Foetal Starvation, Economic Adversity and Health a Difference-in-Difference Approach
The foetal origin hypothesis argues that starvation during the foetal stage increases the probability of the onset of non-communicable diseases in midlife. The theory, however, fails to identify the mechanisms underlying the outcome. Nor does it succeed in distinguishing between study and control groups. The predictive adaptive response theory addresses the former deficiency by hypothesising that nutrition supply at the foetal stage signals the future nutrition supply and leads to adaptation of the foetus to the future expected environment. Mismatch between expected and actual environment will increase the likelihood of non-communicable diseases. The study examines the long-term impact of foetal starvation on anthropometric indicators among residents in the Sundarban region in India. We hypothesise that nutrition deficiency in the foetal stage signals the future expected environment to the foetus. This leads to the growth of a thrifty phenotype ensuring optimal performance of the offspring in a nutrition-deficit environment. A primary survey, undertaken between May 2014 and April 2015, was used to collect the data. In the first stage of the survey, Muslim women who had offspring in the period 1993–1997 were listed. In the second phase, anthropometric measurements of their offspring were taken. Respondents are placed within the study group if their mothers had kept the Ramadan fast (provided it coincided with conception); remaining respondents were defined as controls. Differences in mean anthropometric outcomes are tested using Monte Carlo simulations. A Difference-in-difference method is also applied. Respondents exposed to foetal starvation had better outcomes than those in the control group if they remained in poverty or their economic status deteriorated. Results were reversed for children with a sustained high standard of living, or those whose economic conditions improve. Findings are interpreted to provide support for the predictive adaptive response theory. However, tests using larger samples are required before arriving at a firm conclusion.
KeywordsFoetal origin hypothesis Predictive adaptive response Anthropometric outcomes Monte Carlo simulations Difference-in-difference India
The assistance provided by members of Sundarban Unnayan Niketan, and Koumi Dutta and Rabia Mondol, during the survey is gratefully acknowledged. Sukumar Sarkar and Antara Dhar entered the data. Probal Chaudhuri (Theoretical Statistics and Mathematics Unit, Indian Statistical Institute Kolkata) made some useful suggestions regarding the methodology. We are also grateful to study participants for having borne with our probing. Responsibility for any remaining errors lies with authors.
Consent for Publication
Respondents had given their consent to the data being used for academic purposes after concealing their individual identities.
The study was funded by the Indian Institute of Technology, Kharagpur. The role of funding body was restricted to providing the finance; it did not play any role in the design of the study and collection, analysis and interpretation of data and in writing the manuscript.
Ethics Approval and Consent to Participate
The study is based on a primary survey eliciting history, socio-economic characteristics and anthropometric measures of respondents and their children. There was no intervention. Hence, clearance was not required from the ethical committee. However, informed written consent, witnessed by an independent person, was taken before administering the questionnaires.
- Glazier, J. D., Hayes, D. J. L., Hussain, S., D’Souza, S. W., Whitcombe, J., Heazell, A. E. P., & Ashton, N. (2018). The effect of Ramadan fasting during pregnancy on perinatal outcomes: A systematic review and meta-analysis. BMC Pregnancy and Childbirth, 18, 421.Google Scholar
- Gluckman, P. D., Hanson, M. A., Spencer, H. G., & Bateson, P. (2005b). Environmental influences during development and their later consequences for health and disease: Implications for the interpretation of empirical studies. Proceedings of the Royal Society B: Biological Sciences, 272, 671–677. https://doi.org/10.1098/rspb.2004.3001.CrossRefGoogle Scholar
- Government of West Bengal. (2008). District human development report: South twenty four Parganas. Kolkata: UNDP.Google Scholar
- Haymann, D. J. (1962). Thalidomide and congenital abnormalities. The Lancet, 1, 45.Google Scholar
- Joseph, K. S., & Kramer, M. S. (1997). Should we intervene to improve fetal growth? In D. Kuh & Y. Ben-Schlomo (Eds.), A life course approach to chronic disease epidemiology (pp. 277–295). Oxford: Oxford University Press.Google Scholar
- Kelly, E. (2009). The scourge of Asian Flu: In utero exposure to pandemic influenza and the development of a cohort of British children. IFS working papers, No. 09, 17. London.Google Scholar
- Kumaran, K., Fall, C. H. D., Martyn, C. N., Vijayakumar, M., Shier, R., & Stein, C. (2000). Blood pressure, arterial compliance, and left ventricular mass: No relation to small size at birth in south Indian adults. Heart, 83, 272–277.Google Scholar
- Kunto, Y. S., & Mandemakers, J. J. (2018). The effects of prenatal exposure to Ramadan on stature during childhood and adolescence: Evidence from the Indonesian Family Life Survey. Economics of Human Biology, 19, 29–39.Google Scholar
- Landro, L. (2010). Healthy living for two. Wall Street Journal.Google Scholar
- McCay, C. M., & Crowell, M. F. (1934). Prolonging the life span. The Scientific Monthly, 39(5), 405–414.Google Scholar
- Savitri, A. I., Amelia, D., Painter, R.C., Mohammad Baharuddin, Roseboom, T. J., Grobbee, D. E., & Uiterwaal, C. S. P. M. (2018). Ramadan during pregnancy and birth weight of newborns. Journal of Nutritional Science, 7.Google Scholar
- Schwandt, H. (2017). The lasting legacy of seasonal influenza: In-utero exposure and labor market outcomes. COHERE discussion paper No. 5/2017. Odense.Google Scholar
- Seckl, J. R., Roberts, P., Wild, A. E., Barker, D. J. P., Ravelli, A. C. J., Schroeder-Tanka, J. M., et al. (1997). Glucocorticoids, feto-placental 11 beta-hydroxysteroid dehydrogenase type 2, and the early life origins of adult disease. Steroids, 62, 89–94. https://doi.org/10.1016/s0039-128x(96)00165-1.CrossRefGoogle Scholar
- Stanner, S. A., Bulmer, K., Andrès, C., Lantseva, O. E., Borodina, V., Poteen, V. V., & Yudkin, J. S. (1997). Does malnutrition in utero determine diabetes and coronary heart disease in adulthood? Results from the Leningrad siege study, a cross sectional study. BMJ (Clinical Research ed.), 315, 1342–1348.Google Scholar
- Stein, C. E., Kumaran, K., Fall, C. H. D., Shaheen, S. O., Osmond, C., & Barker D. J. P. (1997). Relation of fetal growth to adult lung function in South India. Thorax, 52, 895–899.Google Scholar
- Van Abeelen, A. F. M., Elias, S. G., Bossuyt, P. M. M., Grobbee, D. E., Van Der Schouw, Y. T., Roseboom, T. J., & Uiterwaal, C. S. P. M. (2012). Famine exposure in the young and the risk of type 2 Diabetes in adulthood. Diabetes, 61, 2255–2260.Google Scholar
- World Health Organization. (2018). Noncommunicable diseases country profile 2018. Geneva: World Health Organization.Google Scholar
- Ziaee, V., Kihanidoost, Z., Younesian, M., Bateni, F., Kazemianfar, Z., & Hantoushzadeh, S. (2010). The effect of ramadan fasting on outcome of pregnancy. Iranian Journal of Pediatrics, 20, 181–186.Google Scholar