Surrogacy in India - A DOHaD Perspective Open Access

Abstract

Commercial surrogacy in India saw a dramatic rise and fall between 2002 and 2015, during which it is estimated that over 325,000 children were born to surrogate mothers. At least 50% of these children are estimated to have been commissioned by Western parents. Until now surrogacy in India, and the effects it may have on the future health of surrogate children, has not often been discussed. Using the theory of Developmental Origins of Health and Disease, which says the way one develops and grows in the womb affects one's health later in life, potential, unforeseen consequences of surrogacy in India are examined through the cues of maternal diet and maternal body composition. A total of 46 primary literature papers - 38 papers concerning humans and 8 papers concerning animals - were drawn from to form the foundation of the stance concerning surrogacy taken here. Maternal intake of protein, carbohydrates, lipids, and the ratios concerning those macronutrients have an effect on fetal development measured by birthweight, length, and adiposity. As it is affected by the mother's immediate surroundings, maternal diet acts as a short term cue for the growing fetus. Maternal body composition, composed of lean mass and fat mass, also has an effect on fetal development measured by similar markers of growth. Unlike maternal diet, maternal body composition is representative of the woman's entire history and everything she has been exposed to in life that may have an effect on her lean and fat mass. The fetus receives cues from both maternal diet and maternal body composition. In India, the thin-fat phenotype - one does not appear obese or overweight but has high levels of adipose tissue - is very prevalent and raises concerns regarding surrogacy due to the affects maternal body composition has on development. An obesogenic environment has negative implications and effects on fetal development and for the child's future health. While it is impossible to change past decisions, being aware of the potential impacts surrogacy may have on the health of these children is important as is being proactive about one's health.

Table of Contents

Table of Contents

Introduction……………………………………………………………………………………………………………………….....1

Background…………………………………………………………………………………………………………………………...4

The case for surrogacy…………………………………………………………………………………………….4

Legal issues concerning surrogacy………………………………………………………………………….6

Benefits for surrogate mothers ………………………………………………………………………………9

A second thought about surrogacy…………………………………………………………………………10

DOHaD, The Barker Hypothesis and Surrogacy in India……………………………………….11

Maternal diet and body composition……………………………………………………………………..12

Methods……………………………………………………………………………………………………………………………....13

The India context……………………………………………………………………………………………………15

Findings/Results…………………………………………………………………………………………………………………..17

Methodology of cohorts included in study…………………………………………………………………………..17

Adelaide, South Australia…………………………………………………………………..………………….17

Project Viva…………………………………………………………………………………………………………….18

Aarhus Birth Cohort………………………………………………………………………………………………..18

Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study…19

Tasmanian Infant Health Survey (TIHS)……………………………………………………………………19

Lifeways Cross-Generation Cohort…………………………………………………………………………..21

Randomized Control Trial of Low Glycemic Index Diet in Pregnancy (ROLO)……………21

Southampton Women's Study (SWS)……………………………………………………………………….22

Healthy Start Study………………………………………………………………………………………………….23

GI Baby 3………………………………………………………………………………………………………………….24

Women and Their Children's Health Study (WATCH)……………………………………………….25

Wollongong, Australia……………………………………………………………………………………………….25

Amsterdam Born Children and their Development (ABCD)……………….…………………….26

Pune Maternal Nutrition Study (PMNS)……………….……………………………………………………26

The importance of maternal diet on development……………………………………………………27

The importance of maternal protein during development………………………………………..28

First Trimester………………………………………………………………………………………………28

Second Trimester………………………………………………………………………………………….29

Third Trimester……………………………………………………………………………………………..31

The importance of carbohydrates on fetal development………………………………………….32

First Trimester………………………………………………………………………………………………32

Second Trimester………………………………………………………………………………………….35

Third Trimester……………………………………………………………………………………………..38

Implications for Surrogacy…………………………………………………………………………..42

The importance of lipids on fetal development………………………………………………………...43

First Trimester………………………………………………………………………………………………43

Second Trimester………………………………………………………………………………………….44

Third Trimester……………………………………………………………………………………………..45

The importance of balance in maternal macronutrient intake…………………………………..46

First Trimester……………………………………………………………………………………………….46

Second Trimester………………………………………………………………………………………….47

Third Trimester……………………………………………………………………………………………..49

India and the thin-fat phenotype……………………………………………………………………………….50

The importance of maternal body composition on development………………………………54

The effects of fat free mass on fetal outcomes………………………………………………………….54

The effects of fat mass on fetal outcomes…………………………………………………………………56

Evidence from animal models………………………………………………………………………………..….61

Potential mechanisms…………………………………………………………………………………………………64

Discussion……………………………………………………………………………………………………………………………….67

Conclusion………………………………………………………………………………………………………………………………78

Bibliography……………………………………………………………………………………………………………………….82

Figures

Table 1: Cohort Characteristics…………………………………………………………………………………………95

Table 2: Effects of Maternal Protein Intake………………………………………………………………………98

Table 3: Effects of Maternal Carbohydrate Intake…………………………………………………………….99

Table 4: Effects of Maternal Lipid Intake………………………………………………………………………….100

Table 5: Effects of Maternal Macronutrient Ratio Intake………………………………………………….101

Table 6: Effects of Maternal Lean Body Mass on Fetal Outcomes…………………………………….102

Table 7: Effects of Maternal Fat Mass on Fetal Outcomes………………………………………………..103

About this Honors Thesis

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School	Emory College
Department	Human Health
Degree	BA
Submission	Honors Thesis
Language	English
Research Field	Anthropology, Cultural Health Sciences, Public Health
Keyword	Barker Hypothesis Surrogacy DOHaD India
Committee Chair / Thesis Advisor	Lampl, Michelle, Emory University
Committee Members	Sarrett, Jennifer C, Emory University Young, Melissa Fox, Emory University Woodworth-Hobbs, Myra , Emory University

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