# You: Having a Baby: The Owner’s Manual to a Happy and Healthy Pregnancy

Michael F. Roizen, Mehmet C. Oz

America's most loved and respected doctors, Michael Roizen and Mehmet Oz, tell you what to expect when you're expecting. Packed with excellent information and surprising advice, the multi-million-copy bestselling authors have written a riveting, definitive resource that every mum- and dad-to-be will want with them throughout their special time.This new tour de force from the bestselling authors of You: On a Diet accompanies expectant parents week by week through pregnancy. Full of the latest cutting edge information and written in the authors’ highly entertaining style, this compelling book is a must for all mums and dads to be.

## YOU. Having a Baby. The Owner’s Manual to a Happy and Healthy Pregnancy. MICHAEL F. ROIZEN, MD. AND MEHMET C. OZ, MD

with Ted Spiker, Craig Wynett, Lisa Oz, Linda G. Kahn,

and Margaret L. McKenzie, MD

Illustrations by Gary Hallgren


## DEDICATION

To mothers, who bring life into the world, and their babies, who are the future

## NOTE TO READERS

This publication contains the opinions and ideas of its authors. It is intended to provide helpful and informative material on the pregnancy-related subjects addressed in the publication. It is sold with the understanding that the authors and publisher are not engaged in rendering medical, health, or any kind of personal professional services in the book. The reader should consult his or her medical, health, or other competent professional before adopting any of the suggestions in this book or drawing inferences from it.

In addition, this book sometimes recommends particular products or websites for your reference. Drs. Oz and Roizen are not affiliated in any way with such products or entities (with the exception of the RealAge website and doctoroz.com). In some instances, other coauthors or contributors may be affiliated with a referenced product or website, but recommendations were made independent of such affiliation. In all instances, bear in mind that there are many websites and reference materials other than those recommended here that may provide useful information to you.

The authors and publisher specifically disclaim all responsibility for any liability, loss, or risk, personal or otherwise, which is incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this book.

## CONTENTS

TITLE PAGE

DEDICATION

NOTE TO READERS

INTRODUCTION: Hey, You! Having a Baby?

Part 1: YOU-OLOGY HOW TWO BECAME YOU

1. Nice Genes A New Twist on Genetics Teaches Us How a Baby Really Develops

YOU TIPS

2. Feeding Time The Delicate Role of the Placenta in the Development of Your Child

YOU TIPS

Part 2: YOU CHANGING THE BABY

3. Eating for Who? Manage the Moments When You Feel Like Feeding on Everything—or Nothing at All

YOU TIPS

4. Growing to Extremes How to Make Sure Your Baby Isn’t Too Plump or Too Puny

YOU TIPS

5. Makes a Lot of Sense The Fascinating World of Senses Teaches Us About the Amazing Development of the Brain

YOU TIPS

YOU TOOL INFANT MASSAGE

Part 3: THE BABY CHANGING YOU

6. The Mind of Mom Manage Your Stress, Sleep Better, and Find the “Om” in Mom

YOU TIPS

7. Let’s Talk About Sex How Hormonal Changes Can Do Quite the Number on You and Your Body

YOU TIPS

YOU TOOL HOW TO PICK A BIRTHING CLASS

8. Body in Motion Tackle the Unpleasant, Uncomfortable, and Sometimes Risky Side Effects of Pregnancy

YOU TIPS

Part 4: YOU BRINGING BABY INTO THE WORLD

9. Special Delivery Find Your Way Through the Adventure That Is Labor and Birth

YOU TIPS

10. And in the Beginning … Challenges—and Rewards—of the First Month After Delivery

11. Your Pregnancy Plan Use This Checklist to Arrive at Life’s Most Amazing Destination

12. Your Pregnancy Toolbox Essential Strategies for Improving the Health of You and Your Child

YOU TOOL 1: Exercise

YOU TOOL 2: Choosing Your Care

YOU TOOL 3: Guidelines For Medications And Toxins

YOU TOOL 4: Preparing Your Home For Baby

YOU TOOL 5: Pop’S Pregnancy Recipes

YOU TOOL 6: Just For Dad

Appendix

Appendix 1: The You Prepregnancy Plan

Appendix 2: Fertility Issues

Appendix 3: Vaccinations

Appendix 4: The Basics of Preemies and Multiple Births

Appendix 5: Postpartum Depression Scale

Appendix 6: In Utero Growth Chart: Average Size

INDEX

ACKNOWLEDGMENTS

OTHER WORKS

COPYRIGHT

ABOUT THE PUBLISHER

### INTRODUCTION Hey, You! Having a Baby?

Stand at the edge of the Grand Canyon, and your body rockets into sensory over-load. Your eyes widen, your jaw drops, and your neurons spit out more adjectives than a novice novelist. Majestic, awe inspiring, glorious, astonishing, so my-oh-my beautiful that you want to fall to your knees and bow to the deity that created this masterpiece.

Then you freak out.

That, in essence, is pregnancy: On one hand, it’s the most breathtaking thing you’ve ever experienced. On the other, it’s a looooong way to the bottom of the canyon, just as it is a looooong way from conception to birth—so you can’t help but have some anxiety about taking a wrong step along the way. There’s no doubt that pregnancy evokes a similar diversity of emotional and physiological responses as do such natural wonders: laughing, crying, screaming, dry mouth, dry skin, dry heaves (and that’s just the first day). What we’re here to do is help you manage both extremes of the emotional spectrum, so you can appreciate such a miraculous process and conquer the anxiety and tension through a very powerful weapon: knowledge.

Whether this is your first pregnancy or your fourth, or you’re trying so hard that you’re spending more time on your bed than a throw pillow, you probably think you know a thing or two about being pregnant. Either you’ve gone through it before or you’ve had friends, sisters, and sixteen trillion baby bloggers to give you the inside-the-womb scoop.

However, we’d ask that you hold on one diaper-changing minute. We’re here to bust myths, challenge your brain, and prepare your body for the greatest journey that any human can ever take—from the moment two cells become one to the second that your little squirt makes its first appearance outside the comforting shell of your belly.

To whet your appetite, we’d bet a case of Gerber bananas that you didn’t know things like:

• The whole notion of nature versus nurture is as wrong as a three-legged crib. That’s because a cutting-edge field called epigenetics has shown us that you have control over how the genes of your baby will express themselves.

• What happens during these 280 days on the inside actually teaches your child about how his body should act on the outside. He’s actually forecasting his future—and that teaches him how healthy or unhealthy he will be years down the road.

• While most people assume that a mom’s biological cocoon supports the child unconditionally, the truth is that your body is actually engaged in a very delicate dance to balance the often competing needs of mom and child.

• There’s a biological reason why your areolas are dark, why your feet swell, and why one minute you gag at the thought of eating a cracker and the next minute you can’t wait to get your hands on a salsa-smothered cantaloupe.

The good news is that we’re here to help by teaching you crazy-cool things about your body and giving you the tools to maximize your experience and get the result you want: a healthy and happy baby.

Now, if you’re like most women, we’re guessing that you’ve already spent a lot of time thinking about what’s in store. You’ve probably spent all-nighters scouring pregnancy websites and parked yourself in cushy bookstore chairs with thigh-high stacks of mom-to-be manuals. Maybe you haven’t been this nervous since your sixth-grade oral report on rain forests, or maybe you haven’t been this obsessed with something since McDreamy made his prime-time debut a few years back. You’re probably poring over baby names, wondering why you crave pretzels dipped in marinara sauce, and debating about whether the nursery walls should have the hue of sunshine, cotton candy, or pomegranate juice.

Nope, there’s nothing quite like this internal conflict that is pregnancy. One moment, you’re thrilled, elated, and impatient for your baby’s first smile, babble, and soothe-your-soul hug. The next, you feel anxious about a million unknowns—about what’s going on inside your belly, about whether your little one is growing properly, about how you’re going to function on zippo sleep. Since this happens to just about everyone, it must, in fact, be strangely ideal. The truth is that vigilance has great benefits. You’re supposed to pay close attention. Our goal is to ensure that you focus on the right clues.

As you struggle to maintain your equilibrium, we want you to relax and take time to enjoy the beauty of the process. The most important thing to keep in mind is that most pregnancies turn out absolutely fine. Absolutely fine. Women’s bodies are designed to carry children safely and efficiently. That doesn’t mean everything will be smooth sailing on this journey, but it does mean that the odds are greatly in your favor. If you can learn how to maximize your chances that nature runs the course it’s supposed to, you will increase those odds even further. This book will help show you how.


### Introducing Your New Dance Partner

So let’s start by rethinking our perception about conception (and beyond). Back in sex-ed class, most of us were taught a pretty simple recipe for how pregnancy works:

Ingredients

1 egg, mature

100 million sperm, very, very excited

Instructions

Preheat oven. Mix ingredients romantically. Cook bun for forty weeks.

Sprinkle with love and serve to the world.

The bun-in-the-oven image has served us well over the years, underscoring the belief that mom is protector and baby is protected, that mom is cook and baby is concoction, that mom is in control and baby is not. But there’s a fundamental problem with this analogy when it comes to the true biology of pregnancy (besides the fact that nobody bakes buns anymore): Baby has a heck of a lot more say about the whole process than a cinnamon raisin roll does.

In fact, pregnancy is more like dancing than cooking. You and your baby have a dynamic, choreographed relationship—one in which you lead and the baby follows. Your subtle movements and directions help show your baby how to grow and develop. After all, it takes two to tango, or in pregnancy terms, it’s uter-us, not uter-I.

But your baby isn’t always the most cooperative partner. Sometimes he’ll want to take the lead, sometimes he’ll send you signals about which way he wants you to move, sometimes he’ll improvise, sometimes he’ll do flips, and sometimes he’ll step on your feet and get everything all tangled up. Part of the reason he’ll act this way is that your body has a certain amount of biological ambivalence about this little cellular critter; after all, only half his genes are yours. Your relationship with him isn’t exactly hostile, but it’s not always warm and fuzzy either. Even at this young age, he’s going to try to assert himself, and your body may try to resist. There are evolutionary reasons for this, which we’ll discuss in the pages to come, but you can also think of these initial rebellious acts as practice for the years ahead.

Pregnancy can be as elegant as a waltz, as high-energy as a salsa, and as scattered as a twist (with a whole lot of shouting). Our main goal in YOU: Having a Baby is to teach you about this ingenious biological dance—a dance in which you have the ability and the artistry to guide your baby not only to a healthy delivery, but to a lifetime of good health as well.


### What’s in It for YOU

While many pregnancy books tell you what to do, we aim to add a deeper level of meaning in true YOU style and explain why. After all, when you truly understand the why, the what is much easier to adopt. Instead of giving you a week-by-week or hiccup-by-hiccup guide to pregnancy, we’re going to take a more holistic approach, focusing on how your mental and physical health affect your baby, and how—at the same time—pregnancy affects your mind and body. Of course, we’ll provide plenty of our signature YOU Tips and YOU Tools to help you make the best choices for a safe and healthy pregnancy, but we’re going to take you there a little bit differently than other pregnancy guides may. Here’s what you can expect[*] from us:

We want you to understand at the base level how epigenetics works and why it’s important. Starting with the moment you go from making love to making a baby,[†] we’re going to explain how you can influence your child’s development through this field—perhaps the most important developed in the last decade. Many of us believe that the genetics of our children are predetermined the moment that the sperm radar locks on its desired egg. But the truth is that research from various sources is suggesting that during pregnancy, you may actually be able to turn your future baby’s genes on and off. Epigenetics is not just how the musical notes of our genes are played but also how loud the volume is turned up. Since the acoustics in the womb and the real world might be different, we want these as aligned as possible. And that’s where all the magic takes place, no matter where you are in pregnancy or in parenthood. You have the ability to control genes anytime.

You’re also going to learn quite a bit about the key player that mediates between you and your baby, transmitting all the signals that create those epigenetic changes. That player, which gets about as much attention as a dollar bill on a blackjack table, is the placenta. This beautifully functioning organ is the place where mom and child interact, where nutrients are exchanged, and where growth and development patterns are determined.

After explaining the workings of the placenta, we’ll focus more closely on nutrition (both yours and baby’s), explaining how too much, too little, or the wrong nutrients all play roles in the health of both you and your child. Here you’ll discover why the thought of food makes you green on some days, while other days you long for an artichoke-heart milk shake. We’ll also talk about such things as fetal brain development, how to manage (and prevent) postpartum depression, and important pregnancy-related medical conditions like gestational diabetes.

In the second half of the book, we’ll help you manage the wide range of side effects you may be feeling—everything from heartburn and insomnia to medical complications like preeclampsia. Finally, we’re going to present a bunch of great features you can use, including:

Broadway to Birth: Our cool, interactive board game will take you through the amazing adventure that is labor and delivery to help you understand which elements you can control and which elements you need to leave to the pros (whom we’ll help you choose, based on your own labor and delivery goals).

A Top Eight List of Postpartum Issues: And after you deliver your baby, you’ll appreciate our chapter on everything you need to know to take care of yourself and your newborn in the first month of life. This is where the second adventure begins.

The Ultimate Pregnancy Flight Plan: Step by step, we provide the instructional dials, controls, and levers that will allow you to pilot your way to a safe landing. After all, you’re carrying a very precious passenger. This plan is the shorthand version of all the best tips and strategies we give throughout the book.

YOU Tools: At the end of the book, we will give you specific advice about exercise, diet, vitamins, and the like that should serve as an action plan not only for pregnant women, but really for all potentially fertile women (that’s because 50 percent of pregnancies are unplanned, and the actions you can take for your baby can start at least three months before sperm and egg mate). We also provide guidance on everything from choosing a doctor or midwife to preparing your home for a baby to recipes your partner can make for you during your pregnancy.

### Yeah, Baby!

Before you get to most of the features at the end of the book, we think it’s helpful to really understand the way the pregnant body works—and remember, it’s your whole body that’s pregnant, not just your belly. Woven throughout the book, you’ll see several major themes that reflect our overall view of pregnancy:

• Your body is an amazingly resilient and adaptive piece of biological machinery. The size of your belly and the stretching of your skin aren’t the only changes that occur during pregnancy:Your insides are metamorphosing too. Your heart beats faster to make sure nutrients are pumped to the fetus. Your hormone levels fluctuate to prepare your uterus for growth. Your musculoskeletal system relaxes, giving you more flexible joints and more curvature in the back to prepare for carrying and delivering a baby. All these transformations mean that you may experience some unpleasant side effects (like constipation, for example). What’s interesting is that there’s an adaptive value to many of the symptoms of pregnancy, so that the nausea, breathlessness, and aching back you might feel, evolutionarily speaking, serve some value in protecting the growth of your child.

• The goal of pregnancy isn’t just to deliver a healthy baby but to lay the foundation for lifelong good health for your child—not to mention that of his children and grandchildren. That’s the amazing thing about epigenetics. Once you see some of the long-term effects you can have on the health of your child while you’re pregnant, you’ll realize that it’s important to start this process with the end goal in mind. We like to call it reverse engineering.

One of the ways that you can increase your chances for a successful pregnancy is to learn as much as you can about what’s happening, so you won’t be anxious. Simply educating yourself about what’s going on in your body is one of the smartest things you can do, because it allows you to roll with the punches rather than get KO’d by every little symptom or complication. In fact, staying calm during pregnancy has repeatedly been shown to have a positive influence on your child’s health.

So we want you to take the pressure off of yourself and not to try to do it alone. The key is to have some support, regardless of whether you’re married (about 40 percent of children are born out of wedlock), in a relationship, or flying solo. Your mother, sisters, friends, or even the internet buddies you meet on pregnancy websites can all become part of your support system. One of the features that has always distinguished human beings is that pregnant women have relied on other women in their communities to support them. Today, social support has been linked to improved fetal growth. (Those cavewomen knew what was good for them.)

In a way, managing your pregnancy really comes down to one overarching goal: managing stress. We’re not just talking about stress management in the traditional bubble-bath kind of way, but in the big-picture kind of way. How does your body cope with the stress of housing and growing what’s essentially a biological hitch-hiker? How does your baby adapt to potentially stressful situations that he’ll face in utero? (“Jalapeño attack, nine o’clock!”) How do you calm your mind in the face of the normal and natural anxieties that often arise during these nine months? How do you tell your mother-in-law that, no offense, but you prefer not to name your child Horatio Horace Humphrey?[*]

That’s exactly why we developed the ultimate pregnancy quality-of-life and stress quizzes. You can take them now (in this book or online at www.realage.com), as well as at various points throughout the next nine months, to see how you’re coping with all of the outside influences on your pregnancy.

Although neither of us has actually experienced pregnancy (obviously), between the two of us, we’ve fathered six children, and if you include our entire authorship team (half of whom are women, including an ob/gyn), we’ve had fifteen kids and delivered or participated in the delivery of more than eight thousand little tykes. So we have a pretty good idea of what it feels like to walk in your soon-to-be-too-tight shoes.

If you’re pregnant right now, we want to offer both congratulations and thanks. Thank you for letting us join you on this journey, and thank you for having the curiosity and passion for learning about what’s going on under the surface, under the skin, under the elastic-waistband pants you’ll soon be needing. As we step out into our exploration of this miraculous mambo, we would be impolite if we didn’t ask one final question: Would you like to dance?

### Pregnancy YOU-Q: Your Quality of Life Quiz

When somebody puts the words pregnancy and test in the same sentence, you expect to read about a little stick that gives you a yes or no, pregnant or not. We’re betting this pregnancy test is like none you’ve ever taken. For one thing, it isn’t going to give you an A or an F, a pass or a fail. This test is about something bigger: about understanding yourself and all the experiences that make up pregnancy. Some are exciting, some are stressful, and some may even be a bit painful.

This test is designed to help you get a sense of how you’re experiencing your pregnancy: how you feel about yourself, your journey, and the promise of parenthood. We will give you an overall score at the end of the test that will serve as a beacon to help you navigate that journey and guide your ship to calmer waters.

Take the test as often as you like, especially as your grow and learn about yourself during these nine months. Your score may change along the way—and that’s because you will too.

### YOUR Quality of Life: Sex

Answer each of the following questions on a scale of 1 to 5, 5 being this is Very True of Me:


Now check the box that best describes your feelings about this statement:


### Sex Score


### Interpreting Your Score

Your interest in sex will change somewhat during the course of pregnancy. In the first trimester, you’re likely to feel generally ill, not sexy. The middle trimester is the one in which most women report feeling best, so your interest in sex may go up again. By the third trimester, changes in your body and worries about hurting the baby may decrease your interest in sex again.

Keeping that in mind, if your score is:

3 to 6: Your interest in sex may actually have gone up since you got pregnant. Hooray for hormones! Remember that your body is going to change a lot over the course of pregnancy, and your interest in sex may vary during that time.

7 to 11: Your interest in sex is about what it was before you got pregnant. All of those changes in your body haven’t dampened your sexuality. Enjoy.

12 to 15: You’re showing less interest in sex than you may be used to. Don’t be too hard on yourself. Your body is going through a lot of changes. If you are feeling a much lower interest in sex even during the second trimester, you might want to check out our strategies for adding sensuality into your life, starting on page 172.

### YOUR Quality of Life: Cognitive

Answer each of the following questions on a scale of 1 to 5, 5 being this is Very True of Me:


### Cognitive Score


### Interpreting Your Score

There seems to be little that is helpful about difficulties making decisions, remembering, and concentrating, particularly for women who are trying to maintain a high level of job performance during pregnancy. As frustrating as these experiences may be, think of them as evidence of the transformative power of pregnancy. Plus, they may be good for a few laughs when it’s all over.

If your score is:

3 to 6: Congratulations. Even though you’re pregnant, you’re sharp as a cat’s claw. Somehow, being pregnant has given you laser focus.

7 to 11: Chances are, you’re having a few lapses in thinking. You may feel more indecisive than you did before you got pregnant, and you may have more trouble remembering things than usual. That’s quite normal during pregnancy, though it can be annoying.

12 to 15: You seem to be having a lot of trouble thinking since you got pregnant. Some moderate thinking problems are quite common in pregnancy. If you feel that you have slipped quite a bit, then you need to review aspects of your lifestyle. Are you eating properly? Are you getting enough sleep? If you have other kids already, are you getting some help taking care of them?

### YOUR Quality of Life: Craving and Appetite

Answer each of the following questions on a scale of 1 to 5, 5 being this is Very True of Me:


### Craving and Appetite Score


### Interpreting Your Score

During pregnancy, it’s crucial that you get good nutrition. Your body is working overtime to keep up your energy and to help you build the brain and body of your developing baby. Pregnancy is not necessarily a time to be adventurous about food. Indeed, in evolutionary terms, there is probably good reason to eat only the foods that you’ve eaten successfully in the past. Morning sickness actually evolved as a protective adaptation. Early in pregnancy, your body is protecting your baby from anything that might be harmful to it. Still, even if you are experiencing a lot of nausea, you need to do your best to feed your baby and to take your prenatal vitamins.

If your score is:

4 to 30: You are probably eating fairly well. Do keep track of how much you’re eating and focus on foods that will give you energy and also help your developing baby. If you do experience some nausea, remember that it is quite normal. See our plan in chapter 3 to help you figure out your diet and do your best to provide your baby with the building blocks for a healthy brain and body. And don’t forget your vitamins.

31 to 50: Nausea is affecting your eating. You may not be making the best choices about your food, so it’s important to listen to your body. At the same time, there may be simple changes you can make to your diet that will make you feel a bit better and will give your baby the nutrients needed for development. See chapter 3 to help you plan your diet. And don’t forget your vitamins.

51 to 70: you’re experiencing moderate nausea, which is affecting the way you eat. In addition, you may be having some cravings. It might be time to make a few midcourse corrections and to work on your diet to give your baby the nutrients needed for healthy brain and body development. Chapter 3 will give you some great suggestions to get started. And don’t forget your vitamins.

71 to 100: Nausea is having a huge effect on what you eat. Pregnancy can be hard on your body and on your frame of mind. It’s hard to think happy thoughts with your head in the toilet bowl. If you’re in your first trimester, remember that that’s when the nausea is usually worst. If you can get through it, you can face anything. You’ll need to make the best choices you can about foods. See chapter 3 to help plan your diet. And don’t forget your vitamins.

### YOUR Quality of Life: Body Image

Answer the following questions about your feelings in the last four weeks (using the scale indicated)


### Body Image Score


### Interpreting Your Score

8 to 16: You don’t seem to be at all worried about your body. In many ways, that is good. Make sure, though, that you are still keeping in shape. Eat balanced meals and nutritious foods. Exercise is good for you and for your baby. See page 310 for our exercise plan.

17 to 32: You have a small amount of concern about your body image, but it is not excessive. Pregnancy is a time of changes in your body. At the same time, you do need to make sure to take care of your body. A healthy body is good for you and your baby, and it will make it easier for you to have a body you like after you give birth. Make sure that you eat balanced meals and nutritious foods. Remember that exercise is good for you and for your baby.

33 to 48: You have quite a bit of concern about your body. It’s really crucial that you exercise during pregnancy and that you eat balanced, nutritious meals. You are eating for you and for your baby. It is possible that you have gained too much weight and that your doctor may recommend ways to help solve any problems that have come up. However, it is also possible that your weight gain is quite normal. (See page 68 for guidelines for gaining weight.)

### YOUR Quality of Life: Overall Score

To get a sense of how you’re doing overall right now, we’re going to create a total score for Quality of Life. Enter the scores from the four tests that make up the Quality of Life survey in the boxes as shown below.


On many tests, you aim to get the highest score possible. This test is a little different. When your Quality of Life score is low (close to 30), your life is in balance.

Trying to maintain your quality-of-life balance during pregnancy is a bit like trying to walk on a four-inch-wide gymnastics balance beam with your pregnant body. It’s not as easy as it looks, and it doesn’t look easy. It is also possible you have not gained enough weight and are overly concerned about your own shape without attending to what your baby may need. If that describes you, see your OB as soon as possible, and perhaps a nutritionist, to make sure you are not underfeeding the baby unintentionally.

So most people are probably not perfectly in balance. Remember that for every gymnast who nails a perfect routine on the balance beam at the Olympics, there are hundreds who slip a little or even fall flat. The trick is just to keep getting up there and trying to balance again.

### Interpreting Your Overall Score

30 to 70: Congratulations! You have achieved some real balance in your pregnant life. There’s still a lot ahead of you, but you’re quite centered so far.

71 to 150: Like most pregnant women, there are days when you have it together and days when things seem beyond your grasp. Keep on reading. We have a lot of tips to help keep you centered.

151 to 238: Between your nausea, your inability to think straight, and your negative feelings about your body, you’re probably looking at pregnancy as more like a never-ending traffic jam than an Olympic gymnastics event. All the same, you’re in the middle of one of life’s peak experiences. We have a lot of tips here to make your worst days more bearable. Hang in there, and read on.

[*] That book is two shelves over.

[†] In this day and age, of course, traditional intercourse isn’t the only way to make a baby.

[*] Apologies to anyone named Horatio Horace Humphrey.

Part 1 YOU-ology How Two Became You

### 1 Nice Genes A New Twist on Genetics Teaches Us How a Baby Really Develops

Back in tenth-grade biology class, you were probably taught—as were we—that the unique combination of genes you received from your mom and dad (your genotype) was responsible for everything that followed: the color of your eyes, the size of your feet, your love of lasagna, your hatred for all eight-legged and no-legged creatures. To a certain extent, that’s true, but over the past few years, studies have suggested that classical genetics may be only part of the picture. It’s not just your genes that determine who you are, but which of those genes are turned on, or expressed, and to what degree they are expressed—a cutting-edge field called epigenetics. While you can’t control which genes you pass on to your child, you do have some influence over which genes are expressed, affecting what features are seen in your baby (his phenotype). In this chapter, after giving you a brief refresher on the basic biology of what happens after your life-changing evening of romantic rasslin’, we’re going to introduce you to a new subject:YOU-ology—how what you eat, breathe, and even feel can affect the long-term health of your child.

### Two to One: The Biology of Conception

We trust that you know the ins and outs of the process that involves his part A and her part B, so we’ll skip what happens deep under the satin sheets and focus on the miracle deep below the flesh and deep inside the body—that is, how the egg and sperm come together.[*]

### The Eggs

Factoid: Though it happens rarely, women who lose their corpus luteum (through a ruptured cyst, for example) might need a progesterone supplement during the first trimester to help maintain the uterine lining until a placenta forms. Other candidates for progesterone supplementation include women who have a history of miscarriages, perimenopausal women, and those having in vitro fertilizations.

On the female side of the conception equation lie her eggs, which are fully formed and stowed away in her ovaries from before birth. Each mature egg contains one copy of each gene in the human genome—half the amount necessary for life. The maximum number of eggs that a woman will ever have is the number she has when she is a twenty-week-old fetus. She’ll have about 7 million of them then, 600,000 when she’s born, and about 400,000 at puberty. Once a woman hits puberty and menstruation begins, her ovaries release one of those eggs every twenty-eight or so days. During each cycle, even though multiple eggs start to develop, hormonal signals ensure that only a single egg will be released and the other eggs will regress. (It’s not wise evolutionarily to blow them all at once, so the body gives females an approximately thirty-year window in which to conceive.) Hormones also work to mature that ready-to-drop egg and to pop a hole in its sac. That hole works as an escape hatch, so the egg can slip out of the ovary and travel down the Fallopian tube, where it may be fertilized by sperm.[*] Tissue left behind in the ovary after the egg is released, called the corpus luteum, will produce hormones essential to successful pregnancy if the egg is fertilized.

### The Sperm

On the other side of the equation, of course, we have those little swimming sperm. As with a woman’s eggs, each sperm contains a single copy of each gene in the human genome. Unlike women, men don’t have a preset number of their reproductive players. In fact, a man produces more sperm in each ejaculation than the total number of eggs that a woman is endowed with for life. (Evolutionarily, a man can continue reproducing for the majority of his adult life, maximizing the chance of passing on his genes. A woman’s reproductive life is limited to the younger years of her life because of the physical strain of pregnancy, childbirth, breast-feeding, and child rearing.)

A man’s sperm, which is carried in semen that’s made by glands such as the prostate, is stored in a duct called the vas deferens. When a man ejaculates, the sperm-carrying semen fires out through the urethra in a seek-and-conquer mission. It may seem that all these millions of sperm are racing one another to the finish. But just like a Tour de France cycling team, the sperm have different roles. Some are deemed the leaders of the pack, trying to be the first to cross the line. Others are designed to assist, specifically by blocking other men’s sperm from making it to the finish line. Competitive little game going on in there, eh? The goal of pregnancy, of course, is for a sperm to find an egg during a precise window of opportunity and fertilize it.


### Print Shop

The word imprinting may sound like something you’ve heard on CSI, but it’s actually a form of epigenetics. Even though two copies of a given gene are inherited, one from mom and one from dad, in certain circumstances, one is permanently turned off. The nonexpressed copy is said to be imprinted. As of now, we know of at least eighty genes that are imprinted by epigenetic markers, causing them to be active or inactive in the offspring based on parent of origin. In general, expressed genes that are inherited from the mother conserve maternal resources and limit fetal growth, while expressed genes inherited from the father promote fetal growth, even if it means hurting the mother.

Problems can occur when genes that are supposed to be imprinted, or turned off, are not, or when the wrong parent’s gene is imprinted. The gene for the chemical messenger called insulinlike growth factor 2 (IGF2) is normally turned on from the father and off from the mother. If the mother’s copy is not turned off, the child can develop Wilms’ tumor, a cancer of the kidney. Loss of imprinting of the mother’s IGF2 gene later in life can contribute to age-related cancers, including cancers of the prostate and colon.

### The Union

The purpose of an orgasm isn’t solely to make you feel good or provide gossip fodder for the neighbors. The biological purpose is to better the odds that this union between sperm and egg takes place.

On the woman’s side, the mucous membranes that line the vaginal walls release fluids during intercourse so that the penis can slide with just the right amount of friction. As intensity and sensations build, the woman’s brain tells the vagina and nearby muscles to contract. That contraction brings the penis in deeper. Why does that matter? It increases the chance of his sperm getting closer to the target. During an orgasm, the cervix, located at the top of the vagina, dips down like an anteater and sucks semen up into the cervix (the cervix is a passageway connecting the top of the vagina and bottom of the uterus). The sperm is trapped in the cervical mucus


Figure 1.1 Tube Ride In the Fallopian tube, an egg has about twenty-four hours in which it may be fertilized. Once the sperm does so, the fragile combo, the blastocyst, multiplies its cells and must implant in the uterine wall to endure the 280-day pregnancy. Even if you try to summit Everest, this is the most dangerous journey you will ever take.

### What’s Age Got to Do With It?

We all know plenty of people who have made the classic clock-ticking jokes about aging women who want kids. But what does that really mean? Before ovulation, eggs have two copies of each of the twenty-three chromosomes. They’re lined up waiting for the signal to divide for mom’s entire life. Unfortunately, the little spindles that pull chromosomes apart don’t work as well when they’ve been waiting for four decades. Instead of a clean break, two copies may be pulled to one side and none to the other. That’s what leads to an increased risk of chromosomal abnormalities such as Down syndrome and an increase in miscarriages in older moms.

Now, that doesn’t let pop totally off the hook. Older men’s (as in over 35) sperm have been linked to an increase in birth defects and autism, as well as an increased difficulty conceiving. New evidence even suggests that children born to older dads score lower on various brain tests through the age of seven.

While older parents may be better equipped to handle some aspects of pregnancy and child rearing (like some of the stresses and emotional wear and tear), and may be better able to support their children financially, there are some physiological trade-offs that you’ll want to consider if you are making a decision about when to have children.

until the release of the egg, and a signal then lets the sperm start the competitive swim up into the uterus.

While it’s by no means necessary to have an orgasm to get pregnant, women who orgasm between one minute before and forty-five minutes after their partner’s ejaculation have a higher tendency to retain sperm than those who don’t have an orgasm. On the man’s side, orgasm is required, because during orgasm fireworks in the brain cause involuntary contractions in lots of muscles in his body. Those contractions help him penetrate deeper and squeeze the prostate to eject sperm deep into the vagina.

Now, the actual fertilization process happens this way: After the egg drops from the ovary, it travels through the Fallopian tube, where there’s about a twenty-four-hour window when it can be fertilized. Since sperm live for up to a week in the cervix (they die after a few minutes of hitting the air), it’s not necessary for two people to have sex precisely when ovulation occurs, as many assume. In fact, conception is more likely to happen if sex occurs a couple days before the egg is released from the ovary. (See “Fertility Issues” on page 380 for more about getting the timing right.)

If all goes according to plan, the sperm meets the egg in the Fallopian tube, and the two half genomes unite to form a complete set of genes containing all the DNA necessary to make a new human being. The fertilized egg says thank you very much and moves along to the uterus. There it will attach to the uterine lining and begin the amazing process of becoming a baby.

### YOU-ology: A New Approach to Genes

One of the most miraculous processes in nature, aside from the formation of such things as the Grand Canyon and the hammerhead shark, has to be how we grow from a single fertilized egg cell to the trillions of cells that make up a new person.

Human cells have twenty-three pairs of chromosomes, structures that hold our DNA. The DNA acts as a complete set of instructions that tells our bodies how to develop. Individual genes are short sequences of these instructions that regulate each of our traits. (See figure 1.2.) As you might imagine, given the fact that virtually every person in this world looks different from every other, the nearly infinite possible combinations of maternal and paternal DNA are what give us our individuality. When maternal brown eyes and maternal red hair get paired with paternal blue eyes and paternal blond hair, there are four possible combinations for offspring, right? Brown eyes – blond hair, brown eyes-red hair, blue eyes-blond hair, blue eyes – red hair. Extrapolate that scenario out to twenty-three chromosomes, and the possible combinations become mind-boggling, unless scientific notation is your thing: 223, or about 8.3 million, combinations—meaning that there’s about a 1 in 8 million chance that the same mother and the same father would have two kids with the exact same coding (excluding identical twins). (See figure 1.3.)

But that’s only part of the story. Consider identical twins. They get dealt exactly the same DNA, but they may develop different traits down the line: One may have allergies and the other may not, one may develop a particular disease and the other may not, one may be able to play the piano without ever learning how to read music, while the other can’t carry a tune with a dump truck. What accounts for these differences? Something in their environment—potentially as early as in utero—affected the expression of their genes differently. That something is called epigenetics.


Figure 1.2 All Wound Up Storing more data than any computer, each chromosome contains all the information needed to give you a base for your physical and emotional characteristics. What we can learn from epigenetics is that you have the power to influence the course of biological destiny.

Here’s how it works:

Each cell in the human body contains about 2 meters of DNA that’s packed into a tiny nucleus that’s only about 5 micrometers in diameter. That’s the rough equivalent of stuffing two thousand miles of sewing thread into a space the size of a tennis ball. As with thread, DNA is wound around spools of proteins called histones. Not all of your DNA gets expressed, or used to create proteins, in every cell; in fact, most of the spools of DNA in each cell are stored away, some never to be seen or heard of again.

A good way to visualize the process: Let’s say that you and your partner each comes to your relationship with a set of favorite family recipes. You may contribute a blue-ribbon chili recipe, and your significant other may bring a killer lemon meringue pie to the table. But it’s not just two recipes, it’s hundreds, maybe thousands. (The human genome has some twenty to thirty thousand genes, after all.) Some on index cards, some in books, some on torn-up shreds of cocktail napkins. So what do you do with all these cranberry mold recipes? Stuff each and every one of them in the kitchen drawer. Now it’s hard to sift through them, you don’t have access to many of them, and you really can’t find what you want. Unless …(you knew there was an “unless” coming) you get them organized, say, by sticking hot pink Post-it notes on the recipes you really want to access quickly. You tag your favorite recipes, so you can quickly search, find, and put them into action.

That’s the way epigenetics works.

Genes are like recipes—they’re instructions to build something. Both mom and dad contribute a copy of their entire recipe book to their offspring, but for many genes, only one copy of each recipe will be used by the baby. Mom and dad have the same recipes (one for eye color, one for hair color, one for toenail growth rate, and so on), except they may have slightly different versions of those recipes (they’re called alleles). For example, eye genes are either brown or blue or green. For such genes, you express only the gene from your mom or dad—that is, only one copy is active, but not both. In some cases, neither copy will need to be expressed: Eye color matters only to eye cells; a liver cell doesn’t need either mom’s or dad’s eye color gene to be cranking away.


Figure 1.3 Cell Power On day one, we start with a single fertilized egg (called a zygote). Then cells divide and divide and divide, forming the biological structure of the fetus. By the end of the pregnancy, cells have divided a whopping forty – one times to end up with trillions of cells.

So how does a cell turn off the 24,999 genes it doesn’t need and turn on the few it does? Every cell—and there are around 200 different types in the body—needs to know which few genes are relevant for it, and, of those genes, whether mom’s or dad’s is going to be expressed. As with the kitchen drawer full of recipes, the genes alone are useless unless there’s a way to find what you need when you need it.

There is. Your body puts biological Post-it notes called epigenetic tags on certain genes to determine which genetic recipes get used. This tagging happens through a couple of chemical processes (such as methylation and acetylation), but guess what? Actions you take during your pregnancy can influence these processes and determine where the Post-it notes go and which genes will be expressed, ultimately affecting the health of your child. (See figure 1.4.)

When DNA gets tagged, it changes from being tightly wound around those histone proteins to being loosely wound, making the genes accessible and able to be expressed. At any given time, only 4 percent of your genes are in this accessible state, while the rest can’t be actively used in the body. By determining which genes are turned off and which are turned on, epigenetics is what makes you unique.

Here’s a point that will help you put epigenetics in perspective: We share 99.8 percent of the same DNA as a monkey, and any two babies share 99.9 percent of the same DNA. Heck, we even have 50 percent of the same DNA as a banana.[*] So genes alone cannot explain the diversity in the way we look, act, behave, and develop. How those genes are expressed plays a huge role in how vastly different we are from monkeys and how explicitly and subtly different we are from one another.


Figure 1.4 The DNA Drawer The way genes are expressed is a little like pulling recipes out of a drawer. They may be there, but it can take some work to find them.

### Epigenetics in Action: What It Means to You

By about this time, we suspect that you’re asking yourself where you can buy yourself some epigenetic Post-it notes, because they sure as heck aren’t in aisle twenty-three of Walmart. The way epigenetics works during pregnancy is that stressors in the mother’s environment cause changes in the gene expression patterns of the fetus. Translation: The chemicals your baby is exposed to in utero via the foods you eat and the cigarettes you don’t inhale serve as biological light switches in your baby’s development. On, off, on, off—you decide how your child’s genes are expressed, even as early as conception. You don’t have total control, though. We still don’t know how you can change your baby’s eye color or how old he’ll be when his hair starts receding. But we do know how to influence some really important factors like your child’s weight and intelligence.

So there’s an important reason why we’re able to turn certain genes on and off. Our bodies have to adapt to a changing environment; that’s how a species survives, after all. But our ability to adapt would be much too slow if we had to wait generations for our genes to change through random mutation (the classical theory of evolution). Our bodies need some other kind of mechanism to allow us to adapt. Epigenetics gives our bodies the ability to influence which genes will be turned on—or as the scientists (and now you) say, expressed—or off, or partially on, depending on our immediate environment. Even more amazing is the fact that epigenetic changes don’t occur just when a baby is developing in the womb—they can also occur throughout life and can be passed down from generation to generation.

One of the best examples of epigenetics is called fetal programming. This refers not to teaching your child to use the remote control before birth, but rather to changes in gene expression that affect the growth and functioning of the placenta, the amazing organ that filters nutrients, oxygen, and waste between mother and baby (more on the placenta in chapter 2). If a mother’s genes for placental growth are turned off and the father’s genes are expressed, a thicker, richer placenta develops and channels more nutrients to the fetus. This puts more strain on the mother, because it both deprives her of nutrition she needs to remain healthy and causes her to carry a larger baby, which is associated with a host of risks. (See chapter 4.) If, instead, the mother’s genes are expressed, a smaller placenta develops and fewer nutrients get to the baby. In this case, the mother is protecting her interests—if this baby doesn’t make it, she can always try again.

Factoid: All of the epigenetic changes that you can make during the development of your fetus don’t just change the way your child’s genes are expressed. These changes can also be passed down from generation to generation—meaning that the small changes you make today can affect generations long after you’ve been said good-bye to—so your responsibility for creating a healthy environment for your offspring is even bigger than you may have thought.

Fetal programming also occurs when a baby is malnourished in utero—either because mom doesn’t eat properly during her pregnancy or because environmental toxins compromise the placenta’s ability to deliver adequate nutrition (more on this in the next chapter). In either case, you get the same result: a smaller baby. You may be asking, “So what if my baby is a couple of pounds smaller than average at birth? So what?” Here’s what:

In utero, if you feed your baby fewer nutrients, you’re programming your child to expect an environment of deprivation ex utero. So genes that cause the fetus to be very thrifty, metabolically speaking, are turned on. Once the baby is born and the external environment is not one of deprivation, that child will conserve more of the food it gets and become fatter, exhibiting what’s known as a thrifty phenotype (we refer to this in chapter 2). More fat storage equals an increased likelihood of becoming overweight and developing heart disease, type 2 diabetes, stroke, cancer, and osteoporosis as an adult. It’s similar to the reason why starvation diets don’t work: When your body thinks it’s faced with famine, it goes into fat-storage mode and your metabolism slows. Poor fetal nutrition may also permanently change the structure and development of vital organs such as the brain. In some cases, these epigenetic changes can even be passed on to future generations as well.

We do want to make one thing clear: If this is not your first pregnancy, don’t beat yourself up that you didn’t know much about epigenetics the last time around. None of us did, either. While epigenetics plays a role in what happens before birth, as we mentioned earlier, you can actually regulate gene activity after birth—for this child, for previous children, even for yourself. Also, if you fear you’ve already done something damaging to this baby, rest assured that human beings are a resilient lot; otherwise we’d have died out millennia ago. Let’s face it: Since 50 percent of pregnancies are unplanned, plenty of women inadvertently expose their babies to toxins like alcohol and tobacco. The key is to stop and make a YOU-turn,[*] reversing damaging behavior as soon as possible. Even the damage caused by smoking can be offset if you quit in the early part of your pregnancy.


Figure 1.5 Time for Change Through processes called methylation and acetylation, you can alter the way genes are expressed, as well as determine which genes are expressed. In other words, you can take certain actions that will influence whether some genes come to the forefront and whether others get locked away forever.

Another way to think about how epigenetics works is to think about how music is created. Consider your DNA to be the musical composition that will determine the individuality of your child; after all, there are zillions of way to put musical notes together. But the catch is that there are many different ways to interpret any given song. The way Johnny Cash sang a song would be different from the way a rocker would today and is way different from how a philharmonic orchestra would perform it.[†] Same song, different interpretations, and different results.

You and your partner each has your own set of DNA, and through your recent rendition of a boogie-woogie-woogie, you made your own biological song in the form of a baby. That genetic coding is indeed fixed, but you still have the ability to interpret the song and change the way your offspring’s genes are expressed. That, dear friends, should be music to your ears.

[*] Please cue “Let’s Get It On” by Marvin Gaye.

[*] Interestingly, too little of these hormones may lead to infertility or miscarriage, while an abundance may lead to twins and other multiple sets. More on this in “Fertility Issues” on page 380.

[*] True statement, not a joke.

[*] A YOU-Turn, as we introduced in YOU: On a Diet, refers to the fact that it’s not too late to make changes. The key is to identify when you’ve gone down the wrong road and get back on the right course as soon as you can.

[†] Not that one would.