Fetal programming, or prenatal programming, is a concept that suggests certain events occurring during critical points of pregnancy may cause permanent effects on the fetus and the infant long after birth. The concept of fetal programming stemmed from the fetal origins hypothesis, also known as Barker’s hypothesis, that David Barker proposed in 1995 at the University of Southampton in Southampton, England. The fetal origins hypothesis states that undernutrition in the womb during middle to late pregnancy causes improper fetal growth, which in turn, causes a predisposition to certain diseases in adulthood. In addition to nutritional impacts, researchers have studied the fetal programming effects of many factors, such as maternal anxiety or violence during pregnancy. Researchers proposing the concept of fetal programming established a new area of research into the developmental causes of disease, pointing towards the in utero environment and its critical role in healthy human development.

On 23 April 2008, the US Government Accountability Office, or GAO, released a report titled, “Abstinence Education: Assessing the Accuracy and Effectiveness of Federally Funded Programs,” hereafter “Abstinence Education,” in which it investigated the scientific accuracy and effectiveness of abstinence-only education programs sanctioned by individual states and the US Department of Health and Human Services, or HHS. GAO is a government agency whose role is to examine the use of public funds, evaluate federal programs and activities, and provide nonpartisan support to the US Congress. In “Abstinence Education,” GAO found that as of August 2006, a variety of factors in such programs, such as inaccurate medical information, contributed to overall conclusions that abstinence-until-marriage programs were unsuccessful at reducing the rates of adolescent pregnancy. In “Abstinence Education,” GAO recommends that HHS implement procedures to better assure the accuracy of educational materials used in abstinence programs and to set standards that measure the effectiveness of those programs.

First manufactured in 1988 by Serono laboratories, recombinant gonadotropins are synthetic hormones that can stimulate egg production in women for use in fertility treatments. Recombinant gonadotropins are artificially created using recombinant DNA technology, a technology that joins together DNA from different organisms. In vertebrates, naturally-occurring gonadotropins regulate the growth and function of the gonads, known as testes in males and ovaries in females. Medical professionals can derive female gonadotropins from the urine of pregnant and post-menopausal women, often using it to facilitate in vitro fertilization, or IVF. With the rapid development of assisted reproductive technologies like IVF, demand for human-derived gonadotropins rose to a global yearly demand of 120 million liters of urine by the beginning of the twenty-first century, which resulted in a demand that could not be met by traditional technologies at that time. Therefore, researchers created recombinant gonadotropins to establish a safer and more consistent method of human gonadotropin collection that met the high demand for its use in fertility treatments.

Henrietta Lacks, born Loretta Pleasant, had terminal cervical cancer in 1951, and was diagnosed at The Johns Hopkins University in Baltimore, Maryland, where researchers collected and stored her cancer cells. Those cells went on to become the first immortal human cell line, which the researchers named HeLa. An immortal cell line is an atypical cluster of cells that continuously multiply on their own outside of the organism from which they came, often due to a mutation. Lacks’s cancer cells enabled scientists to study human cells outside of the human body, though that was controversial since she did not voluntarily donate her cells for such research. Science writer Rebecca Skloot chronicled Lacks’s life in her book, The Immortal Life of Henrietta Lacks, which became a movie in 2017. Lacks’s HeLa cell line has contributed to numerous biomedical research advancements and discoveries and her story has prompted legal and ethical debates over the rights that an individual has to their genetic material and tissue.

Orchiopexy, also known as orchidopexy, is a surgical technique that can correct cryptorchidism and was successfully performed for one of the first times in 1877 in Scotland. Cryptorchidism, a condition where one or both of the testicles fail to descend before birth, is one of the most common male genital birth defects, affecting approximately 2 to 8 percent of full-term male infants, and around 33 percent of premature infants. Typically in the womb, male testes form within the abdomen, then descend into the scrotal area between twenty-five to thirty-five weeks’ gestation. If one or both testicles fail to descend before birth, physicians use orchiopexy to surgically relocate the undescended testes to their normal position in the scrotum. According to many researchers, most cases of cryptorchidism do not resolve on their own, and therefore, orchiopexy surgery is often necessary. Orchiopexy, when performed before puberty, can decrease the risk of testicular cancer and infertility associated with cryptorchidism.

In 2001, researchers Leonie Welberg and Jonathan Seckl published the literature review “Prenatal Stress, Glucocorticoids, and the Programming of the Brain,” in which they report on the effects of prenatal stress on the development of the fetal brain. The fetus experiences prenatal stress while in the womb, or in utero. In discussing the effects of prenatal stress, the authors describe prenatal programming, which is when early environmental experiences permanently alter biological structure and function throughout life. Throughout “Prenatal Stress, Glucocorticoids and the Programming of the Brain,” Welberg and Seckl provide a number of potential biological explanations, derived from both animal and human studies, to explain the underlying mechanisms involved in programming, which helped establish how in utero stress can affect fetal brain development.

Gestational diabetes is a medical condition that causes blood sugar levels to become abnormally high, which manifests for the first-time during pregnancy and typically disappears immediately after birth for around ninety percent of affected women. While many women with the condition do not experience any noticeable symptoms, some may experience increased thirst and urination. Although gestational diabetes is treatable, if left unmanaged, the resulting fetus is more likely to have elevated risks of increased birth weight, birth injuries, low blood sugar, stillbirth, and later development of type 2 diabetes. The International Diabetes Federation estimates that worldwide in 2019, gestational diabetes affected one in six pregnant women, with many cases occurring in women living in low and middle-income countries. Despite the prevalence and risks associated with gestational diabetes, as of 2020, researchers have yet to reach a unified consensus on the best guidelines for diagnosis and treatment.

In 2004, Amanda J. Drake and Brian R. Walker published “The Intergenerational Effects of Fetal Programming: Non-genomic Mechanisms for the Inheritance of Low Birth Weight and Cardiovascular Risk,” hereafter, “The Intergenerational Effects,” in the Journal of Endocrinology. In their article, the authors assert that cardiovascular disease may develop via fetal programming, which is when a certain event occurring during a critical point of pregnancy affects the fetus long after birth. Drake and Walker were among the first to show that the programming effects of cardiovascular disease could be sustained across generations through non-genetic means. In “The Intergenerational Effects,” the authors identify how non-genetic mechanisms may perpetuate fetal programming influences over generations, highlighting the importance for further research on fetal programming.

Vincenz Czerny was a surgeon in the nineteenth century who specialized in cancer and women’s surgical care. Czerny performed one of the first breast augmentations using a reconstruction method to correct asymmetry and disfigurement of a woman’s breasts. Additionally, Czerny improved the safety and efficacy of existing operations, such as the vaginal hysterectomy, which involves the surgical removal of some or all of a woman’s reproductive structures. He contributed to other surgeries involving the esophagus, kidneys, and intestines. He was also one of the first individuals to research alternative methods of cancer treatment and founded the Institut für Experimentelle Krebsforschung (Institute for Experimental Cancer Research), in Heidelberg, Germany. The institute became one of the first hospitals dedicated solely to the study of cancer. Czerny’s development of the breast augmentation and vaginal hysterectomy, as well as his cancer research, helped shape the creation of modern-day surgical procedures.

James Edgar Till is a biophysicist known for establishing the existence of stem cells along with Ernest McCulloch in 1963. Stem cells are undifferentiated cells that can shift, or differentiate, into specialized types of cells and serve as a repair system in the body by dividing indefinitely to replenish other cells. Till’s work with stem cells in bone marrow, which produces the body’s blood cells, helped form the field of modern hematology, a medical discipline that focuses on diseases related to the blood. He also worked on issues in the medical field including patient inclusion in clinical trials, matters of effective and ineffective clinical communication, and limitations of public access to medical and scientific research. Till’s work with stem cells furthered scientists’ understanding of abnormal blood cell development, which helped set the foundation for regenerative medicine.