Epigenetics and Blaming Pregnant Women: Hasty Conclusions, Control, and Simplified Burden of Responsibility

In a recent (13.8.2014) article in Nature , Sarah S. Richardson and colleagues maintain that careless discussion of epigenetic research on how early life affects health across generations could harm women.

Authors discuss the extensive history of placing the burden of responsibility of a child’s health on the lifestyle of the pregnant mother – and the means for controlling women’s behavior. Authors describe how, for example, evidence of any fetal harm easily lead to zero-tolerance regulatory frameworks and severe informal and formal consequences (e.g. social condemnation for an occasional sip of alcohol despite the ambiguous evidence that very moderate and occasional drinking should harm the fetus), and how the “lack of emotional warmth” of the “refrigerator mothers ” was considered to be the reason to child autism as late as the 1970s. Going even more backwards in the history, various defects were attributed, for example, to the company the mother kept during pregnancy.

The authors note, although admitting a major difference of scale in extremity, a disturbing similarity between the well-known blaming strategies and how epigenetic research on the developmental origins of health and disease (DOHaD) are discussed especially in the public: fast conclusions about the effects of pregnant women’s lifestyles are made, and the mother’s individual influence over the vulnerable fetus is emphasized while forgetting the role of societal factors to the very issue at hand. Authors note that especially the media simplifies these modifications to mere maternal impact; thus, to the epigenetic effects in the uterine environment. However, the situation is far more complex:

Studies suggest that diet and stress modify sperm epigenetically and increase an offspring’s risk of heart disease, autism and schizophrenia. In humans, the influence of fathers over mothers’ psychological and physical state is increasingly recognized. So are effects of racial discrimination, lack of access to nutritious foods and exposure to toxic chemicals in the environment.

Overall, the authors state that

DOHaD would ideally guide policies that support parents and children, but exaggerations and over-simplifications are making scapegoats of mothers, and could even increase surveillance and regulation of pregnant women. As academics working in DOHaD and cultural studies of science, we are concerned. We urge researchers, press officers and journalists to consider the ramifications of irresponsible discussion.

I continue the article’s discussion with three issues: the complexity of applying scientific research results straightforwardly into everyday guidelines, hasty guidelines as control politics, and oversimplified targets of intervention while discussing environmental and lifestyle issues.

Epigenetic (or genetic) research conclusions are rarely straightforward or easily applicable to everyday life

Converting scientific articles into a short piece of news is indeed not an easy task. On the one hand, it is utmost necessary that newspapers report scientific findings in an understandable way. On the other hand, it can be very harmful if this is made in a simplifying manner, overstating what the research actually was about (often on possible correlations, certain increases in risks). Knowing the limited resources in the media and the potential lack of interest (or lack of resources) to popularize one’s own research that too often takes place, the equation is difficult. It should be possible to write about scientific findings that “maybe tell something related to X but the finding is preliminary”. Trying to make the headline as interesting as possible by using scary numbers and absolutist choices of words is rarely for anyone’s advantage.

As Richardson and colleagues point, the context is an important key for understanding science. For example in the case of risk-talk consider this: let’s say that the risk in the average population for some disease is 10%, and some research declares that a certain risk factor elevates this risk up to 15%. Now consider the options: either you report that the risk increases from 10% to 15%, or you report that the risk increases 50%. Quite a difference in the headline, and the latter option often is the prevalent one.

Let’s take another example from headlines:  “Mother’s Diet At Time Of Conception May Alter Baby’s DNA (STUDY)”. Sounds impressive and something that could be easily considered to be relevant for persons related to pregnancy. True, the original research does indicate preliminary results about correlations on baby’s DNA and mother’s diet. But although mentioned in the piece of news, not much focus was given to relevance of the context: the research was conducted in rural Gambia, where naturally occurring seasonal differences in diet are major due to rainy seasons and dry seasons – as opposite to a mainstream woman in a wealthy country who is in a position to make choices about her diet. Yes, sufficient energy-intake and certain nutrients and vitamins are important for a fetus, but the finding does not dictate that it’s more important than ever to eat well and be healthy if you’re considering getting pregnant and we should hope for the development of an optimal diet for mothers-to-be. Furthermore, the fact that mother’s diet may alter baby’s DNA does not automatically mean that mother’s diet might alter baby’s DNA in a manner that will be harming or otherwise very relevant to the baby in the future. It could, but suggestions for lifestyle guidelines ought to be careful with hasty conclusions.  As the original article reports, the phenotypic consequences of the variations in methylation are not yet known.

Control and micromanaging pregnancy

Although the motive behind the regulations and blaming practices can be a genuine concern about the future human being, it is tempting to see them also as a representation of a cross-cultural phenomenon of controlling women’s behavior. Why are we so concerned about the fetus when the fetus is in the uterus? If the mother’s diet should be optimized while pregnancy in order to guarantee the best possible life for the child, why do we lose such interest to that child (who definitely does not yet make decisions about her diet) when it is no more a fetus? Why fetuses are not allowed to eat unhealthy food, but the business for children’s food is full of fatty and sugary cereals, ready meals and candies? Why do children in many countries eat mostly deep-fried food in school? If the wish to protect children’s life was so strong that the mother’s freedom of choice concerning lifestyle should be compromised, why are we not ready to compromise the freedom of schools to choose what they serve, or the freedom of corporations to sell unhealthy food?

Yes, of course: it might be true that something happening to the fetus is worse than the same thing happening to a child. But still, also children are vulnerable to the same chronic diseases if their diet consists of fries and burgers. A double-standard about “protecting children” is at least somewhat visible and raises the question whether the issue at hand is not only about the children but also about controlling women with blaming strategies.

As Kerri Sackville puts it in “When pregnancy seems like a nine-month guilt trip”:

What does it mean for pregnant women to have so many restrictions? Should we just live in protective bubbles while we are pregnant? Do we not take any drugs for pain relief while we are sick? And should we not trust the doctors who tell us it is safe? After all, paracetamol was safe until this week. Who knows what will be unsafe next week. Toothpaste?

Epigenetic research, among other research, is important and will most likely reveal important facts about, for example, child development. But using preliminary and overstated research results to enforce micromanaging normative frameworks is pseudoscientific control politics.

(This is not to say that all regulations and recommendations would be a part of control politics – I’m discussing especially the normative atmosphere created by public discussion and captivating headlines.)

Even if the research results are very relevant, the mother is not the only target of intervention

The discussion on mother’s freedom of choice (concerning lifestyle) vs fetus safety is of course relevant, but it can hide a question of utmost relevance: if we are concerned about the fetus, why are we only discussing about the mother?

As mentioned by Richardson and colleagues, epigenetic research also suggests that paternal effects matter.  Following the above mentioned guideline, neither these results should lead to hasty conclusions, but research findings suggest that paternal epigenetics also matter (or don’t matter). (For example: paternal epigenetics in general, folate in diet, and parent’s stress related to child’s behavior)

Furthermore, the case is often, also in wealthy countries, that the parents are in a disadvantaged position and cannot make the required “right choices” at a reasonable cost.  Healthy food is famous for being more expensive than junk food and many people are not in the position of having much influence for their work or living conditions. As the authors claim, these facts point to the need for societal solutions, not only individual ones. Surely many people have great possibilities of making the best choices, but many don’t.