thin and fat.

0:31:500:31:54

From birth,

0:32:000:32:02

it was as if these people's bodies had the wrong settings.

0:32:020:32:05

People with low birth weights looked thin, but they were actually

0:32:070:32:11

carrying the same amount of fat as someone much heavier than them.

0:32:110:32:14

Ranjan thought he, too, might have this unusual body composition

0:32:200:32:24

as he was also a low birth weight baby.

0:32:240:32:27

I was born less than five pounds and I thought we could investigate

0:32:280:32:33

to find out whether I was at the higher risk of diabetes.

0:32:330:32:36

So I did this by actually studying myself and my friend.

0:32:360:32:41

We have both same body mass index, 22.3,

0:32:440:32:49

but John has 9% body fat

0:32:490:32:52

and I have 21% body fat.

0:32:520:32:54

The same body mass index,

0:32:540:32:56

an Indian has more than twice the amount of fat

0:32:560:33:00

that an Englishman has.

0:33:000:33:01

This is a perfect example of a thin/fat Indian.

0:33:010:33:05

Ranjan decided to see if the mother's diet in pregnancy

0:33:090:33:12

could be causing these thin/fat bodies to develop.

0:33:120:33:15

He looked at every aspect of the diet...

0:33:170:33:19

and strangely he found it wasn't all about calories.

0:33:190:33:24

To our great surprise, it was not the mother's calorie

0:33:280:33:31

and the protein and the fat intake which predicted the foetal growth.

0:33:310:33:36

It was the...

0:33:360:33:38

eating of the micro-nutrient rich foods.

0:33:380:33:43

It was how much green vegetables, the fruits and the milk

0:33:430:33:46

which decided the size of the baby and how that baby was built.

0:33:460:33:50

Ranjan's work showed that it wasn't the quantity of food we received in the womb,

0:33:520:33:56

but getting the right vitamins and minerals which was crucial.

0:33:560:34:00

Mothers who had low B-12 and high foliate

0:34:010:34:05

gave birth to thin/fat babies

0:34:050:34:07

which were insulin resistant as children

0:34:070:34:10

and they seemed to be at higher risk of getting diabetes in future.

0:34:100:34:15

These small variations in diet

0:34:260:34:28

suggested that even quite ordinary changes in life before birth

0:34:280:34:32

can have noticeable effects on our future health.

0:34:320:34:36

The picture we now have is that normal human development is fragile.

0:34:390:34:44

That very often there is insufficient resource available to the baby

0:34:440:34:49

to perfect every bit of its body.

0:34:490:34:52

The body has repair mechanisms for mending broken bits.

0:34:540:34:59

The body has a store of stem cells of varying quality.

0:34:590:35:04

The body has immune defences, it has defences against oxygen,

0:35:040:35:09

and the quality of these systems

0:35:090:35:14

determines the quality of health through life

0:35:140:35:17

because health is essentially about the body's ability

0:35:170:35:20

to maintain equilibrium in the face of challenges.

0:35:200:35:25

If our future health was determined by the quality of our growth

0:35:260:35:30

in the womb, David Barker saw an intriguing possibility -

0:35:300:35:35

the chance to intervene and prevent all these diseases of later life.

0:35:350:35:39

It was becoming clear to him that if you wanted a healthy happy old age,

0:35:410:35:46

the nine months you spent in the womb could be the most important nine months of your life.

0:35:460:35:52

Cheese!

0:35:580:36:00

Scientists are discovering it's not just the food that reaches us in the womb,

0:36:010:36:07

but also the hormones we're exposed to that could powerfully affect how our life unfolds.

0:36:070:36:12

These monkeys could hold clues that our behaviour is not all down to the way we were brought up.

0:36:180:36:22

According to Professor Melissa Hines of Cambridge University,

0:36:250:36:29

testosterone levels in the womb could have changed the way we think.

0:36:290:36:33

The reason people have gotten interested in testosterone levels

0:36:340:36:38

in human beings is because there's thousands of studies in other species

0:36:380:36:43

that show that if you manipulate testosterone experimentally

0:36:430:36:47

during development, it influences the way the brain develops

0:36:470:36:52

and as a consequence of that, the individual's behaviour

0:36:520:36:55

across the lifespan in respect of behaviours that differ for males and females.

0:36:550:37:00

Melissa has found the same effects of testosterone in the womb in both monkeys and children.

0:37:110:37:17

Female humans, and other primates, tend to play with this sort of toy...

0:37:170:37:21

Baby.

0:37:240:37:27

..while the males, whether monkey or man, go for another kind.

0:37:270:37:30

My favourite is the fire engine.

0:37:320:37:34

But the female monkeys, and the girls, with higher testosterone levels in the womb

0:37:360:37:41

end up acting more like the males

0:37:410:37:43

and ditch the dolls for the trucks.

0:37:430:37:46

More testosterone exposure makes your behaviour more male.

0:37:500:37:53

So in two recent studies, we've looked at normal variability.

0:37:550:37:59

In the first instance by measuring maternal testosterone during pregnancy

0:37:590:38:04

and in the second instance by looking at testosterone and amniotic fluid.

0:38:040:38:09

In both cases we find that the more testosterone the individual

0:38:090:38:13

was exposed to pre-natally, the more male-typical their childhood behaviour is.

0:38:130:38:19

So can you see this shape?

0:38:190:38:20

I think...

0:38:200:38:23

-it might be that one.

-Yeah.

0:38:230:38:26

Other skills could be linked to testosterone levels in the womb, from reading emotions

0:38:260:38:30

to reading a map,

0:38:300:38:32

-or spotting hidden triangles in complex shapes.

-Well done!

0:38:320:38:37

Could the level of testosterone in the womb be changing our brains, affecting our abilities?

0:38:370:38:43

It's a question another group of Cambridge scientists are studying

0:38:440:38:47

by looking at the brains of eight-year-olds in an MRI scanner.

0:38:470:38:52

So this is the human brain

0:38:520:38:54

and this white section that you see here is called the corpus closum.

0:38:540:38:58

It's a fibrotract that connects the right hemisphere to the left hemisphere.

0:38:580:39:02

One part of this region of the children's brains varied,

0:39:050:39:08

depending on the levels of testosterone in the womb.

0:39:080:39:12

So what we found is that low testosterone actually meant that

0:39:140:39:18

this part of the closum was bigger on the left side than on the right side.

0:39:180:39:23

This is one of the first times physical differences

0:39:260:39:29

in our brain have been directly linked to testosterone levels in the womb.

0:39:290:39:33

So we can really ask the question, is foetal testosterone a mechanism

0:39:350:39:39

that sort of pushes brains to being more male or more female?

0:39:390:39:44

This work with testosterone suggests hormones can have

0:39:460:39:50

a crucial impact during the nine months that made you.

0:39:500:39:53

And because they affect our brain,

0:39:550:39:57

they may affect all aspects of our personality.

0:39:570:40:01

CALL TO PRAYER

0:40:050:40:08

By 2011, David Barker had been working on his theory for over two decades.

0:40:190:40:25

He had evidence that the way we grew in the womb could have lasting effects on our health.

0:40:260:40:31

But now, he wanted to not just understand our destiny,

0:40:340:40:37

but potentially re-write it.

0:40:370:40:39

I'm here because there are potentially important

0:40:410:40:45

medical records here in the desert of Saudi Arabia.

0:40:450:40:49

Records like these are the key to David's work.

0:41:040:41:08

He's always looking for places where human experience creates a natural experiment.

0:41:100:41:16

David is working with Saudi scientists

0:41:230:41:25

to connect these records to real people living in the town of Unizah today.

0:41:250:41:30

We have three different types of records

0:41:320:41:35

that we can get a nice idea of the babies and how they grew up,

0:41:350:41:40

what problems they faced,

0:41:400:41:42

how this can be linked to the life in utero and so on.

0:41:420:41:47

We have found records in China, we have found records in India.

0:41:480:41:52

There are records in different European countries.

0:41:520:41:56

Some records in America.

0:41:560:41:59

Nothing like the records here,

0:41:590:42:01

so this is very exciting.

0:42:010:42:03

This latest set of records could reveal a crucial piece of the puzzle.

0:42:060:42:10

They contain the details of an overlooked companion

0:42:130:42:16

that shared our nine months in the mysterious world of the womb.

0:42:160:42:21

We all began life in a world of water...

0:42:330:42:37

..bathed in warm fluid,

0:42:380:42:40

surrounded by the muted sounds of the outside world and our mother's heartbeat.

0:42:400:42:44

Graham Burton of Cambridge University has been investigating

0:42:490:42:53

life in this strange world his entire career.

0:42:530:42:57

This is really where it all began.

0:43:010:43:03

There's general agreement that when life evolved on the planet, it did so in the seas.

0:43:050:43:10

And even today, we recreate this watery environment within the womb.

0:43:130:43:18

The baby develops within a sac of salty fluid, very similar to the sea.

0:43:180:43:23

It's not until the waters break at the time of delivery that we learn

0:43:280:43:32

to take our first breath of air.

0:43:320:43:33

Graham knew our mysterious companion in the womb

0:43:400:43:43

would be crucial to David Barker's work.

0:43:430:43:46

So when David first presented his theory,

0:43:480:43:50

I thought this was extremely interesting, but my first reaction

0:43:500:43:54

was of course, "Well, what about the placenta?"

0:43:540:43:57

Because everything that goes between the mother and the baby

0:43:570:44:00

must pass through the placenta.

0:44:000:44:02

Your placenta was created during the same nine months that made you.

0:44:050:44:09

It is the link between a baby, its mother

0:44:100:44:14

and the outside world.

0:44:140:44:16

Within the placenta there are these finger-like processes,

0:44:180:44:21

rather like the fronds of the seaweed.

0:44:210:44:23

Mother's blood comes in through the arteries

0:44:250:44:28

into this space within the placenta

0:44:280:44:33

and passes between these frond-like processes,

0:44:330:44:36

bringing oxygen and nutrients to the placenta.

0:44:360:44:40

Everything that reached us in the womb

0:44:410:44:45

passed through this extraordinary organ.

0:44:450:44:47

Of course, none of us would be here today without our placentas.

0:44:470:44:51

It's really an extension of us. It shares the same DNA

0:44:510:44:55

and in some cultures, it's almost considered a twin.

0:44:550:44:59

To really understand how we developed in the womb, we need to unravel the role of our placenta.

0:45:010:45:07

It acts as a selective barrier,

0:45:090:45:12

designed to both feed and protect the baby.

0:45:120:45:15

And Graham has discovered key evidence of exactly how this happens.

0:45:170:45:21

So for example, in placentas where the mother has smoked during pregnancy,

0:45:240:45:29

what we see is a reduction in the size of the blood vessels within the placenta

0:45:290:45:34

and a thickening of the barrier separating the mother's and the baby's blood.

0:45:340:45:38

So both of those effects will impair the transfer of nutrients

0:45:380:45:43

from the mother to the baby

0:45:430:45:45

and that may account for why the baby is smaller in women who smoke.

0:45:450:45:50

This is just one example of the many things which can affect

0:45:540:45:58

this delicate and responsive organ.

0:45:580:46:00

Graham's work shows just how important the placenta is during the nine months that made you.

0:46:020:46:07

Every placenta is different and in a way every placenta tells a story,

0:46:100:46:15

and if we can read the clues within the placenta,

0:46:150:46:18

then in a way we have a record of how the placenta and the baby develop

0:46:180:46:22

and that may help us in predicting the future health of the baby.

0:46:220:46:27

It's because our placenta has such a powerful influence on how our lives unfold

0:46:360:46:41

that David Barker has come to Saudi Arabia.

0:46:410:46:43

He has recently begun work with Dr Saleh Al-Wasel

0:46:460:46:48

of King Saud University in Riyadh.

0:46:480:46:51

They're in the early stages of an important new research project.

0:46:550:46:58

Hidden in the records of the Saudi town of Unizah,

0:47:030:47:07

Dr Al-Wasel has already found evidence of how the placenta

0:47:070:47:10

may protect the baby from changes in our mother's diet.

0:47:100:47:14

He's discovered the placenta seems to respond to Ramadan.

0:47:160:47:20

Ramadan is a month that most people here in Saudi Arabia

0:47:220:47:25

change their lifestyle.

0:47:250:47:27

The frequency of food, the amount of food and also the quality of food.

0:47:310:47:36

If Ramadan occurred during later pregnancy, Saleh found the placentas were smaller than usual.

0:47:380:47:44

The placenta is not a solid organ.

0:47:460:47:49

It's a very plastic organ.

0:47:490:47:50

It's very sensitive to the environment

0:47:520:47:54

and responds quickly to changes.

0:47:540:47:57

I mean, in Ramadan,

0:47:570:47:59

it's just only one month among nine months of the pregnancy

0:47:590:48:03

and you can see changes in the placenta.

0:48:030:48:06

Just for one month, changes in the size.

0:48:060:48:09

You would think a smaller placenta would mean a smaller baby,

0:48:120:48:16

but intriguingly the size of the babies didn't change.

0:48:160:48:20

It seemed the smaller placenta was capable

0:48:220:48:25

of transferring the same amount of nutrients as a larger one would,

0:48:250:48:29

that it was protecting the baby from any effects of the dietary change.

0:48:290:48:33

Here is the baby weight. 2.8, 3.4, 3.2,

0:48:350:48:40

3.3, 3.3, 3.4...

0:48:400:48:43

These birth records suggest

0:48:450:48:47

that even though the Saudi placenta is always smaller than a Western one,

0:48:470:48:51

it's capable of producing as large a baby.

0:48:510:48:54

Well, it's absolutely clear looking down this column,

0:48:570:49:00

and I've looked at hundreds of such columns,

0:49:000:49:03

that these babies are of Western size,

0:49:030:49:06

but the placentas are much smaller.

0:49:060:49:08

The Saudi babies are growing large and healthy from these smaller placentas.

0:49:120:49:17

It's as if they're working more efficiently.

0:49:170:49:19

To understand why, Saleh is now working with a hospital in Riyadh.

0:49:270:49:31

They are measuring newborn babies and then analysing their placentas in the lab.

0:49:360:49:40

It's 30 cms.

0:49:420:49:43

They hope to discover why some placentas are better at transferring nutrients than others.

0:49:460:49:50

The interesting thing about this is that the placenta does not transport

0:49:540:49:59

nutrients in the same manner all day, all stages.

0:49:590:50:02

It fluctuates.

0:50:020:50:04

So by looking inside the placenta, we would hope to investigate

0:50:080:50:12

how this placenta takes the nutrients from the mother's side

0:50:120:50:16

and delivers it to the baby's side.

0:50:160:50:18

Our companion in the womb is now being given as much respect

0:50:210:50:25

by Western science as it has always had in Saudi culture.

0:50:250:50:29

You cannot separate culture from science

0:50:300:50:32

and here, for example, in Saudi Arabia,

0:50:320:50:35

toward the end of the pregnancy,

0:50:350:50:38

we look at the placenta as if it is going to die to bring a live baby

0:50:380:50:44

and for this, we respect this unique organ

0:50:440:50:47

and handle it carefully and bury it in the graveyard.

0:50:470:50:52

So I'm very excited that the placenta is beginning to get the recognition that it deserves.

0:50:590:51:04

David's work has really highlighted the importance of the intra-uterine

0:51:040:51:08

period for adult health and, of course, the placenta is critical to that, and it's very rewarding to see

0:51:080:51:15

that a number of young investigators are turning their attention to the placenta

0:51:150:51:19

and I think in the next five, ten years

0:51:190:51:22

we're really going to gain a much greater insight into its function.

0:51:220:51:25

If we can understand why some placentas seem to work better than others,

0:51:290:51:33

it might be possible to ensure every baby gets the best start in life,

0:51:330:51:38

thanks to a really efficient placenta.

0:51:380:51:40

In the tough environment of the slums of Mumbai,

0:51:570:52:01

David Barker is hoping his ideas can change lives.

0:52:010:52:04

The underlying mechanisms which affect the quality

0:52:120:52:15

of our growth in the womb are still under investigation,

0:52:150:52:19

but David believes we already know enough to alter the health destiny of future generations.

0:52:190:52:24

It is a new way, it is a feasible way

0:52:270:52:30

and it's not even a very expensive way,

0:52:300:52:33

so it's time we got going.

0:52:330:52:36

Inspired by David's ideas, his colleague, Professor Caroline Fall,

0:52:370:52:42

is leading a study with the potential to fix the diabetes epidemic in India.

0:52:420:52:47

At the moment, if you talk about preventing diabetes,

0:52:490:52:52

people are talking about making middle-aged people lose weight,

0:52:520:52:56

and A, that's impossible to do,

0:52:560:52:58

and B, it doesn't seem to work very well anyway.

0:52:580:53:01

The idea that you could build a human being that was

0:53:020:53:05

more resistant to this disease was amazing to me.

0:53:050:53:08

Caroline's plan to halt the diabetes epidemic

0:53:130:53:16

doesn't rely on high-tech labs or fancy science.

0:53:160:53:19

It rests mainly on these women

0:53:200:53:23

and one kitchen.

0:53:230:53:24

These recipes contain all the crucial building blocks needed to build a body resistant to disease.

0:53:310:53:36

'Folic acid, calcium, iron, vitamin A.'

0:53:370:53:41

The calcium will be important for bone growth.

0:53:410:53:45

The green leafy vegetables contain small quantities

0:53:450:53:47

of essential fatty acids which are important for brain growth.

0:53:470:53:51

All of those nutrients are important in different tissues of the body.

0:53:520:53:56

The foetus, at a very, very early microscopic stage,

0:53:590:54:02

is sensitive to the nutrients around it and if we miss that,

0:54:020:54:06

we feel that we would be missing the most important stage of development.

0:54:060:54:11

Every day, over 1,500 snacks are made in this kitchen.

0:54:250:54:29

There are nutrient-rich recipes and others that are green vegetable-free

0:54:290:54:34

to act as scientific controls.

0:54:340:54:36

They are taken to about 50 clinics in the slums across the city.

0:54:400:54:44

In total, over 6,700 women have participated

0:54:490:54:54

and each must begin eating the supplements well before they fall pregnant.

0:54:540:54:58

It's a logistical nightmare where the utmost care must be taken

0:54:590:55:03

to be scientific.

0:55:030:55:04

I'm very glad to have met Meera.

0:55:080:55:11

It's been hard work, it's been hard work setting up a study like this.

0:55:110:55:15

To carry it out on the ground

0:55:150:55:18

in a population like this is very difficult.

0:55:180:55:21

It's mandatory for a woman to come to the centre

0:55:230:55:25

and have the supplement in front of the project clerk

0:55:250:55:28

because it is very important, you know, because if they take it home,

0:55:280:55:31

somebody else can eat it.

0:55:310:55:34

They can throw it out or the child can eat it.

0:55:340:55:36

We are not sure who the supplement has gone into,

0:55:360:55:39

whose stomach, so it's very important to have women coming to the centre.

0:55:390:55:42

The centre is full of women eating supplements

0:55:440:55:47

from well before pregnancy until they give birth.

0:55:470:55:50

And there are also babies who must be measured at one, three, six and 12 months.

0:55:520:55:58

Their weight, length and body fat are recorded,

0:56:000:56:03

and they are even testing their mental development.

0:56:030:56:06

It is an ambitious long-term project.

0:56:100:56:14

-For seven-and-a-half years.

-How many more?

0:56:140:56:17

-Forever, I think.

-So nice!

0:56:170:56:21

The results of this study will begin to come in next year.

0:56:210:56:27

We're providing better nutrition into the mother,

0:56:290:56:31

but the mother herself has had a poor early development,

0:56:310:56:35

which may affect the quality of her eggs.

0:56:350:56:39

It certainly affects the size of her uterus

0:56:390:56:41

and the quality of the blood supply to the uterus.

0:56:410:56:44

So she is still constraining the development and growth

0:56:440:56:49

of that foetus, even if we are providing enough building blocks

0:56:490:56:53

to develop a better foetus.

0:56:530:56:55

We need to follow these children through and we need to follow

0:56:550:56:59

into the next generation to see the full benefit.

0:56:590:57:03

David Barker's ideas have transformed the way we think about our time in the womb.

0:57:160:57:21

If the work in India is successful, the study of foetal origins

0:57:220:57:27

that began in Hertfordshire could alter the health of future generations across the world.

0:57:270:57:32

Many people have looked at genes, but it hasn't been as promising as we thought

0:57:340:57:39

and it's been very difficult to change lifestyles,

0:57:390:57:42

to prevent heart disease, for instance, but I think this field of research

0:57:420:57:46

that focuses on development during pregnancy is really very promising.

0:57:460:57:51

The benefits of improving the nutrition of the human embryo

0:57:560:58:00

and foetus are not just reducing the burden of diabetes.

0:58:000:58:06

It will reduce the burden of cardiovascular disease,

0:58:060:58:09

osteoporosis, various brain disorders,

0:58:090:58:14

and will prolong lifespan.

0:58:140:58:17

Particularly it will prolong healthy lifespan.

0:58:170:58:19

I would like to think that what we're seeing

0:58:210:58:23

here in India is the beginning of a new dawn

0:58:230:58:28

and a new understanding

0:58:280:58:30

that will lead us to take command of our destinies

0:58:300:58:34

in terms of our long-term health.

0:58:340:58:36

Subtitles by Red Bee Media Ltd

0:58:590:59:02

E-mail [email protected]

0:59:020:59:05

Horizon explores the secrets of what makes a long, healthy and happy life. It turns out that a time you can't remember - the nine months you spend in the womb - could have more lasting effects on you today than your lifestyle or genes. It is one of the most powerful and provocative new ideas in human science, and it was pioneered by a British scientist, Professor David Barker. His theory has inspired a field of study that is revealing how our time in the womb could affect your health, personality, and even the lives of your children.


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