The Fetal Origins Hypothesis

Ludovica Gazzè
University of Warwick

EC979, 2021
The Womb May Be More Important than the Home
I Barker, David J. "The fetal and infant origins of adult disease." BMJ: British Medical Journal 301, no. 6761 (1990): 1111.
I It was widely understood that childhood environment affects adult health
I Especially in low-income conditions (think infectious diseases)
I Some evidence that this is true for degenerative diseases too: patient with heart
attacks have higher infant death rates among their siblings
I Barker observes a correlation in UK data between infant mortality 70 years prior
and current mortality from cardiovascular disease
I In Hertfordshire: babies who weighed more at birth and were breastfed had lower
death rates from cardiovascular diseases
I During the 1944-1945 winter, the Nazi occupied NL and cut food supplies:
I Children in utero through that period were more likely to be obese but didn’t show
IQ effects at 18 (when they were examined for military service)
I Other studies found higher schizophrenia rates in this cohort
I Birth weight is also inversely related to future blood pressure
I Birth weight is related to maternal nutrition
I In conditions of nutritional deficiency, the developing fetus will differentially
compromise functions that are operative only late in the life-cycle, beyond the
normal age of reproduction, thus maximizing the chances of survival through
reproductive ages and the number of offspring
Correlation Is Not Causation

I If birth weight is correlated with poor maternal nutrition while gestating

I It’s probably correlated with poor nutrition and living conditions in the child’s
early years and maybe later on in life
I Which could also influence the child’s ability to learn and accumulate human
capital
I Note also: if this is a biological process, then why don’t we see higher prevalence
of cardiovascular disease in low-income countries where low birth weight is very
common?
Testable Hypotheses

1. The effects of fetal conditions are persistent.

2. The health effects can remain latent for many years— typically heart disease does
not emerge as a problem until middle age, for example.
3. The hypothesized effects reflect a specific biological mechanism, fetal
“programming,” possibly through effects of the environment on the epigenome,
which are just beginning to be understood.
3.1 The epigenome can be conceived of as a series of switches that cause various parts
of the genome to be expressed or not
In the Grossman Model the Effects of Fetal Conditions Decrease over Time

Source: Almond, Douglas, and Janet Currie. "Killing me softly: The fetal origins hypothesis." Journal of economic perspectives 25, no. 3 (2011):
153-72.
Model Extensions

φ φ
Hadult = A[Iprenatal + (1 − γ)Ipostnatal ]1/φ

I 1
1−φ : elasticity of substition of inputs
I φ = 1: perfect substitutes
I φ = −∞: perfect complements: in this case in-utero damages are hard to remediate
AND it is optimal for parents to reinforce them
I Dynamic complementarities imply that both early investment and very proximate
shocks affect current outcomes
I Because of these endogenous responses in investments, what we can hope to
measure are NET effects
I Heckman, James J. "The economics, technology, and neuroscience of human
capability formation." Proceedings of the national Academy of Sciences 104, no.
33 (2007): 13250-13255.
Empirical Evidence 1

I Within twins pairs, birth weight not only affects cardiovascular morbidity but also
adult height, IQ, earnings, and education
I Identifying effects of shocks (e.g. pollution) is hard:
I Can compare to cohorts not yet conceived. But there might be selection into who
gets conceived after the shock
I Can compare to cohorts already born: but shock could also affect them?
I To study the effect of the 1918 influenza pandemic, one can compare affected
children (born in 1919) to those born in early 1918
I Furthermore, we can use variation across U.S. states in the severity of the pandemic
I Despite the brevity of the health shock, children of infected mothers were about 20
percent more likely to be disabled and experienced wage decreases of 5 percent or
more, as well as reduced educational attainment
Empirical Evidence 2

I Across siblings: in utero exposure to elevated levels of the stress hormone cortisol
negatively affects offspring cognition, health, and educational attainment
I Mothers with low levels of human capital have higher and more variable cortisol levels
I The negative impact of elevated cortisol on offspring is greater for mothers with low
levels of human capital
I When the shock happens during the pregnancy might matter:
I Cohorts who were exposed to famine during the first half of pregnancy had relatively
normal birthweight but later showed more evidence of health effects such as incipient
heart disease. In contrast, cohorts affected later in pregnancy suffered greater
reductions in birthweight but were relatively healthier in later life. Thus, “One of the
important observations from the Dutch Hunger Winter Study was that intrauterine
exposures that have long-lasting consequences for adult health do not necessarily
result in altered birth weight”
Additional References

I Black, Sandra E., Paul J. Devereux, and Kjell G. Salvanes. 2007. “From the
Cradle to the Labor Market? The Effect of Birth Weight on Adult Outcomes.”
Quarterly Journal of Economics, 122(1): 409–39
I Almond, Douglas. 2006. “Is the 1918 Infl uenza Pandemic Over? Long-Term
Effects of in utero Infl uenza Exposure in the Post-1940 U.S. Population.” Journal
of Political Economy, 114(4): 672–712.
I Schulz, Laura C. 2010. “The Dutch Hunger Winter and the Developmental
Origins of Health and Disease.” PNAS: Proceedings of the National Academy of
Sciences, 107(39): 16757–58.
I Aizer, Anna, Laura Stroud, and Stephen Buka. "Maternal stress and child
outcomes: Evidence from siblings." Journal of Human Resources 51, no. 3
(2016): 523-555.