Responsibility in the age of Developmental Origins of Health and Disease (DOHaD) and epigenetics

The development of preterm infants from low socio-economic status families: The combined effects of melatonin, autonomic nervous system maturation and psychosocial factors (ProMote): A study protocol

Preterm births constitute a major public health issue and a chronic, cross-generational condition globally. Psychological and biological factors interact in a way that women from low socio-economic status (SES) are disproportionally affected by preterm delivery and at increased risk for the development of perinatal mental health problems. Low SES constitutes one of the most evident contributors to poor neurodevelopment of preterm infants. Maternal perinatal mental health disorders have persistent effects on behavioral and physiological functioning throughout the lifespan and may even be evident across generations. The overall objective of the proposed longitudinal, multi-disciplinary and multi-method study is to compare the association of psychosocial (maternal mental health, intersubjectivity, attachment, family functioning, dyadic coping and perceived social support), and biological factors (melatonin and heart rate variability) with preterm infants' development at 9 months (corrected age), between low and high SES families. We will collect data from preterm neonates (<37 weeks gestational age) hospitalized in the Department of Neonatology/Neonatal Intensive Care Unit of the University General Hospital of Heraklion, Greece, and their mothers. Data collection of psychosocial and biological factors will be carried out at birth, and at the corrected age of 6 and 9 months, while preterm infants' cognitive and social development will be assessed at 9 months corrected age. The findings of this study may highlight the need for early interventions for new mothers coming from low SES in order to promote their preterm infants' optimal early neurodevelopment and for community-evidence-based prevention efforts to restrict the cycle of health inequities and intergenerational mental disorders.

A scoping review of individual health responsibility: A context-base concept

BACKGROUND

Individual health responsibility plays an important role in maintaining and improving people's health. There are controversial opinions related to this concept. This study aimed to investigate controversial opinions related to individual health responsibility and familiarize researchers and policy makers with the available evidence and gap of knowledge in the recent years.

MATERIAL AND METHOD

This paper is a scoping review. The five-step approach of Arksey and O'Malley was used to review the relevant literature from the beginning of 2017 to the end of 2022. The search was done in the PubMed, Embase, Scopus, web of sciences, Cochrane databases, and Google Scholar search engine using the English keywords "health responsibility" AND "individual" OR "personal".

RESULTS

All articles and theses related to individual health responsibility, which were in English and had access to their full text, were included in the study. After a 2-stage screening for 1,412 articles and theses, 32 were included in the study. The findings indicated that most of the studies were conducted in developed European continent. The published articles included a wide range of quantitative, qualitative, and mixed research, and acute and chronic diseases have been considered in this field.

CONCLUSION

Individual health responsibility is a multidimensional concept that is influenced by individual, social, and cultural factors, and emphasizing it can have both positive and negative effects on people's health. To the concept be effective in health promotion, it is important to pay attention to individual and social context, health status, and community and health policy makers views about individual health responsibility.

Stimulating the Uptake of Preconception Care by Women With a Vulnerable Health Status Through mHealth App-Based Nudging (Pregnant Faster): Cocreation Design and Protocol for a Cohort Study

BACKGROUND

Women with a low socioeconomic status often have a vulnerable health status due to an accumulation of health-deteriorating factors such as poor lifestyle behaviors, including inadequate nutrition, mental stressors, and impaired health literacy and agency, which puts them at an unnecessary high risk of adverse pregnancy outcomes. Adequately preparing for pregnancy through preconception care (PCC) uptake and lifestyle improvement can improve these outcomes. We hypothesize that nudging is a successful way of encouraging engagement in PCC. A nudge is a behavioral intervention that changes choice behavior through influencing incentives. The mobile health (mHealth) app-based loyalty program Pregnant Faster aims to reward women in an ethically justified way and nudges to engage in pregnancy preparation by visiting a PCC consultation.

OBJECTIVE

Here, we first describe the process of the cocreation of the mHealth app Pregnant Faster that aims to increase engagement in pregnancy preparation by women with a vulnerable health status. Second, we describe the cohort study design to assess the feasibility of Pregnant Faster.

METHODS

The content of the app is based on the eHealth lifestyle coaching program Smarter Pregnancy, which has proven to be effective in ameliorating preconceptional lifestyle behaviors (folic acid, vegetables, fruits, smoking, and alcohol) and an interview study pertaining to the preferences of the target group with regard to an mHealth app stimulating PCC uptake. For moral guidance on the design, an ethical framework was developed based on the bioethical principles of Beauchamp and Childress. The app was further developed through iterative cocreation with the target group and health care providers. For 4 weeks, participants will engage with Pregnant Faster, during which opportunities will arise to earn coins such as reading informative blogs and registering for a PCC consultation. Coins can be spent on small fun rewards, such as folic acid, fruits, and mascara. Pregnant Faster's feasibility will be tested in a study including 40 women aged 18 to 45 years, who are preconceptional or <8 weeks pregnant, with a low educational level, and living in a deprived neighborhood. The latter 2 factors will serve as a proxy of a low socioeconomic status. Recruitment will take place through flyers, social media, and health care practices. After finalization, participants will evaluate the app through the "mHealth App Usability Questionnaire" and additional interviews or questionnaires.

RESULTS

Results are expected to be published by December 2023.

CONCLUSIONS

Pregnant Faster has been designed through iterative cocreation with the target group and health care professionals. With the designed study, we will test Pregnant Faster's feasibility. If overall user satisfaction and PCC uptake is achieved, the app will be further developed and the cohort will be continued with an additional 400 inclusions to establish effectiveness.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45293.

Understanding the importance of the early-life period for adult health: a systematic review

Evidence clearly indicates that the nutritional and non-nutritional environment and level of physical activity during the early-life period from preconception through infancy has a lifelong impact on the child's health. However this message must be communicated effectively to parents and other stakeholders such as grandparents, health professionals, policymakers and the wider community in order for positive change to occur. This systematic review explores how both awareness and understanding of the long-term effects of the early-life environment have been measured in various populations and whether any patterns are evident. Ten articles were retrieved via a search of Embase, Medline and Scopus databases for peer-reviewed studies designed to assess participants' knowledge of the links between early-life exposures and adult health. Eligible articles spanned a wide range of countries, population groups and research methods. Three common themes were identified using thematic analysis: 1. a tendency for researchers to conflate participant understanding of the issue (the WHY) with a knowledge of key phrases and nutrition guidelines (the WHAT); 2. bias in both researchers and participants towards short-term thinking due to difficulty conceptualising long-term risk; and 3. challenges in comprehending the complexity of the evidence resulting in oversimplification and the overemphasis of maternal factors. Taken together these findings underscore the importance of a multi-level, whole-of-society approach to communicating the evidence, with the goal of influencing policy decisions as well as building a foundation of community support for parents and prospective parents to create a healthy early-life environment for the long-term wellbeing of all.

Researcher perspectives on ethics considerations in epigenetics: an international survey

Over the past decade, bioethicists, legal scholars and social scientists have started to investigate the potential implications of epigenetic research and technologies on medicine and society. There is growing literature discussing the most promising opportunities, as well as arising ethical, legal and social issues (ELSI). This paper explores the views of epigenetic researchers about some of these discussions. From January to March 2020, we conducted an online survey of 189 epigenetic researchers working in 31 countries. We questioned them about the scope of their field, opportunities in different areas of specialization, and ELSI in the conduct of research and knowledge translation. We also assessed their level of concern regarding four emerging non-medical applications of epigenetic testing—i.e., in life insurance, forensics, immigration and direct-to-consumer testing. Although there was strong agreement on DNA methylation, histone modifications, 3D structure of chromatin and nucleosomes being integral elements of the field, there was considerable disagreement on transcription factors, RNA interference, RNA splicing and prions. The most prevalent ELSI experienced or witnessed by respondents were in obtaining timely access to epigenetic data in existing databases, and in the communication of epigenetic findings by the media. They expressed high levels of concern regarding non-medical applications of epigenetics, echoing cautionary appraisals in the social sciences and humanities literature.

Social Inequities Contributing to Gestational Diabetes in Indigenous Populations in Canada: A Scoping Review

The prevalence of gestational diabetes mellitus (GDM) is dramatically higher in Indigenous compared with non-Indigenous populations in Canada. In this scoping review, we synthesize the existing literature regarding GDM among Indigenous peoples in Canada, including social and structural determinants that contribute to its higher prevalence in this population. Seven themes related to GDM in Indigenous populations emerged from a synthesis of the 44 included articles. The themes were GDM prevalence and trends; risk factors; screening; diagnosis and treatment; maternal outcomes; child outcomes; systemic barriers; and Indigenous perceptions, concerns and health behaviours. The findings from this review suggest culturally appropriate health care and improved screening practices may help to mitigate the high prevalence and poor health outcomes associated with GDM in Indigenous communities across Canada. More community-driven, participatory research that includes the social determinants of health and a culturally safe lens is required to assess the effects and reduce the impact of GDM in this population.

Socio-economic determinants of healthcare costs in early life: a register-based study in the Netherlands

Background

Children with low socioeconomic status (SES) have an increased risk of a suboptimal start in life with ensuing higher healthcare costs. This study aims to investigate the effects of individual- (monthly household income) and contextual-level SES (household income and neighborhood deprivation), and perinatal morbidity (preterm birth and small for gestational age ((<10th percentile), SGA)) on healthcare costs in early life (0–3 years of age).

Methods

Individual-linked data from three national registries (Perinatal Registry Netherlands, Statistics Netherlands, and Healthcare Vektis) were obtained of all children born between 2011 and 2014 (N = 480,471) in the Netherlands. Binomial logistic regression was used to model annual healthcare costs as a function of their household income (per €1000), neighborhood deprivation index (range − 13.26 – 10.70), their perinatal morbidity and demographic characteristics. Annual healthcare cost were dichotomized into low healthcare costs (Q1-Q3 below €1000) and high healthcare costs (Q4 €1000 or higher).

Results

Children had a median of €295 annual healthcare costs, ranging from €72 to €4299 (5–95%). Binomial logistic regression revealed that for every €1000 decrease in monthly household income, the OR for having high healthcare costs is 0.99 (0.99–0.99). Furthermore, for every one-unit increase in neighborhood deprivation the OR for having high healthcare costs increase 1.02 (1.01–1.02). Finally, the model revealed an OR of 2.55 (2.48–2.61) for preterm born children, and an OR of 1.44 (1.41–1.48) for children SGA, to have high healthcare costs compared to their healthy peers.

Conclusion

More neighborhood deprivation was directly related to higher healthcare costs in young children. On top of this, lower household income was consistently and independently related to higher healthcare costs. By optimizing conditions for low SES populations, the impact of low SES circumstances on their healthcare costs can be positively influenced. Additionally, policies that influence more timely and appropriate healthcare use in low SES populations can reduce healthcare costs further.

More voices are always better: Tackling power differentials in knowledge production and access in human biology

OBJECTIVE

Academic human biology seeks to characterize and explain human biocultural variation in terms of adaptations to local environments. Understanding and educating about such variation, if not carried out thoughtfully, can reinforce power asymmetries around who can produce and access the knowledge, and in what ways and places. One of many factors contributing to power inequities in knowledge production and access concerns histories of state-driven colonization, with people(s) dispossessed of land through colonization generally having relatively less power. Because human biologists disproportionately work with communities/sub-populations living in marginal environments, most of which have been moved, dispossessed, and/or reconfigured through colonization, we are prone to reproducing these land-related power imbalances but we are also well-situated to level them.

METHODS

Here, we do three things we hope will move us toward research and teaching practices that recognize and begin to disrupt colonial power inequities in human biology knowledge production and access.

RESULTS

First, after defining terms core to understanding the power matrices at stake, we outline likely benefits to human biologists of using anticolonial approaches. Second, we highlight two frameworks offering anticolonial tools (community-based participatory research and "two-eyed seeing"). Third, we suggest several practical, behavioral changes to make and skills to develop for human biologists looking to shift power balances.

CONCLUSION

We conclude by reflecting on our own positions along the colonially rooted power gradients structuring human biology. We argue that doing so constitutes an essential early step toward creating anticolonial spaces for more ethical and just production, consumption, and application of knowledge.

Exploring the Ethics of Implementation of Epigenomics Technologies in Cancer Screening: A Focus Group Study

New epigenomics technologies are being developed and used for the detection and prediction of various types of cancer. By allowing for timely intervention or preventive measures, epigenomics technologies show promise for public health, notably in population screening. In order to assess whether implementation of epigenomics technologies in population screening may be morally acceptable, it is important to understand – in an early stage of development – ethical and societal issues that may arise. We held 3 focus groups with experts in science and technology studies (STS) (n = 13) in the Netherlands, on 3 potential future applications of epigenomic technologies in screening programmes of increasing scope: cervical cancer, female cancers and ‘global’ cancer. On the basis of these discussions, this paper identifies ethical issues pertinent to epigenomics-based population screening, such as risk communication, trust and public acceptance; personal responsibility, stigmatisation and societal pressure, and data protection and data governance. It also points out how features of epigenomics (eg, modifiability) and changing concepts (eg, of cancer) may challenge the existing evaluative framework for screening programmes. This paper aims to anticipate and prepare for future ethical challenges when epigenomics technologies can be tested and introduced in public health settings.

Health Agency and Perfectionism: The Case of Perinatal Health Inequalities

Poor pregnancy outcomes and inequalities in these outcomes remain a major challenge, even in prosperous societies that have high-quality health care and public health policy in place. In this article, we propose that justice demands the improvement of what we call the ‘health agency’ of parents-to-be as part of a response to these poor outcomes. We take health agency to have three aspects: (i) the capacity to form health-goals one has reason to value, (ii) the control one perceives to have over achieving those health-goals and (iii) the freedom(s) one has to achieve those health-goals. We will moreover argue that this demand of justice can be best based on a perfectionist rather than neutralist method of justification. Subsequently, we will argue that perfectionist policy may be paternalistic but not wrongfully paternalistic. This leads us to conclude that perfectionism should be adopted to inform and justify public health policy that is aimed at improving health agency in general and counteracting poor pregnancy outcomes and inequalities in perinatal health outcomes in particular.

Family-Centered Health Promotion: Perspectives for Engaging Families and Achieving Better Health Outcomes

Communities and populations are comprised of individuals and families who together affect the health of the community. The family unit is an unparalleled player for maintaining health and preventing disease for public health because members may support and nurture one another through life stages. Preliminary research confirms that family-oriented health promotion and disease prevention are promising strategies because the family unit is both a resource and a priority group needing preventative and curative services across the life course. Although there are growing numbers of successful efforts, family health systems are generally underutilized in health promotion practice. This lack of utilization in policy and practice have hampered the collection of robust evidence for family health. This paper purports that families are important actors in public health. Yet, since no one pattern for healthy families is known, public health practitioners can consider six principle-based approaches to legitimately and respectfully advance the families’ innate potential for health promotion and disease prevention. Each perspective aims to foster higher capacity for family health systems to function appropriately in public health practice. Health promotion practitioners and researchers can explore family health perspectives with the potential for systems policy and practice adjustments in public health.

Ethical Issues in Research and Development of Epigenome-wide Technologies

To date, few scholarly discussions on ethical implications of epigenetics and epigenomics technologies have focused on the current phase of research and development, in which researchers are confronted with real and practical ethical dilemmas. In this article, a responsible research and innovation approach, using interviews and an expert meeting, is applied to a case of epigenomic test development for cervical cancer screening. This article provides an overview of ethical issues presently facing epigenomics researchers and test developers, and discusses 3 sets of issues in depth: (1) informed consent; (2) communication with donors and/or research participants, and (3) privacy and publication of data and research results. Although these issues are familiar to research ethics, some aspects are new and most require reinterpretation in the context of epigenomics technologies. With this article, we aim to start a discussion of the practical ethical issues rising in research and development of epigenomic technologies and to offer guidance for researchers working in the field of epigenetic and epigenomic technology.

Epigenetics, ethics, law and society: A multidisciplinary review of descriptive, instrumental, dialectical and reflexive analyses

Epigenetics, defined as 'the study of mitotically and/or meiotically heritable changes in gene function that cannot be explained by changes in DNA sequence', has emerged as a promissory yet controversial field of scientific inquiry over the past decade. Scholars from many disciplines have formulated both optimistic and cautionary claims regarding its potential normative implications. This article provides a comprehensive review of the nascent literature at the crossroads of epigenetics, ethics, law and society. It describes nine emerging areas of discussion, relating to (1) the impact of epigenetics on the nature versus nurture dualism, (2) the potential resulting biologization of the social, (3) the meaning of epigenetics for public health, its potential influence on (4) reproduction and parenting, (5) political theory and (6) legal proceedings, and concerns regarding (7) stigmatization and discrimination, (8) privacy protection and (9) knowledge translation. While there is some degree of similarity between the nature and content of these areas and the abundant literature on ethical, legal and social issues in genetics, the potential implications of epigenetics ought not be conflated with the latter. Critical studies on epigenetics are emerging within a separate space of bioethical and biopolitical investigations and claims, with scholars from various epistemological standpoints utilizing distinct yet complementary analytical approaches.

An Altered DNA Methylation Status in the Human Umbilical Cord Is Correlated with Maternal Exposure to Polychlorinated Biphenyls

Maternal exposure to polychlorinated biphenyls (PCBs) results in abnormal fetal development, possibly because of epigenetic alterations. However, the association between PCB levels in cord serum with fetal DNA methylation status in cord tissue is unclear. This study aims to identify alterations in DNA methylation in cord tissue potentially associated with PCB levels in cord serum from a birth cohort in Chiba, Japan (male neonates = 32, female neonates = 43). Methylation array analysis identified five sites for female neonates (cg09878117, cg06154002, cg06289566, cg12838902, cg01083397) and one site for male neonates (cg13368805) that demonstrated a change in the methylation degree. This result was validated by pyrosequencing analysis, showing that cg06154002 (tudor domain containing 9: TDRD9) in cord tissue from female neonates is significantly correlated with total PCB levels in cord serum. These results indicate that exposure to PCBs may alter TDRD9 methylation levels, although this hypothesis requires further validation using data obtained from female neonates. However, since the present cohort is small, further studies with larger cohorts are required to obtain more data on the effects of PCB exposure and to identify corresponding biomarkers.

Translating the Developmental Origins of Health and Disease concept to improve the nutritional environment for our next generations: a call for a reflexive, positive, multi-level approach

Evidence supporting the Developmental Origins of Health and Disease (DOHaD) hypothesis indicates that improving early life environments can reduce non-communicable disease risks and improve health over the lifecourse. A widespread understanding of this evidence may help to reshape structures, guidelines and individual behaviors to better the developmental conditions for the next generations. Yet, few efforts have yet been made to translate the DOHaD concept beyond the research community. To understand why, and to identify priorities for DOHaD Knowledge Translation (KT) programs, we review here a portion of published descriptions of DOHaD KT efforts and critiques thereof. We focus on KT targeting people equipped to apply DOHaD knowledge to their everyday home or work lives. We identified 17 reports of direct-to-public DOHaD KT that met our inclusion criteria. Relevant KT programs have been or are being initiated in nine countries, most focusing on secondary school students or care-workers-in-training; few target parents-to-be. Early indicators suggest that such programs can empower participants. Main critiques of DOHaD KT suggest it may overburden mothers with responsibility for children's health and health environments, minimizing the roles of other people and institutions. Simultaneously, though, many mothers-to-be seek reliable guidance on prenatal health and nutrition, and would likely benefit from engagement with DOHaD KT. We thus recommend emphasizing solidarity, and bringing together people likely to one day become parents (youth), people planning pregnancies, expecting couples, care workers and policymakers into empowering conversation about DOHaD and about the importance and complexity of early life environments.

DOHaD in science and society: emergent opportunities and novel responsibilities

The field of Developmental Origins of Health and Disease (DOHaD) has grown considerably in recent decades and is receiving increasing recognition from health policymakers. Today, DOHaD research aims to offer a comprehensive perspective on health and disease that traces how different life experiences shape health and disease risks over the entire life course. This integrative perspective opens up distinct possibilities for improving health. At the same time, it raises questions regarding the specific social responsibilities of DOHaD as a field and about possible pathways to a socially just and scientifically robust implementation of DOHaD knowledge in society. In this article, we review the history and key characteristics of DOHaD as a field of scientific knowledge production. We argue that based on its key assumptions - that life circumstances, health and disease are closely linked on a molecular scale - DOHaD is an inherently political research field. When tracing how life environments affect health and disease, it is of utmost social and political importance to specify how DOHaD understands and frames these life environments, which aspects of life worlds are included and which excluded, and how research results are interpreted and translated into health recommendations at individual, societal and policy levels. We suggest a number of ways by which the DOHaD community can constructively and responsibly meet the demands that these inherent characteristics place on knowledge production and dissemination in the field.

Transgenerational epigenetic inheritance and social responsibility: perspectives from the social sciences

Research in environmental epigenetics explores how environmental exposures and life experiences such as food, toxins, stress or trauma can shape trajectories of human health and well-being in complex ways. This perspective resonates with social science expertise on the significant health impacts of unequal living conditions and the profound influence of social life on bodies in general. Environmental epigenetics could thus provide an important opportunity for moving beyond long-standing debates about nature versus nurture between the disciplines and think instead in 'biosocial' terms across the disciplines. Yet, beyond enthusiasm for such novel interdisciplinary opportunities, it is crucial to also reflect on the scientific, social and political challenges that a biosocial model of body, health and illness might entail. In this paper, we contribute historical and social science perspectives on the political opportunities and challenges afforded by a biosocial conception of the body. We will specifically focus on what it means if biosocial plasticity is not only perceived to characterize the life of individuals but also as possibly giving rise to semi-stable traits that can be passed on to future generations. That is, we will consider the historical, social and political valences of the scientific proposition of transgenerational epigenetic inheritance. The key question that animates this article is if and how the notion of transgenerational epigenetic inheritance creates new forms of responsibilities both in science and in society. We propose that, ultimately, interdisciplinary conversation and collaboration is essential for responsible approaches to transgenerational epigenetic inheritance in science and society.