WEBVTT

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Today I'm talking to
Vivette Glover, who

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is Professor of Perinatal
Psychobiology at Imperial

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College, London.

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Vivette.

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We've been exploring
in this course,

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the way in which the
parents' emotional mind

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and their cognitive
mind influence

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the development of the foetus.

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Can you start by
telling us a little bit

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about foetal programming?

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Yes.

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Foetal programming is the
idea that the environment

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in the womb affects how
the foetus develops,

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with a long term
effect on the child.

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We've always known
that how we turn out

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depends on an interaction
between our genes

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and our environment.

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What we now realise is the
environment starts in the womb.

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So can you tell us a
little bit about what

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the particular aspects
of the environment

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are that are important?

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Well, there are different
ones depending on what

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outcome one's interested in.

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This whole subject was
given a great impetus

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by the work of David Barker.

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And he found that
babies that had

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grown less well in the
womb, smaller babies,

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were more likely to die
of cardiovascular disease

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in their 70s than larger babies.

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So he formulated what was
called the Barker hypothesis.

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That was that undernutrition,
as he called it in the womb,

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predisposed to vulnerabilities
to the metabolic syndrome

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in later life.

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That's cardiovascular disease,
raised blood pressure,

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diabetes, obesity.

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And we now understand a lot
about the mechanisms underlying

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that.

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That if the baby is grown less
well than it was genetically

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designed to in the womb, the
less kidney cells laid down,

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less pancreatic cells.

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And that makes it harder for
the child and later adult

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to deal with environmental
problems such as high salt

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in later life.

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Makes he or she more vulnerable
to cardiovascular disease

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and so on.

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If the baby was small because
the parents are genetically

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small, or they come from an
ethnic group that is small,

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then that's not a problem.

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It's only if they've
grown less well than they

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were genetically designed to.

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So the original
interest was really

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in the nutritional
status of the mother.

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Yes.

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Though we now understand that
how the baby grows in the womb

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depends on lots of factors.

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So the nutritional status
of mother is only one.

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In fact, rather a minor one.

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If the mother has very
little calorie intake,

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less than a thousand calories a
day, then the baby is smaller.

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But there are actually
a lot of other reasons

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why the baby can grow
less well in the womb.

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It is not primarily usually
the nutritional state

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of the mother.

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OK.

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So we've discovered recently
about the importance

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of the mother's emotional
state of mind in pregnancy

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and in particular, things such
as anxiety and depression.

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Can you tell us a bit about
what that research tells us?

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Yes.

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We now realise that foetal
programming is as important

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for neural development
and for vulnerability

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to psychopathology, as it
is for physical development

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and vulnerability
to physical disease.

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There's now a lot of
evidence that if a mother

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is anxious or depressed or
stressed while she's pregnant,

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this affects the development
of the foetal brain

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and has an impact
on the later child.

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It has an increased risk.

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All the things we're talking
about are increase of risk.

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Most children of even very
stressful, depressed mothers

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actually aren't affected.

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But if the mother is in the top
15% for anxiety or depression

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in a normal population,
this doubles the risk

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of her child having
symptoms of ADHD

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or conduct disorder or emotional
problems as they grow up.

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So what you're saying is that
the duration and the chronicity

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of her experience of
anxiety or depression,

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affects whether the foetus
is adversely affected.

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We don't know very much about
the duration or the chronicity,

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actually.

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That's an aspect that we need to
have much more evidence about.

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We know that if she is
anxious or depressed

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at some stage in pregnancy,
that does increase the risk,

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but there are a lot of unknown
questions about the timing

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and the chronicity.

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So it's essentially the
severity that is the key issue.

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Well also, there's a lot
we need to know about that.

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In some of our research, we
found a dose response curve.

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That the more anxious the
mother was, the greater

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the risk of the child
having problems.

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But it's not true to say
it's only toxic stress

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or extreme stress that matters.

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Some studies have found
increased risk for the child

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if the mother's exposed to more
daily hassles, for example.

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Or if she has increased
pregnancy-related anxiety.

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So there does seem to be
a dose response curve.

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But we mustn't just focus
on the very extreme end.

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There's some evidence
that for some outcomes

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for cognitive development
and physical maturation,

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that a certain amount of stress
actually can improve outcome.

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Prove cognitive development.

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And it's been suggested
that for some outcomes,

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it might be an inverse
U-shaped curve.

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That a little bit of stress
improves and a lot of stress

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makes the outcome worse.

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But I think a lot depends which
outcomes you're looking at.

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For emotional
behavioural outcomes,

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we haven't found that.

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We just found a linear
dose response curve.

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So what other sorts
of outcomes are

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affected by anxiety and
depression in pregnancy?

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Well, one thing that's
striking about this research

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is the wide range of outcomes
that can be affected.

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There's emotional, a child's
more likely to be anxious

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or depressed themselves ADHD,
conduct disorder, cognitive

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development.

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Some studies have
looked at, particularly,

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language development.

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There also can be an impact
on physical development.

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The babies are somewhat
more likely to be

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born a few days early, or a
little bit lower in weight.

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It's a fairly small
effect. but well-reproduced

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in large studies.

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There can also be
physical effects.

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There can be effects
on the immune system,

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more vulnerability to asthma.

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Two recent studies have shown
a decrease in telomere length.

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And that's interesting
because the telomere

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is the end of the DNA, and
a shorter telomere length

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is associated with
living less long.

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So the one thing
that's really striking

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is there's certainly not just
one outcome that's affected.

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There seem to be a range of
outcomes, that are affected.

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We're starting to
do research now

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on trying to understand why
some children are affected

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and not others
and we're starting

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to have evidence that there's
a gene environment interaction.

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So that if the child has
a particular form of gene,

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for example, it
causes vulnerability

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to emotional problems.

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Then, if the mother is
anxious while she's pregnant,

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they're more likely to
have emotional problems.

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So you have another form of
the gene, very resilient.

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And the same with symptoms of
ADHD, the same with memory.

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So, we think that
what's happening

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is that if the mother
is anxious in pregnancy

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and the child has a particular
genetic vulnerability

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to a particular condition
and that double whammy

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can make the child have that
increased risk of that outcome.

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And things aren't
all over at birth.

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The outcome is also affected by
the quality of the mothering.

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The attachment and so on.

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We've also found that the
child is securely attached.

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For example, that could
protect against some problems

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with cognitive outcomes.

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So what are the
mechanisms by which

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this happens in pregnancy?

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Well, from animal models,
we've had a particular focus

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on the HPA axis, a system that
makes us stressful in cortisol.

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But in humans, we're
not rats and it

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looks as though it could
be a bit different.

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If the mother is stressed
or actually so depressed,

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her cortisol often
doesn't go up very much.

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And we actually don't know
what the biological change

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in the mother is, that's
significant for this.

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There must be something.

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We've looked quite a
lot, and others are too,

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at the function of the placenta.

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And it's clear the placenta
filters what passes

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from the mother to the foetus.

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And if the mother is
anxious or depressed,

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this affects the
function of her placenta.

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And allows more cortisol
to pass through.

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So even if the mother's
own cortisol isn't raised,

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the foetus may be
exposed to more cortisol.

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We're also getting some
evidence that there's

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a decrease in the enzyme
that breaks down serotonin

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and the foetus may be more
exposed to serotonin too.

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And we know that if the foetal
brain and development is

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exposed to higher levels
of cortisol or serotonin,

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that can affect the
neural development.

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So we're just starting to begin
to understand the underlying

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mechanisms, but we're only
scratching the surface

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of understanding that.

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More research is needed.

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Much more research.

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But it's not so much a mystery.

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I mean, we could see the
sort of pathways that are

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likely to be underlying this.

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So in terms of the
mechanisms, what

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does recent research
about epigenetics tell us?

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There's a lot of research now
in this area about epigenetics.

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Epigenetics means
on top of genetics.

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And it's how genes
are expressed.

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Whether a gene is turned
on or off or how much

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it's turned on or off.

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And that's affected
by the environment.

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And we think and there's
growing evidence,

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that a lot of these effects
on the foetus and the child

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are mediated by
epigenetic changes.

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So that if the
foetus in the womb

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is exposed to higher
levels of cortisol,

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this could cause epigenetic
changes in the brain.

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Which then affect the
development of the brain.

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So what sorts of
things can we do

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to help women in pregnancy who
are experiencing high levels

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of anxiety or depression?

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Well there's a range
of things we can do.

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We know that perinatal
services is still

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a Cinderella, well mental
health services in general,

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is Cinderella of the NHS.

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We know that most women who
are anxious or depressed

00:10:41.060 --> 00:10:44.480 align:middle line:84%
in pregnancy, this isn't picked
up and they're not treated.

00:10:44.480 --> 00:10:49.010 align:middle line:84%
So the first thing to do is
to have increased training

00:10:49.010 --> 00:10:52.330 align:middle line:84%
of midwives and health
visitors, obstetricians,

00:10:52.330 --> 00:10:54.465 align:middle line:90%
so that they detect this.

00:10:54.465 --> 00:10:56.620 align:middle line:84%
There's a lot of
willingness to do it,

00:10:56.620 --> 00:10:59.674 align:middle line:84%
but they haven't got time and
they're not properly trained

00:10:59.674 --> 00:11:00.965 align:middle line:90%
often, though that's improving.

00:11:00.965 --> 00:11:03.870 align:middle line:90%


00:11:03.870 --> 00:11:06.060 align:middle line:84%
Professionals looking
after pregnant women

00:11:06.060 --> 00:11:08.450 align:middle line:84%
have to be much more
aware that these

00:11:08.450 --> 00:11:12.980 align:middle line:84%
are very important problems for
the mother and for the child,

00:11:12.980 --> 00:11:15.446 align:middle line:84%
and to detect an
offer treatment.

00:11:15.446 --> 00:11:17.950 align:middle line:90%


00:11:17.950 --> 00:11:20.220 align:middle line:84%
Then as a society, there's
a lot more we can do.

00:11:20.220 --> 00:11:23.600 align:middle line:84%
Employers need to be aware
that this could be a problem.

00:11:23.600 --> 00:11:26.580 align:middle line:84%
And some women love
working through pregnancy.

00:11:26.580 --> 00:11:27.820 align:middle line:90%
But some don't.

00:11:27.820 --> 00:11:30.250 align:middle line:84%
Some find it's getting too
much, physical activity

00:11:30.250 --> 00:11:31.000 align:middle line:90%
could be too much.

00:11:31.000 --> 00:11:32.541 align:middle line:84%
There should be much
more sensitivity

00:11:32.541 --> 00:11:35.800 align:middle line:84%
to giving women a choice
of how and when they

00:11:35.800 --> 00:11:37.900 align:middle line:90%
work during pregnancy.

00:11:37.900 --> 00:11:40.150 align:middle line:84%
We know that social
support is very important.

00:11:40.150 --> 00:11:43.410 align:middle line:84%
The partner is probably
the most important of all.

00:11:43.410 --> 00:11:45.090 align:middle line:84%
The support of
partner can really

00:11:45.090 --> 00:11:48.240 align:middle line:84%
buffer against emotional
problems in other.

00:11:48.240 --> 00:11:50.920 align:middle line:84%
Not completely, but they
could do a lot to help.

00:11:50.920 --> 00:11:53.780 align:middle line:84%
An abusive partner
could, on the other hand,

00:11:53.780 --> 00:11:55.700 align:middle line:90%
make things much worse.

00:11:55.700 --> 00:11:58.230 align:middle line:84%
So I think to be aware of
the role of the partner,

00:11:58.230 --> 00:12:00.300 align:middle line:84%
health professionals
and others ought

00:12:00.300 --> 00:12:04.620 align:middle line:84%
to help bring the partner
in to maternity services.

00:12:04.620 --> 00:12:08.170 align:middle line:84%
And friends, family,
we all could do a lot

00:12:08.170 --> 00:12:10.550 align:middle line:90%
to support pregnant women.

00:12:10.550 --> 00:12:14.129 align:middle line:84%
Then in terms of what
actual professional help can

00:12:14.129 --> 00:12:15.670 align:middle line:84%
be offered, there's
a range of things

00:12:15.670 --> 00:12:17.310 align:middle line:90%
depending on the problem.

00:12:17.310 --> 00:12:20.540 align:middle line:84%
But we know how to treat
anxiety and depression,

00:12:20.540 --> 00:12:23.210 align:middle line:84%
and it's not different
in pregnancy.

00:12:23.210 --> 00:12:26.470 align:middle line:84%
So if it's very severe,
a woman's very severely

00:12:26.470 --> 00:12:29.150 align:middle line:84%
depressed, antidepressants
are probably indicated.

00:12:29.150 --> 00:12:32.200 align:middle line:84%
But for many other women,
it won't be the right thing.

00:12:32.200 --> 00:12:37.700 align:middle line:84%
So one could try CBT
or IPT or mindfulness.

00:12:37.700 --> 00:12:42.250 align:middle line:84%
A lot of interventions
that can help.

00:12:42.250 --> 00:12:44.930 align:middle line:84%
But the main thing,
I think, is not

00:12:44.930 --> 00:12:47.620 align:middle line:84%
which intervention - though
that has to be worked out -

00:12:47.620 --> 00:12:50.900 align:middle line:84%
but detection and then
having enough people who

00:12:50.900 --> 00:12:52.660 align:middle line:90%
can provide interventions.

00:12:52.660 --> 00:12:54.540 align:middle line:84%
And you've developed
a website that

00:12:54.540 --> 00:12:58.210 align:middle line:84%
is targeted at both
parents and professionals?

00:12:58.210 --> 00:12:58.720 align:middle line:90%
Yes.

00:12:58.720 --> 00:12:59.350 align:middle line:90%
Yes.

00:12:59.350 --> 00:13:01.590 align:middle line:84%
Just to tell people more
about all the things

00:13:01.590 --> 00:13:02.960 align:middle line:90%
we've been discussing.

00:13:02.960 --> 00:13:05.540 align:middle line:90%
It's called Begin Before Birth.

00:13:05.540 --> 00:13:07.150 align:middle line:84%
If you google
Begin Before Birth.

00:13:07.150 --> 00:13:10.130 align:middle line:84%
What sort of things will
people find on the website?

00:13:10.130 --> 00:13:12.990 align:middle line:84%
Well, they'll find
more about the effects

00:13:12.990 --> 00:13:15.950 align:middle line:84%
on the child, the nature
of anxiety and depression,

00:13:15.950 --> 00:13:18.770 align:middle line:90%
the underlying mechanisms.

00:13:18.770 --> 00:13:20.810 align:middle line:84%
Vivette, this is
fascinating material.

00:13:20.810 --> 00:13:22.930 align:middle line:90%
Thank you very much.

00:13:22.930 --> 00:13:28.149 align:middle line:90%