Ageing Starts Before Birth?

We usually think our stories begin when we are born, but what if some of that story started long before that?

We often think a disease begins when its symptoms first appear. My father developed high blood pressure in his 40s and was diagnosed as prediabetic at 63, and we looked for explanations in his lifestyle or diet. This is what we normally do. When someone develops high blood pressure, diabetes or a neurological disorder in adulthood, we turn to their genes, environment or lifestyle, or simply brush it off as ageing. But what if the story started much earlier? Not during adulthood or childhood, but before birth?

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I know it sounds crazy, but hear me out. Scientists have become increasingly interested in a question that could hold answers: Could the environment a fetus experiences during pregnancy affect its health decades later?

This question has become the focus of a research area known as Developmental Origins of Health and Disease, or DoHaD. It proposes that conditions experienced during pregnancy and early childhood can shape health decades later, influencing the development of organs, metabolism and the immune system. One fascinating example comes from a tragedy.

During the Dutch Hunger Winter of 1944–1945, the Nazi-occupied Netherlands experienced severe famine. Pregnant women struggled to access food amid widespread shortages. They were hungry, malnourished and under immense stress. Their unborn babies were exposed to famine during critical stages of development. But could this experience have lasting consequences?

Six decades later, researchers comparing people exposed to famine before birth with those who were not found something remarkable. They observed differences in DNA methylation among those exposed, even decades later. Studies also linked prenatal famine exposure to increased risks of schizophrenia, heart disease and Type 2 diabetes, while possible links with neurodegenerative disorders remain under investigation. The famine lasted months, but its effects could still be observed six decades later. How was that possible?

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The underlying explanation involves a fascinating concept called epigenetics. It describes how our environment, behaviour and lifestyle can influence how genes function. Think of DNA as a guidebook containing the information needed to build and maintain our bodies. Epigenetics cannot rewrite that information, but it can influence which parts are accessible to our cells and how frequently they are used.

One of the best-studied mechanisms is DNA methylation, in which chemical groups attach to DNA and modify gene regulation. This is where pregnancy becomes particularly interesting. During rapid fetal development, factors such as maternal malnutrition, stress and exposure to toxins can affect how certain genes are expressed.

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A 2023 meta-analysis pooled data from 12 cohorts across 10 longitudinal studies, comprising 5,496 mother-child pairs. It found that stressful events during pregnancy were associated with differences in DNA methylation in newborn cord blood, including genes associated with neurodevelopment, metabolism, immunity and neurodegeneration.

This brings us to an intriguing possibility. Could circumstances during pregnancy shape a person’s biological vulnerability decades later? If early-life conditions influence brain development, could they also contribute to diseases emerging much later?

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Could diseases we associate with ageing begin before our stories even start? Could Alzheimer’s disease begin long before the first forgotten name, or Parkinson’s disease long before the first tremor?

We do not know yet. Science does not have definitive answers. But perhaps that is precisely why these questions are worth asking.

Amna Athar KhanThe writer is a public health and nutrition researcher with a Master of Science in Public Health and a background in food and nutrition.

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