For its remarkable research project Generation R, Erasmus University has been following seven thousand children from Rotterdam for the last 15 years. Literally from the womb – research started during pregnancy and continues into their teenage years. Vincent Jaddoe is one of the professors involved in the follow-up study, Generation R Next. ‘Research on this scale is unique in the world. No other university has ever done this.
Which results of Generation R can you share at this point?
‘We noticed that a lot of the things that happen during pregnancy have effects on the health of the child later on. Some things you don’t notice right at birth, not until many years later. We always knew drinking alcohol and smoking were bad for a baby’s health. Through this research we now have ways to register the effects years and years down the road. Nevertheless, a lot of women continue to consume alcohol or cigarettes during pregnancy, about fifty percent.
We started out with thirty thousand people, children as well as their parents. This alone is unique in the world, research on this scale has not been done before. Erasmus Trustfonds helped us getting started.’
Why this follow-up, called Generation R Next?
‘In order to find out how we can improve the health of children and future generations, it’s important to start collecting data at the very beginning of a pregnancy, or even before a woman becomes pregnant. Existing studies always start at 13 weeks, from around the time a pregnant woman sees her midwife for the first time. But it’s even more interesting to start monitoring a woman’s health before she gets pregnant.’
Why is that?
‘What happens during the first twelve weeks of pregnancy is essential to our health later in life. Diseases like high blood pressure or obesity sometimes find their cause in these first twelve weeks. We would like to to monitor pregnancies from the very day of conception, and also be able to stage interventions. What happens after we advise women to go on certain diets, or take other lifestyle-related measures? Will the health of their babies improve? After all, the ovum from which each of us originates came into being when our mothers were still in our grandmothers’ wombs. In the perfect situation, women adopt healthy lifestyles before they ever get pregnant. Ideally, you’d live a healthy life throughout your whole lifetime. I know that’s not realistic. But what we can do, at least, is raise awareness of the fact that everything a woman does has consequences for later generations. That’s why we seek to include more women who plan to have children in the near future.’
It hasn’t been done before?
‘A few universities tried something similar, but never at this scale. For Generation R Next, we would like to follow as many as five thousand women. We’ve already found more subjects than expected for our pilot, about five hundred of them, so I’m sure we will succeed. With all the knowledge gained from Generation R we’ll be able to move forward successfully. It’s helpful that Sophia Kinderziekenhuis is located in the centre of the city of Rotterdam. As is the fact that we collaborate with a lot of midwives. And Rotterdammers in general tend to be familiar with the project Generation R. For many people, a compelling reason to sign up for the project is that we provide an additional echo.’
What do you hope to achieve?
‘The main reason for this research is developing better healthcare, and having healthier children as a result. Rotterdam is a challenging city, because of the diverse population, both socially and ethnically. Apparently, we still haven’t managed to get our message across to women. Why do so many women still make unhealthy choices during pregnancy? We aim to change our approach so we can reach every family, especially those who are most vulnerable. It’s not just about not smoking, or taking folic acid. In certain groups of women we see every conceivable health problem converge. They smoke, drink alcohol, eat an unhealthy diet, suffer from anxiety, can’t understand advice from their midwives, et cetera.’
When do you expect the first results?
‘Generation R Next started last August. We expect to present our first results in about four years’ time. Currently we’re in the start-up stage. We started the monitoring process, and later this year we will begin intervening. One group of pregnant women receives regular care, while the other receives specific health-related advice.’
Is it possible to change someone’s lifestyle or nutrition habits?
‘It is very difficult indeed. But women who are hoping to get pregnant tend to be more open to changing their habits. Because in the end, everybody wants to have a healthy baby.’
It’s probably not just about smoking and alcohol.
‘We know these three things are very harmful – alcohol, smoking and doing drugs – but of course, health is a broader concept. We’ve identified four themes. Lifestyle, which includes smoking and alcohol; and diet - we know for example that overloading on sugar is harmful for unborn babies. There’s coping with stress; and then there’s the process of raising a child; everything that happens after birth. These four themes are interconnected. If you don’t take action to decrease someone’s stress level, it doesn’t make sense to prescribe a diet. It’s very important to work on all four of these themes. For women who suffer from stress, depression or anxiety during pregnancy, we have mindfulness courses, for example.’
Why does this project need donations?
‘Because we won’t have any results to show within the next four or five years. That makes it difficult to get subsidies at this point. As soon as the research is well underway and we have outcomes, that changes. But in this early stage we need people who really believe in this project. En who believe it’s important to do this kind of research, on this scale, in Rotterdam; this unique city with so much diversity and so much opportunities to improve.’
What’s your personal motivation?
‘Here at work, at Erasmus MC, we face every kind of problem that can possibly occur during birth, or in the early stages of life. I would like to contribute to healthier generations in the future.’