It's the mother!: How assumptions about the causal primacy of maternal effects influence research on the developmental origins of health and disease

• Published in: Social science & medicine (1982) 2018-09, Vol.213, p.20-27
• Main Authors: Sharp, Gemma C., Lawlor, Deborah A., Richardson, Sarah S.
• Format: Article
• Language: English
• Subjects: Assumptions; Breastfeeding & lactation; Causal inference; Causality; Childrens health; Developmental origins; DOHaD; Epidemiology; Family medical history; Female; Health problems; Health research; Humans; Imbalance; Infancy; Maternal effects; Maternal Exposure - adverse effects; Maternal Inheritance; Mothers; Paternal effects; Postpartum period; Pregnancy; Pregnancy complications; Prenatal; Prenatal Exposure Delayed Effects - etiology; Primacy; Public health; Research Design - standards; Research translation
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2018.07.035

Research on the developmental origins of health and disease (DOHaD) has traditionally focused on how maternal exposures around the time of pregnancy might influence offspring health and risk of disease. We acknowledge that for some exposures this is likely to be correct, but argue that the focus on maternal pregnancy effects also reflects implicit and deeply-held assumptions that 1) causal early life exposures are primarily transmitted via maternal traits or exposures, 2) maternal exposures around the time of pregnancy and early infancy are particularly important, and 3) other factors, such as paternal factors and postnatal exposures in later life, have relatively little impact in comparison. These implicit assumptions about the “causal primacy” of maternal pregnancy effects set the agenda for DOHaD research and, through a looping effect, are reinforced rather than tested. We propose practical strategies to redress this imbalance through maintaining a critical perspective about these assumptions. •Many maternal pregnancy exposures are assumed to affect offspring health.•Other factors like paternal and postnatal exposures are also likely to be important.•Nevertheless, maternal pregnancy exposures are assumed to be most important.•We need to retain a critical perspective regarding this assumption.•Improving the causal evidence base and contextualising findings will help.