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Medical Writer Annie Murphy Paul's 'Origins' Examines Everyone's First Nine Months

My mother often said, sometimes as a point of pride, that she was plastered when she went into labor with me. At her favorite restaurant, she had had a couple too many highballs the night I wanted out. At the Catholic hospital where I was delivered, two nuns tried to assist her. Ma waved off their insistent offers, and on the final refusal she puked on them, forcing them into new habits.

Ma also smoked through all her pregnancies and another 30 years beyond. And not just any old brand: She is the only person I ever knew who favored a lung-buster called Philip Morris Commander, a nonfilter that had her removing tobacco from the tip of her tongue after every other drag.

I related these twin sins to Annie Murphy Paul, the New Haven-based author of a book called Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, and asked whether I was doomed in utero. Not necessarily, she said. But then Paul related something an expert on fetal alcohol syndrome had told her: "How do you know you're fine? You still don't know the total effect."

Paul's book examines the effects of events that take place between conception and birth, a hybrid space in the Venn diagram of nature and nurture. A medical writer for magazines and newspapers, Paul became more interested in fetal development after she had her first son, Teddy. She noticed people often fell into one of two camps — genes vs. environment — while discussing Teddy, "as if his personality traits were lottery numbers drawn at conception," she writes in Origins.

Free Press issued a paperback version of the book in July.

Paul began wondering about the effects of behavior, stress, food and drug intake, and the environment on the period spent in the womb. Riding a wave of research on fetal development, she collected new research and compared it with older studies. She combined her areas of expertise when she became pregnant with her second son, Gus, and distilled that research into Origins, which itself is in a hybrid space in that it reads like a breezy, nine-month memoir that happens to contain 45 pages of notes on research.

"It seemed like a dynamic field that nobody had put together before," said the 38-year-old Paul. But she added, "The experience I wanted to write about was my pregnancy."

In Origins, Paul contends that pregnancy is a sort of spring training for the baby. While there are no guarantees that doing all the "right" things — whatever they may be from one generation to the next — will result in a five-tool player and doing the wrong things will produce a dud, she maintains that many characteristics are developed during the gestational period.

While the time spent in the womb shouldn't completely define a person, "we should add the prenatal period in the accounting of who we are," she said. "It was previously under-acknowledged."

Paul busts open for good the notion that the womb is a tomb that seals the unborn child off from toxins. Though you can find recipes on the Web for a lasagna made from placenta, many people continue to believe it has an infallible ability to guard the baby even 50 years after the morning-sickness drug thalidomide was shown to permeate that seal and cause severebirth defects.

Research has discredited the idea that the fetus "is protected from all manner of pollutants and poisons by the ever-vigilant placenta," she writes. In an interview, she adds, "there's a lot we don't know" about how well or poorly the placenta defends against many drugs the mother might take. Pregnancy is a dangerous testing ground for drugs, and the FDA has acknowledged that.

Origins delves into the mix of nature and nurture in on the subject of obesity. Paul cites studies showing that prenatal development has an effect on the child's weight. In one, researchers found that children who were born after their mother had had anti-obesity surgery were 52 percent less likely to be obese than their siblings who were born to the same mother before the surgery.

Paul's research shows how what my mother did — and what many mothers of her generation did as well — during pregnancy probably lowered my odds of winning a Nobel Prize. Smoking and drinking (at least excessive drinking) have been definitively shown to harm the fetus. On the other hand, initial studies warned of irreversible damage to "crack babies" conceived during the cocaine epidemic of the 1980s, but follow-up research has shown that "the worst-case scenarios have not come to pass," she writes. Meanwhile, studies have found that babies born to mothers who drank lightly (a couple per week, not per night) fared better than the offspring of teetotalers. Paul writes that this may reflect on the mothers, "who may be more relaxed themselves."

Relaxation may be key, according to Paul. While everyday stress may "actually be good" for the child, chronic and especially traumatic stress may be harmful. So, too, is depression, she said.

While acknowledging that male doctors have been behind some of the signature research on fetal development, Paul believes that the increasing number of female doctors has changed the field. Being female helped in preparing the book, too. "Having been pregnant certainly gives you a perspective," she said. "I wanted to incorporate the personal aspect into the scientific." She combines the research with her personal experiences in each of the nine months of her pregnancy.

Pregnancy "is a very fraught subject," Paul said, and she hopes her book helps to put pregnant women at ease. Women too often fear that "they're one false move away from hurting their fetus," she said. "Women are so afraid of doing things wrong that they're forgetting the miracle of how often things go right."

By putting the research into perspective, Paul hopes to let women think that they can work during pregnancy as long as they realize that it's OK to not go full bore at all times. "I think the notion that pregnant women can't slow down is foolish," she said, though "our continuing economic malaise may keep that anxiety going."

"There's no such thing as a perfect pregnancy," Paul said. "It's an adaptive process. It allows us to be fitted for the world we live in." No matter how good the prenatal care is — and she urges more and better prenatal care — "so many factors are out of our control."

That said, she doesn't recommend lots of highballs and Philip Morris Commander.

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