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富爭議性的fetal origins research
( 2010-11-19 )



      母親在懷孕期的生活習慣,吃的、喝的、服用的,以及身體和精神狀況,究竟對孩子日後的身心健康有什麼影響?若有影響,程度又有多大呢?
      這些都是大家關心的問題。醫學界也做了很多研究,但在很多問題上仍未有共識,而且一些論點也引起了不少爭議。最近出版的Origins - How the Nine Months Before Birth Shape the Rest of Our Lives(《源頭——出生前的九個月如何影響我們的一生》),討論的就是這個課題。
      後天影響始於受孕
      書的作者Annie Murphy Paul是屬於“影響派”:
       ... fetal origins research suggests that the lifestyle that influences the development of disease is often not only the one we follow as adults, but the one our mothers practiced when they were pregnant with us as well.
       (有關懷胎期影響的研究指出,影響生病的,並不只我們作為成年人所選擇的生活方式,還包括我們的母親懷胎時的生活方式。)
      但這種論點未必人人接受。英國的David Barker醫生在二十多年前提出,母親懷孕時營養不良增加孩子長大後患心臟病機會,這論點就引來批評:
      Barker's hypothesis(推論) was initially dismissed by the medical establishment as an artifact (人工製品) of looking in hindsight(事後觀察) at birth-weight and the later development of disease, without detailed knowledge of what happened in the interim.
      研究這個課題必須面對很多限制。你只能主要靠觀察孕婦的日常生活,斷不能刻意採取危害孕婦或甚至胎兒的方法:
       ... no one would purposefully have one group eat in a possibly risky(具危險性的) way or be exposed to a potentially dangerous(有潛在危險的) substance, and compare outcomes with an unperturbed(不受騷擾的) control group.
      以這種研究方法,最多只能找到母親的生活方式與孩子的未來健康的可能關係,而非明確的因果:
      We have, at best, only correlations between a mother's lifestyle and her child's future health, not clear causation.
      但根據Annie Murphy Paul的論點,世界各地越來越多這種observational studies(觀察式的研究)指向"nurture begins at the time of conception"(後天的影響是由受孕一刻已開始),而不是等到孩子誕生。
      “準媽媽”更添焦慮
      傳媒報道的手法,也是令有關母親行為影響胎兒的理論富爭議的原因之一。因為這些研究往往是用"sensational and scolding"(煽情和責備性的)手法報道,"cast as one long ringing alarm bell"(被描繪成一種長響的警鐘)。
      很多孕婦的心情本已戰戰競競,強調她們的行為對胎兒的影響只會火上加油︰
       ... risks bringing the normal simmering anxieties(正常的慢燃的焦慮) of pregnancy to a neurotic boil(神經質的沸騰).