Początki. Jak 9 miesięcy w łonie matki wpływa na resztę naszego życia

by Annie Murphy Paul

What makes us the way we are? Some say it's the genes we inherit at conception. Others are sure it's the environment we experience in childhood. But could it be that many of our individual characteristics—our health, our intelligence, our temperaments—are influenced by the conditions we encountered before birth? That's the claim of an exciting and provocative field known as fetal origins. Over the past twenty years, scientists have been developing a radically new understanding of our very earliest experiences and how they exert lasting effects on us from infancy well into adulthood. Their research offers a bold new view of pregnancy as a crucial staging ground for our health, ability, and well-being throughout life.

Author and journalist Annie Murphy Paul ventures into the laboratories of fetal researchers, interviews experts from around the world, and delves into the rich history of ideas about how we're shaped before birth. She discovers dramatic stories: how individuals gestated during the Nazi siege of Holland in World War II are still feeling its consequences decades later; how pregnant women who experienced the 9/11 attacks passed their trauma on to their offspring in the womb; how a lab accident led to the discovery of a common household chemical that can harm the developing fetus; how the study of a century-old flu pandemic reveals the high personal and societal costs of poor prenatal experience.

Origins also brings to light astonishing scientific findings: how a single exposure to an environmental toxin may produce damage that is passed on to multiple generations; how conditions as varied as diabetes, heart disease, and mental illness may get their start in utero; why the womb is medicine's latest target for the promotion of lifelong health, from preventing cancer to reducing obesity. The fetus is not an inert being, but an active and dynamic creature, responding and adapting as it readies itself for life in the particular world it will enter. The pregnant woman is not merely a source of potential harm to her fetus, as she is so often reminded, but a source of influence on her future child that is far more powerful and positive than we ever knew. And pregnancy is not a nine-month wait for the big event of birth, but a momentous period unto itself, a cradle of individual strength and wellness and a crucible of public health and social equality.

With the intimacy of a personal memoir and the sweep of a scientific revolution, Origins presents a stunning new vision of our beginnings that will change the way you think about yourself, your children, and human nature itself.

Genres: Parenting, Nonfiction, Science, Health, Psychology, Childrens, Medical

304 pages, Paperback

First published September 28, 2010

Reviews

[Elizabeth · Rating 3 out of 5]

The information in this book was pretty fascinating. I picked it up after listening to this story by the author on NPR a few weeks ago. Although I think the book could have been much better organized and edited to avoid excruciating repetitiveness (Dutch Hunger Winter: I'm looking at you), I enjoyed it overall.

The book details the emerging scientific research showing that the fetal period can be a powerful source of influence over who we are as people -- focusing in particular on the mother's nutrition while pregnant; the pollutants, drugs and infections the fetus was exposed to during gestation; and the mother's health, stress level and emotional state while pregnant. I'm not sure this was a great time for me to read this book, considering it occasionally FREAKED me out about all the things I did wrong early on that are no longer within my control (or the things I may continue to do wrong that are way out of my control).

A few of the fascinating yet utterly unhelpful facts I learned while reading this book:

*If you're pregnant, it's better to be a crack addict than an alcoholic, although if you're going to be an alcoholic, it's better to be a rich one.

*The smaller your baby is, the greater its risk of obesity/heart disease/schizophrenia, etc. later in life. At the same time, women gain too much weight during pregnancy, which increases their babies' risk of health problems later in life.

*You should eat tons of fish while pregnant because omega 3s are vital to the emotional health, physical health, and cognitive development of your baby. But you should not eat fish because of the high mercury content. Unless it's sardines (no mercury for some reason), which I don't think I have ever seen anyone eat. Ever. Even Sam. Don't they have bones? Ick!

*If there is a major disaster (flood, famine, ice storm, nazi invasion) while one is in one's second month of pregnancy, the baby is pretty much screwed all around.

*People who live in Manhattan, like the author, have a much better selection of convenient, healthy take-out than any place I have ever lived, which makes me tremendously jealous and bitter.

*65% of women take some sort of over the counter medicine while pregnant (mostly allergy medicine or tylenol). The author was totally SHOCKED and DISMAYED and JUDGY about how high this number was considering no one really knows exactly how these drugs affect human fetuses; I was shocked about how low it was, considering how miserable pregnancy already is without also adding unchecked allergy symptoms and hormone headaches.

BTW, if you are interested in the topic, but don't feel like wading through this entire book, Time Magazine recently had a good article about it, which was written by this same author.

[G · Rating 3 out of 5]

In Origins, Paul attempts to explain how intrauterine influences - dietary, emotional, hormonal, epigenetic, etc. - affect the futures of the people fetuses become. It's an interesting premise, hinted fascinatingly at in one of my favorite environmental books, Theo Colburn's Our Stolen Future. While the research has certainly progressed in the ten years since, Paul's book still feels a bit light.

The book is nominally structured into nine month-based chapters, but these aren't used to discuss some of the key developments that can be influenced by outside forces at each stage; instead, Paul mostly uses the premise to turn any subject back to her own pregnancy, at times lapsing into uncomfortable overshare as she gives us enough information to steal her elder son's identity along with the minutiae of her second pregnancy. The book is arranged more topically than chronologically, beginning with a discussion of dietary influences, then swinging through emotional events, alcohol and drugs, and mental health. She mentions epigenetics but unfortunately doesn't go into much detail about recent findings, which is unfortunate, since this is one of the least common sense and most interesting aspects of human fetal biology.

There are plenty of fascinating tidbits of information here and good overviews of the effects of historical crises (like the Mao-induced Great Leap Forward famine around 1960, or the Dutch Hunger Winter of 1944-45). Poor alcoholics are much more likely to give birth to babies with fetal alcohol syndrome than wealthier alcoholics, even if both drink heavily during pregnancy; the hypothesis is that better nutrition protects against alcohol's effects. Babies born after wars and famines are more likely to suffer from schizophrenia. Confirming an old wives' tale, women pregnant with girls are more likely to suffer morning sickness while those pregnant with boys have larger appetites, probably due to hormones trasmitted from fetus to mother. Much of it is common sense, some is an interesting validation of historical wisdom. I did get the impression, though, that Annie Paul never leaves Manhattan, and anyone outside this microcosm either gets a phone call or doesn't get interviewed.

Perhaps the strangest part of the book is at the end, where Paul compares assisted (that means grabbing the baby with tongs and yanking), vaginal, and c-section births, and comes to the conclusion that they go from more to less stressful on the baby in that order. Paul had a scheduled c-section herself, and I have no interest in finding out her own reasons or debating her choices, but I think this makes her fail, somewhat, to question the effects of the move to higher c-section rates over the last 10 years. There aren't really any downsides to this posited, let alone confirmed or debunked. It's a bit odd next to a book like Pushed (read last year with my book club), which is much less keen on sections.

All in all, Origins contains a lot of fascinating information, viewed through a slightly myopic lens. I enjoyed reading it, but will keep waiting for someone to do the topic better justice.

[Stephanie · Rating 2 out of 5]

A book written for the masses that attempts to distill some interesting research. It has a catchy one-word title (in the vein of "Bonk") and an Upper West Side Manhattanite's perspective on her own life and pregnancy mixed in with the reporting bits (a la Michael Pollan).
So: the research is interesting, though I've seen most of it already in the science and medical news, and I find the pop-science way of describing studies distracting, since there is never quite enough information there for me to gauge the validity of any one study. I am even more distracted by the author embedding her own story, fears, hopes, worries into the text. She seems like a nice lady, and I'm sure she has a lovely family; but I just wanted the facts. Or the facts with a bit of well-written connective tissue between them. This world-through-the-lens-of-reporter's-life style is a bit too solipsistic for me.

I might recommend this to a patient or friend who had a lot of interest in the subject, but I'd be more likely to send them to the original studies or solid reporting of those studies.
As for the science of epigenetics itself, it has many implications for the medical world. Right now, I agree with Darshak Sanghavi, MD, who Paul quotes as saying: "Turning to the womb to explain complex social and public-health problems ultimately means people have given up on changing the things that really matter. That's too bad."

[Laura · Rating 4 out of 5]

For the most part, I found this one riveting and strangely empowering. It's the total opposite of the evil "What to Expect" empire: Paul writes for smart readers, and explores ways women can potentially positively influence the adulthood of their child while it's in utero. I appreciated reading, "Eat sardines and chocolate, to maybe make your baby smarter and smile more" rather than "DON'T eat [huge list of stuff] or else your baby will be deformed." Positive suggestions and ideas always work better than threats.

However, Paul writes--and I read--from a position of extreme privilege. Our respective fetuses are very much wanted. We're both fairly affluent, have health insurance and access to prenatal care, and are highly educated. Chances are our two fetus's origins are pretty much OK. Paul doesn't much address the alternative, only getting around to it in the 8th month, nor does she reach satisfying conclusions about what should be done to help improve the fetal origins of low-income babies. I'm sure there's no easy solution. Perhaps it's enough that she's raised the question?

[Kelly Lamb · Rating 3 out of 5]

As is typical of my current pregnant state, I was hot and cold with this book. It's introduced in such a way that it makes you believe you WON'T be reading a diatribe about all the terrible things that you could do during pregnancy to ruin your child. This seems to be accurate at first, but honestly, by the end of the book I just felt overwhelmed with all the potential disasters I could be inflicting upon this fetus. I know that Paul occasionally reiterates the fact that fetal origins research doesn't mean that environment post-birth has no effect on a child, but I think she HAS to continually say that because the research makes you feel that way the more you read it.

That said, I did appreciate the fact that this book is more well-informed than most pregnancy books. For example, where other books just tell me I can't do this, this, and this, Origins more specifically tells you where these mandates come from and how different researchers have agreed/disagreed with them. I enjoy knowing that type of information, and I feel more educated on the "whys" of all the pregnancy rules.

I do have one other caveat to share, specifically about the food chapter at the beginning of the book. Paul mentions how her nutritionist gave her all these great ideas for different foods to eat in order to keep her diet varied and healthy. This is great, but the clearly upper-middle-class Paul does not realize that all of us are not going to be able to afford arugula over iceberg lettuce everytime we go to the store. It bothered me that she didn't address the obvious financial issue that may make this difficult for a lot of pregnant women.

[Ciara · Rating 4 out of 5]

a really interesting & engaging (in my opinion) book about fetal origins. that is to say, how the prenatal environment affects a person after s/he is born.

the author was pregnant while writing the book, so it is split into nine chapters, each of which represents one month of gestation, from conception to birth. the chapter breaks don't really have anything to do with anything. "chapter five" didn't really have anything to do specifically with the prenatal environment in month five of human gestation or anything. it was just kind of a cute way to split up the book. or an annoying gimmick, depending on how you feel about the memoir aspect of the book.

personally, i didn't mind it. but nor did i relate at all. not only am i not pregnant or a mother (yet), but i do not live on the upper west side of manhattan & i am not employed by the "new york times". i do not live upstairs from a fancy grocery store at which i shop at least once a day. i am unlikely to name my future children teddy or gus. some reviewers found the pregnancy memoir part of the book really, really annoying, & i can understand why they felt that way, for sure. there's definitely a "liberal yuppie" vibe to it that is pretty grating. but i guess i have a secret soft spot for liberal yuppie memoirs. i learn something new about myself every day!

i definitely found the science stuff far more interesting. apparently the science of fetal origins is a rather emerging field. paul explains that historically, doctors had themselves convinced that the placenta provided a faultless protective barrier between a fetus & the outside world--including any hormones or toxins to which the gestating woman was exposed. of course, now we know that that's not true. pregnant women are routinely informed about the dangers of smoking, drinking, eating soft cheeses, taking medications, etc during pregnancy. but researchers in the field of fetal origins are discovering that the prenatal environment may be impacting fetuses in all kinds of ways--many of which the mother really has no control over at all.

paul routinely comes back to the idea that all of this emphasis on fetal origins may cause evn more maternal guilt if, say, fifty years down the line, a person develops type 2 diabetes. (there is some evidence supporting the possibility that a prenatal environment indicating food scarcity may genetically prepare a fetus for a world of poor nutrition; upon being born into a world full of chicken mcnuggets & honey roasted peanuts, that baby grows into an adult that has a more difficult time regulating his blood sugar. for example.) definitely i was concerned when i first heard about the book that it was going to be yet another tome that blames mothers for every last little thing that can possibly go wrong with their children. paul seems to make an effort to avoid that...but as other reviewers pointed out, she spills about six pages of ink wringing her hands over how frequently pregnant women in the u.s. take over-the-counter painkillers, even though there isn't any indication that they are linked to significant numbers of birth defects or poor fetal outcomes. so...that's a little weird.

a lot of the fetal origins research also seems somewhat contradictory, or irrelevant, or has discovered correlations that may or may not have much to do with causation, or has discovered outcomes in such tiny numbers that the relevance to the greater body of fetal existence seems almost inconsequential. i mean, you can take pretty much any story & spin its results so they sound really exciting & important. that's how studies get published. & publishing is how scientists secure funding. it's all kind of a shell game sometimes. do i need to know that women in sweden were negatively impacted by the radioactive fall-out from the chernobyl disaster, leading to behavior & cognition problems in their children, without even realizing it? not really. i guess it's kind of interesting, but it's not like i have any power to really protect myself or my unborn children if there is nuclear disaster 1000 miles away from me. ditto all the stuff about the great leap forward & the hunger winter. it's not like i didn't already have a hunch that malnutrition might be bad for my fetus, anyway.

i guess what i'm saying is that this is really interesting...but it's also worth taking it all with a great big grain of salt.

[Jennifer · Rating 4 out of 5]

Origins is a fascinating exploration of the impact of our environment in the womb on our experience in the world. Annie’s Zen teacher and psychotherapist expresses it best when she asks her group to contemplate a koan, a riddle with no solution: Not one, not two. Our minds are separate from our bodies. Babies are separate from their mother. And pro life and pro choice activists are adamantly opposed. But all are inextricably interdependent as well. Both our differences and dependencies must be considered. As a protest sign read, pro-choice supporters have “forgotten the fetus.” But pro-life forces have also “forgotten” someone: the pregnant woman. Perhaps fetal origins research can help restore to the debate both parts of the whole. Epigenetic research points to the biodirectionality of pregnancy. “It’s not only that the pregnant woman affects the fetus; the fetus, in turn, exerts an influence on the woman.” I cannot help but be reminded of the ancient biblical text from Christ’s birth story, “As soon as the sound of your greeting reached my ears, the baby in my womb leaped for joy” (Luke 1:44). The joy of her fetus affected the joy of his mother, undoubtedly caused by the at once miraculous and scientific fetus-to-fetus communication between two heartbeats: the Firstborn of Creation and the prophet that would prepare His way.

What are the implications of epigenetics in enhancing the prenatal environment?
The answers spill out of the nine chapters corresponding with the nine months of the author’s concurrent pregnancy.
“We would improve access to prenatal care, and its quality.
We would ensure that healthy, wholesome food was available to all pregnant women.
We would make plans for protecting and provisioning pregnant women in emergency situations, such as natural disasters or terrorist attacks.
We would offer pregnant women stress reduction in support building programs.
We would regulate or ban chemicals that endanger fetuses, and would make more intensive efforts to understand how over-the-counter and prescription medications affects the fetus.
We would provide drug treatment and smoking-cessation programs
to pregnant women who are addicted.
We would screen pregnant women for depression, anxiety, and other psychological conditions, and when problems were detected, we would offer therapy or counseling on the use of psychotropic medication during pregnancy.”

While explaining to her three year old the baby behind the bump in her stomach, Annie receives an episode of double vision, in which she sees all the adults around her from a new angle: as former fetuses all, organisms shape by a prenatal experience. I plan to adopt this perspective myself and when anxiety threatens to paralyze me (i.e. curriculum night), I will perceive my audience through the lens of their former lives as fetuses all!

To all former fetuses, this book is for you!

[Lightreads · Rating 3 out of 5]

You know, it is hard to find relevant books when you are really interested in gestation but not at all interested in babies. I frequently find myself in conversations these days with one of my compatriots in Project Make a Baby Like a Boss that go something like, “blah something something childhood development blah, what do you think?” And I go, “not my department – hey, have you read that cool stuff about omega 3 intake in the first trimester correlated with better labor outcomes?”*

This one is pretty close, though as usual I would have honestly preferred a textbook over popular science. There’s a lot of pretty great stuff here. The sections on the perinatal transmission of vulnerability to PTSD were particularly striking, and I was delighted to finally come across a sensible biological explanation for the finding that the more older brothers a boy has, the more likely he is to be gay. None of this creepy Freudian incestuous homoeroticism bullshit, thank you.

Still, there just isn’t all that much to epigenetics to talk about yet. Insert joke about a science in the embryonic stages here. And while Paul writes a good survey, all her shopping at Whole Foods, living in Manhattan, attending pre-natal meditation classes makes it pretty painful when she starts going on about the plight of poor mothers and the things “we” can do to make sure “they” have access to the sanitation/nutrition/medicine necessary for healthier gestation. It’s not that we need to force women to make healthy choices, you know, we just need to encourage it. Uh-huh. Said with the blithe ignorance of someone who’s never been on the wrong end of a government poverty program based in “science”, like I have.

*Personally, I think the way the four of us are dividing the labor on this one is brilliant, even if it’s dictated by medical necessity, since the people required to feed/care for the shrieking infant will not be the person who has just shoved a shrieking infant out through her v-hole. I’m just saying. Sensible.

[Dora · Rating 2 out of 5]

I thought there was interesting information in this book-- a lot of cutting edge research being done in this field, and I liked learning about the various effects of the mother's lived experience on a fetus. Unfortunately, the tone was absolutely unbearable.

First of all, I appreciate that the author gave a nod to how there is a terible cultural policing of women's bodies during pregnancy these days, and how much that bothers her. Then she tries to explain that her book is different! She's going to spin the tone of the book to be more about empowering yourself with this great knowledge, and how wonderful that can be, right? Except then the rest of the book kind of felt like it was in that same chiding tone she claimed to hate so much. I think it's inevitable that a book about women's experiences during pregnancy will come out a little lecture-y and woman-nagging, but still.

Second of all-- and this was the thing that eventually made me toss the book aside-- the totally annoying writing style. UGH, the tone. Clearly, I like books that are colloquial discussions of academic research, see my sparkling reviews of "The Art of Choosing", "NurtureShock", and "The Upside to Irrationality". This was different, because I found the author so annoying. Just like the Tara Parker-Pope book on marriage (yuck, another dud...), I felt kind of embarrassed to rep NYC in the midwest when these New York Times writers have this annoying yuppie tone, these wealthy NYC stereotypes-- waxing poetic about going to the Fairway and telling her "where I was on 9/11" story. I mean seriously, the book reads like a Sex & the City Carrie Bradshaw monologue! **eyeroll**

It gets two stars for the valuable information it contains. I cannot in good conscience give it three.

[Asha Tenbroeke · Rating 3 out of 5]

It is always nice if an accomplished science writer takes on a subject that hasn't really been covered extensively before. Fortunately for us, that is exactly what Annie Murphy Paul does in Origins. She covers the subject of outside influences on the development of the growing foetus with ease, and even takes it one step further when she links the scientific research she encounters with her own experiences during her second pregnancy (Paul is pregnant while researching and writing the book). This gives the book some personality and depth it would otherwise miss.

The only problem is that Origins really needs this extra something. Without it, it would fall flat. Paul is not anywhere near skeptical enough to safely navigate her readers through a new and emerging field of science, often leaving her readers with a chapter full of loose ends to figure out for themselves. In her chapter about the influence of stress on a baby's (mental) health after birth, she doesn't pose a single critical question when she tells about how one researcher finds that stress in the second trimester (but not so much in the other stages of pregnancy) has negative effects, while others place the sensitive period in the first or third trimester. Instead of going into the methodology of the studies, trying to find if one of them is superior to the others, Paul stays on her 'happy-just-curious' course, leaving the active reader somewhat unsatisfied.

[Peggy · Rating 4 out of 5]

I enjoyed this book, but I wouldn't necessarily recommend it to all "parents-to-be". I think you have to set expectations with this book first. It's rich with information and research about the 9 month development process, but it's not a step by step guide of what to do and not to do. In addition, I think you have to realize that it's developing research, not dogma. I loved it as a reservoir of new research that shines light on how the 9 month incubation period affects the next 80 years (if we're so lucky) of life. Each chapter is organized by a specific topic of influence toward the developing baby (food and drink, stress, toxins (environmental, medicine, etc), gender, etc). I thought is was also nice that the author was actually pregnant (with her second child) while writing this book - that way there is a subtle understanding and compassion of the entire process that I don't think would be equally matched by a man, or non-mother. With all that being said, if you like research and "science-y" books, this is a great addition to all the other prego books you buy!

[Anna Edwards · Rating 3 out of 5]

I read this book for my job and was pleasantly surprised by the quality of the information and writing. This is not a book that I would have picked up on my own.

This book was written by Annie Murphy Paul as a way to understand the impact of nine months we spend in utero and to understand her own pregnancy. The book discusses the impact of fetal and maternal experience on the future health of a child.

This book also had one of the most nuanced discussions of abortion that I have seen in years. Rather than pandering to one side or the other, Paul looks at the finding of her research and it's potential effects of the augments of both sides, pointing out that each has forgotten to consider "someone" (the fetus for pro-choice advocates and the mother for pro-lifers).

Overall this book is well-researched and well-written. I would recommend it to anyone with an interest in fetal origins or pregnancy in general.

[Carolina · Rating 3 out of 5]

If women skip breakfast, they are more likely to get pregnant with a girl? Morning sickness has been said to be a psychological response of "secretly rejecting" your baby? This book is interesting, but most points are theoretical only. I doubt the intrauterine environment is really more influential than epigenetics. So if a mother is depressed during pregnancy, are her hormones REALLY going to make the fetus more likely to develop depression later in life, or is the mother just passing on her depression genes? And is your uterine environment just an excuse in life - "Well, my mother gained too much weight when pregnant with me so that is why I am obese now." There are too many factors in play. My advice to pregnant mothers (instead of reading this book) is to avoid toxins, smoking, alcohol, and stress; and eat healthy and exercise and your fetus will be just fine!

[Shannon Weynand · Rating 3 out of 5]

This book was fascinating and yet almost too much. It may have caused more needless worry than actually be informative. I have to admit I skimmed the middle 2/3 of the book. But the ending contained some interesting scientific data abt the ways that we influence the infants inside us (diet/nutrition, stress, drugs, toxins, etc) and the way they (infants) just may be influencing us at the same time.

[Moniii · Rating 3 out of 5]

3,5/5

[Kendell Timmers · Rating 3 out of 5]

Interesting ideas! But hard to tell fact from speculation

[Gold Dust · Rating 4 out of 5]

The book blends the author’s pregnancy memoir with information about how babies are impacted by their environment in the womb. The book is divided into nine chapters as if these chapters are about each month of pregnancy, but that’s actually not the case. Instead, ch. 1 is an introduction, ch. 2 is about food, ch. 3 is about stress, ch. 4 is about drugs, ch. 5 is about gender/ultrasound, ch. 6 is about mood, ch. 7 is about “bad blood,” ch. 8 is about the importance of fetal development to society, and ch. 9 is mainly about the author’s own birth experience.

SPOILERS BELOW:

FOOD NOTES:
“Women who consume junk food during pregnancy will make their children more likely to eat such foods themselves, and more likely to become obese” (20).

“By seven months, the fetus’s taste buds are fully developed” (21).

Both starved mothers and fat mothers are more likely to produce children who are likely to become overweight (24).

“The risk of diabetes is especially high among people exposed to malnutrition in mid-to-late gestation, while the risk for heart disease is three times higher in people whose mothers were starved very early in pregnancy” (24).

Low weight babies are at high risk of heart disease in middle age (25). The babies with the healthiest adult outcomes are the eight pound babies (30).

Eating less than 12 oz of seafood per week during pregnancy is associated with low verbal IQ, social and communication problems, and poor fine-motor skills in kids age six months to eight years (33).

Babies are less likely to get cancer if their mothers consume green tea, and cruciferous veggies like broccoli, cabbage, and brussels sprouts (38). Eating five or more servings of chocolate per week in the third trimester lowers the risk of preeclampsia, and the babies at six months old show less fear and smile and laugh more (40).

Scientist David Williams thinks that there will one day be a dietary supplement to protect future children from cancer (39). I doubt it since cancer industry is too profitable. All the healthy foods and vitamins can’t be patented.

STRESS NOTES:
Pregnant mothers who develop PTSD have babies which are more likely to also have PTSD, especially if the mothers experienced the traumatic event in their third trimester (47).

Mothers having a stressful event in the first trimester deliver their babies two weeks early on average. The earlier in pregnancy the stressful event, the earlier the delivery (49).

“Women who had experienced the death or serious illness of a relative during or just before pregnancy were 16% more likely to deliver prematurely; when it was one of their own children who had died or become ill, the incidence of premature delivery increased by 23%” (50).

Babies who lose their fathers while still in the womb are more likely to develop schizophrenia and behavior disorders (51).

Babies who are in their second month in the womb during war are significantly more likely to develop schizophrenia as young adults, females at a rate of 4.3 times more likely and males at a rate of 1.2 times more likely (51-52, 162).

Stress during pregnancy causes low birth weight babies and poor toddler abilities (54). At 10 years old, the kids born of stressed out mothers have IQs 10-20 points lower than low-stressed moms (55).

Women who work at physically demanding jobs have four times the risk of having an underweight baby. Women who work temporary jobs have four times the risk of delivering a premature baby than women who work permanent jobs (61). Unemployed moms are more likely to suffer from depression and may give birth to low birth weight babies (65). Moms who take time off work four weeks before their delivery are four times less likely to need a c-section (71).

A little bit of anxiety and stress during pregnancy produces kids with better motor and mental development scores at age two. Two-week-old infants have faster neural conduction (a more mature brain) if they were born of stressed mothers (63).

Moms who practiced yoga an hour a day had babies higher birth weights and were less likely to have a preterm labor or birth complications (72). Women who have robust social support, especially from many different sources, tend to have heavier babies (73).

DRUG NOTES:
The placenta doesn’t protect against particles that are small, neutrally charged, and that easily dissolve in fat (86).

“The use during pregnancy of five common nonprescription drugs rose between 1976 and 2004. Pain relievers, cold remedies, and allergy medications are the drugs most often consumed” (87). 65% took acetaminophen (Tylenol); 18% took ibuprofen (Advil/Motrin), and 15% took pseudoephedrine (Sudafed). Ibuprofen has a risk of miscarriage or fetal heart defect (88).

“Smoking during pregnancy has been tied to miscarriage, stillbirth, preterm delivery, low birth weight, birth defects, and SIDs” (89).

“While high prenatal cocaine exposure was associated with behavior problems, these effects were not as significant as those produced by their mothers’ use of alcohol and tobacco” (90).

Traffic-related air pollution causes premature delivery, low birth weight, and heart malformations (102).

Anything plastic with the recycling code 3, 6, or 7 is bad for you (98).

Phthalates cause male genital problems (99).

GENDER NOTES:
Old gender tests and modern evidence of them being true: “You shall put wheat and barley into purses of cloth, the women shall pass her water on it every day (it being mixed with dates and sand). If both sprout, she will give birth. If the wheat sprouts, she will give birth to a boy. If the barley sprouts, she will give birth to a girl. If they do not sprout, she will not give birth at all” (111). Predicts pregnancy 70% of the time. No evidence (yet) whether it predicts gender.
“Women carrying boys are in good spirits, while women bearing girls have volatile moods. Dreams about knives or clubs mean a boy, while dreams about spring or parties signify a girl. Morning sickness mean it’s a girl; a big appetite, a boy. A woman favors her right side when she is pregnant with a boy; her left side, with a girl. A fetus who is quiescent is female; a fetus who moves early and vigorously is male. The future mother of a male child has rosy cheeks, while her counterpart with a female child is pale” (112).
Women with severe morning sickness have a 55.7% chance of delivering a girl. Women who were hospitalized for three days or more for their inability to keep food down had odds of having a girl that were 80% higher than other mothers. “A hormone called human chorionic gonadotropin may be to blame: female fetuses produce more of it than males” (125).
Boy babies do tend to be 3.5 oz bigger than girl babies at birth. Women pregnant with sons consumed about 10% (200) more calories than women pregnant with daughters (126).
(I didn’t have morning sickness, but I had a girl. I also didn’t have a big appetite. My left side was the side that was hurting when I was pregnant with her; not sure if that qualifies as “favoring” it or not.)
13 out of 17 mothers correctly predicted their baby’s sex based on intuition. 8 out of 8 correctly predicted their baby’s sex based on dreams (126). (I dreamt of my child being a boy more than once, but I had a girl.)

To increase the chances of having a son, the ancient Greeks would lie on their right side during copulation. In 18th century France, the man would bind up his left testicle before sex. In 20th century Italy, the man would bite the woman’s right ear during sex (133).

Stressed mothers are 5% more likely to give birth to girls (128, 131). The boys that ARE born to stressed mothers are stronger than the boys born to non-stressed mothers (128). Women taking antidepressants are less likely to birth a boy (131).

Abortion rates of females in the past 20 years: 10 million in India, 20 million in China (135).

MOOD NOTES:
Benefits of exercise during pregnancy: alleviates depression, reduces the risk of preeclampsia and gestational diabetes, helps manage musculoskeletal problems like low back pain (151). Moderate-intensity aerobic exercise for at least 30 minutes three times a week improves fetal heart health (152). “Women who exercise while expecting tend to have larger babies who grow up to be smarter adults” (152).

“Women with mild symptoms of depression are 60% more likely to deliver early; women who are severely depressed have twice the risk of premature birth” (154).

SSRIs (antidepressant) during pregnancy “has been associated in some studies with an increase in breathing problems in the newborn” (154). Women who continue to take their antidepressants while pregnant, about 25% still became depressed. Of women who stopped their antidepressants, more than 2/3rds became depressed. But since the percentage was not 100%, I think it’s worth a try to go off the meds. If the woman experiences a relapse, she can go back on them. 60% of depressed pregnant women recovered when in a therapy group, so that too is something that should be tried before resorting to drugs (165).

Fetuses of women who are depressed or anxious have increased heart rates when their mothers do (158).

“Newborns of depressed others are more irritable and hard to soothe, have more problems sleeping. . . . Later on in children’s lives, maternal depression and anxiety during pregnancy is associated with higher rates of impulsivity, hyperactivity, and emotional and behavioral problems” (159).

BAD BLOOD NOTES:
“The more older brothers a man has, the better the chance that he will be gay” (178). “The hypothesis doesn’t explain all homosexuality, of course, but we estimate that about a third of gay men are gay because their mothers had sons before them” (178). “Biological older brothers made a man more likely to be gay, whether he’d grown up with them or not; older stepbrothers raised in the same household had no effect on sexual orientation” (179).

“Low-birth-weight babies become adults with a higher risk of diabetes” (192). “If we could intensively control diabetic women’s blood sugar during pregnancy, we could really bring down the number of children who go on to develop diabetes” (180).

“The children of women who have a higher intake of vitamin D during pregnancy are less likely to show early signs of asthma” (185). Taking antioxidants during pregnancy could prevent the development of high blood pressure in the child. Injecting the hormone leptin into newborn rats stops the rat offspring from becoming obese. Soy offsets the negative effects of BPA (192).

High levels of fetal testosterone are associated with autistic symptoms (191).

CH. 8 NOTES:
“People who were in utero during the [Spanish Flu] pandemic did worse, on average, on just about every socioeconomic outcome recorded” (203).

“Women who fasted while pregnant gave birth to babies who were born earlier and had lower birth weights. A similar study by Almond of Muslims in Uganda found that individuals who were born nine months after Ramadan were 22% more likely to be disabled as adults, with higher rates of vision, hearing, and learning problems” (204-205).

“Low birth weight has an effect on the functioning of the blood vessels in later life that is ‘as great as the effects of smoking.’ Each one kg decrease in birth weight . . . Leads to a reduction in the capacity of blood vessels equivalent to smoking 20 cigarettes for a day for 4.5 years” (213).

“Each additional inch of height above the average is worth $789 per year in salary” (206). “On average, taller children score higher on tests of cognitive ability” (207).

“The intrauterine environment accounts for 20% of IQ similarity between twins, and genes for only 34%” (208). “The twin born at the higher birth weight scored significantly better on IQ tests” (209).

Toxins to a pregnant rat affected even the great-great grandchildren (215).

The unwanted child “who was born due to abortion restrictions was as much as 50% less likely to survive to old age than was the average child born in the same era, perhaps because of low maternal investment in the pregnancy” (219).

CH. 9 NOTES:
Infants experiencing pain or high stress (like circumcision or forceps/suction delivery) become more sensitive to future pain (238).

“87% of pregnant women receive some kind of medication for pain during labor” (230).

“Soldiers born in spring and summer generally died earlier than those born in fall or winter” (232). “Recruits with spring or summer birthdays were more likely to develop heart disease, and were 70% more likely to die of stroke, than those born later in the year. Costa suggests that is because their mothers had less to eat during the winter, and were more likely to have respiratory ailments while pregnant” (232). “On average, children born in late summer or early fall are a centimeter taller and have thicker bones by age 10 than their peers born at other times of the year—perhaps because their mothers were exposed during their pregnancies to more sunshine, which promotes the body’s manufacture of bone-building vitamin D” (232).

[April Helms · Rating 4 out of 5]

This is a fascinating (and occassionally disturbing) read for those interested in childhood development and epigenetics. The author parallels her own thoughts and experiences with her second pregnancy with the growing bodies of evidence that are showing the incredible impact of the environment, nutrition and other factors on the unborn child -- effects that can be felt and documented even decades later. Two examples that struck me:
One was a study of children and adults who were in-utero during the 1944 "Hunger Winter" in the Netherlands. The famine, brought on by a tight German blockade coupled with an unusually severe and early winter, left an estimated 18,000 dead. Those children who were still in the womb during this time were not only smaller than average, but their own children were smaller than average. The children studied also had a significantly higher pecentage of ailments such as heart disease and cancer, even decades later. Higher rates of schizophrenia and other neurological disorders were also found among children who had been in the second trimester during the Hunger Winter (and, indeed, in other famines and times of intense stress).
The second is more recent: the ice storm that struck parts of the northern United States and Canada. This storm shut down some cities for several days. Researchers conducted two studies on children who had been in-utero at the time of the storm. They noticed significant delays in development when the children were toddlers, compared to children who had not been impacted by the storm, and in IQ. Those children were tested about a decade later; while the gap between those who were impacted by the storm and those who were not had closed somewhat, that gap still remained. At least one researcher quoted in the book said she was surprised that such a sizable gap would have remained, even a decade later.
The implications of such studies are sobering, to say the least.
I liked the writing style and the author's own asides about her pregnancy, and she doesn't seem to leave any stone unturned, any side or angle unmentioned. I do like how Paul at least tries to give the positives -- what can be done to help improve the unborn child's future. But many things seem rather daunting. Also, there were a couple pieces of advice that might seem a bit misguided. For example, she said she eschewed some fish because of mercury concerns (understandable) and instead went for others, including catfish. Huh? I don't know about the mercury concerns of catfish, but that is not a fish I'd recommend, given its feeding patterns (bottom feeders tend to be chock full of other pollutants, and I don't know the safety of farmed fish other than often its no safer.) Also, her observation of how children born via C-section don't feel pain as intensely as those born "naturally" was, while may be true, left the impression that voluntary C-sections should be done more. Sorry -- but while C-sections are sometimes necessary, they can bring a whole host of other problems for the mother and infant (higher rates of respiratory ailments in newborns, for example).
I do like how the book was chaptered-- nine chapters for nine months. I do wonder if the information could have been a bit better organized. I've read far worse, but a couple things got repeated, and there were similar items that should have been grouped together. It's not bad -- the themes are fairly well established per chapter. It just needed tweaked. All in all, I really enjoyed this book.

[Sarah · Rating 3 out of 5]

This book is full of fascinating facts based on research into fetal origins. Some things I found especially interesting include:

* According to some researchers, about one-third of gay men are gay because their mothers had more sons before them. The researchers hypothesize that this is because the mother's immune system manufactures antibodies directed at proteins secreted by male fetuses. When she becomes pregnant with another son, these antibodies allegedly affect the baby's developing brain in a way that predisposes him to homosexuality. According to these researchers, the more older brothers a boy has, the more likely he is to be gay.
* Babies reap the same benefits their moms do from cardiovascular exercise: their heart rates and heart-rate variability are lower than those of fetuses whose moms don't exercise.
One emerging consensus coming about due to fetal origins research is that one's disposition to heart disease may have as much to do with prenatal nutrition as one's diet and activity level. Specifically, a lack of healthful nutrients during gestation seems to predispose offspring to cardiac and other organ problems.

These are just a few examples of the interesting research that Murphy Paul writes about. The reason I can’t give the book more stars is that the author seems particularly prone to confirmation bias; she is all too eager to unquestioningly accept research that supports her theories, and is apt to confuse causation with correlation. One example of this is Murphy Paul’s descriptions of the effects of obese mothers on their babies. She cites a study comparing the obesity rates of children born to the same mothers pre- and post- gastric bypass surgery. The kids gestated post-surgery were 52 percent less likely to be obese than siblings born to the same mom when she was obese. Murphy Paul takes this as proof that the changed physiology of the mother causes the changed obesity rates of the post-surgery offspring.

I found this conclusion arresting, because anyone who successfully loses and keeps weight off after bariatric surgery has made major changes to her diet and presumably her household environment that supports that diet. Murphy Paul erroneously drawing these conclusions, and blindly accepting research results and/or confusing causation with correlation, cast a pall over the rest of the book for me. It made me doubt whether I could trust her reporting of the clinical studies. Fortunately, the book is well-sourced, so I can personally look up any studies that I have questions about.

Another thing that disturbed me was how Murphy Paul blindly seemed to use the research she found to justify her own experiences. She was pregnant at the time she wrote the book, and it flows between data about fetal origins and how that meshes with Murphy Paul’s experiences as a pregnant woman. Both of her sons were born via cesarean sections, and I found myself rolling my eyes when she was extolling their virtues, such as the assertion that children born via c-section are less likely to experience pain as infants. There was no information whatsoever about the very real risk of c-sections to fetuses. In the interest of fairness in a book about fetal origins science, I would have preferred a more balanced look at the pros and cons of vaginal and caesarean births for the baby in light of current research on the topic.

Overall, this is a very entertaining read, but take it with a gigantic grain of salt.

[Ericka Clou · Rating 4 out of 5]

An interesting, well-researched book on how the influences on the fetus during pregnancy affect the child throughout its life. The book has a good organization and numerous scientific studies to back up the claims. Unfortunately, it's also gimmicky and tries to provide pregnant mothers with empty assurances that ring hollow relative to the actual studies.

One thing I intensely disliked about this book was the chapter titles: "One Month- Nine Months" actually provides no information about what the chapters are about but is just a cutesy way of imitating basic pregnancy books, and also a shoutout to the fact that the author is herself pregnant as she writes this book. (Though I hope this is indeed a gimmick and she didn't rush through this book in 9 months.)

So here is the breakdown:
One Month- A basic introduction to the book

Two Months- How the food the mother eats affects the offspring throughout his or her life

Three Months- How traumatic stress for the mom during pregnancy affects the offspring for life

Four Months- The dangers of alcohol, cigarette smoking, prescription drugs, pollution, plastics, and other chemicals in everyday products (total horror here) that can cause either immediate birth defects or later-in-life cancers in the offspring.

Five Months- Some rambling about the history of gender predictions (and some subsequent scientific studies confirming some old wives tales), quickening, and sonograms. Finally: only 20 to 40 percent of fertilized eggs result in live birth, the rest are lost to miscarriage often before a woman knows she's pregnant. Numerous factors can prevent male embryos from succeeding relative to the number of female embryos that succeed: pollution, economic depressions, natural disasters, etc... or skipping breakfast. (Skip breakfast to have a girl, eat a lot of cereal for breakfast to have a boy. Or maybe this study is totally wrong- and it's just chance.)

Six Months- The effects of partum and post-partum depression

Seven Months- A more broad exploration of studies in progress concerning the prenatal origins of numerous adult diseases, abilities, or personality traits.

Eight Months- Again as in Chapter 7, specifically looking at the effect of large-scale traumatic events, (as in Chapter 3).

Nine Months- The effects of the process of birth itself: whether natural, assisted birth, or Cesearean, and other birth factors such as time of year the baby is born.

[Kat · Rating 3 out of 5]

I sought this book out after reading the chapter in "YOU: Having a Baby" about fetal programming and epigenetics, which I find fascinating, especially now as I do preliminary research before preparing to get pregnant. The author compiles various studies that you may have heard about before in other books or documentaries, such as the biological effects of famines and trauma on future generations, the links between environmental toxins and various developmental disorders, how maternal bonds are forged in utero, etc. Fascinating and at times upsetting, this is the kind of information that I want to arm myself with in order to feel empowered and in control of my own body. While arguably some of the studies included in the book could be construed by some as scare tactics to manipulate women into certain behaviors or to make women feel guilty about their lifestyles, I abide by the old adage that "knowledge is power". It is your choice what you will do with it and how you will let it affect you. For this reason, I appreciate all of the information that the author brings to the table, as well as the many citations included in the back for further exploration.

I didn't really enjoy her anecdotal side-story about her yuppie Manhattan pregnancy while she researched the book, with nine chapters for each of her nine months of pregnancy. And in some cases, her reactionary responses (ie "I threw away all of the plastic in my kitchen after reading about BPA") as a memoir writer seem to stumble in the way of the scientific findings that she is trying to deliver as an unbiased science writer. All in all though, a fascinating pregnancy book for curious nerds like me.

[Paul Signorelli · Rating 5 out of 5]

Those of us fascinated by learning and how we are affected by the places where learning occurs find ourselves exploring a wonderfully unexpected learning space in Annie Murphy Paul’s "Origins: How the Nine Months Before Birth Shape the Rest of Our Lives": the womb. It is Paul's contention, throughout this well-researched and thought-provoking book, that we haven't given nearly enough attention to all we learn and acquire in those critical nine months before we enter the world. "Origins" is a great first step in filling that gap. Organized into nine chapters representing the nine months of the writer's second pregnancy, the book takes us through tantalizing views of the latest research into what we learn and how we are shaped in utero. Her Month Three explorations of how tremendously stressful situations affect mothers and the children they are carrying remind us that significantly less stressful situations can have significant and long-lasting effects on a learner's ability to absorb and retain information. Her Month Six explorations document how a mother's emotional state might have significant lifelong physiological impacts on her developing child. And the concluding chapters leading us to the moment of her second child's birth remind us of a variety of physical and emotional elements that teach the unborn child what to expect upon entering the world--just as we, as facilitators of learning, convey important messages to learners about what they can expect and might accomplish once they leave our learning spaces and re-enter the world in which they live and work and play.

[Jill · Rating 3 out of 5]

Well, this book certains give a pregnant woman a lot to contemplate. First my pet peev: Why does every part-memoir, part-nonfiction writer live in New York? Also, is there a new category for this type of contrived non-fiction memoir? It isn't exactly memoir since the authors know going in that they will be relating their interesting factoids to their personal experience.

Anyway, Annie Murphy Paul cites plenty of interesting studies and references to allow the book to stand on its own--without the need to follow her through her own nine months of pregnancy. In fact, the "real" material is so interesting, I wish she spent more time delving into some of the controversial topics such as how these thoeries affect the rights of pregnant women and how to adopt healthy strategies for pregnant women without mandating them. As it is, she merely glosses over the research. I'm left not knowing in what ways I could shape my fetus's time in the womb, and in what ways I just have to step aside and let nature take its course. I have some unanswered questions--if stress during pregnancy affects the baby for the rest of his life, how much stress qualifies as "stress"? Can anything be done to counteract these effects in fetuses? Maybe these questions haven't been answered by researchers yet, but I don't know--each chapter cut over to the author's personal montly experience before such questions could be answered.

[Megan · Rating 3 out of 5]

If you have been pregnant recently, a fair amount of the information in this book will not be completely new-- a lot of this is what appears in the average book that you would pick up to read while preparing for pregnancy. Some of the more recent epigenetics is outside of the kind of content that those "when you're expecting" books cover. That being said, many of the examples that Paul covered are examples that I had read about in the news.

Paul weaves the scientific information in with information about her second pregnancy (she was pregnant when she wrote the book). I enjoyed this structure-- her execution was very clever. However, she seemed to decide that this lighter, personal approach meant that she shouldn't go into very much detail about many of the studies that she talks about. The details of the methods of many of the studies were unclear to me-- they seemed to be showing correlation rather than causation, but the results are presented with a lot of drama as though they definitely prove that certain events or factors are very influential on the developing fetus. Without more discussion of what the genetic or developmental mechanism might be for this effect, though, I was left unconvinced.

Overall, a quick, interesting read but not as in-depth as I had hoped.

[Erin · Rating 2 out of 5]

I really wanted to like this book, and in fact, I was looking forward to reading it. I had heard of the author from her "Tiger Mother" article in Time magazine on 1/31, so when I learned about her subject expertise (fetal origins), I thought it would be a perfect "pregnancy reading" for me. I guess I just had really high expectations (and hopes).

The book, itself, is a pretty quick read. She weaves into her research tales and anecdotes of her own pregnancy (#2), which makes it a bit more "human." Otherwise, the book really reminds me of Bonk, which I read in December. It's basically just an historical/literature review of the ideas and concepts people have had for a long, long time related to pregnancy- things like what women should (or should not) eat, what women should (or should not) do, etc. while pregnant.

I will say that Paul's book is an interesting way to examine some of the more recent advances in fetal origins science, things that scientists are currently working on or pursuing. It seemed, though, that much of the book was more historically-focused than future-focused.

I don't regret reading it, but I'm glad I got it from the library and didn't purchase it, myself.

[Alison · Rating 3 out of 5]

This was a good compilation of current research into prenatal experience and how those might affect the grown adults. It's by a NY Times science writer who also happened to be pregnant at the time so some of her personal story was woven in to the narrative. Here are the things I disliked: The table of contents was so vague (one month, two months,...) as to be completely useless. The subjects in each month had nothing to do with whether it was one month or seven and there was no way to even guess what each chapter would be about. I would have preferred at least a subtitle after each describing the chapter topic, such as stress, sex selection, nutrition, etc. The other thing I disliked was that the final two chapters felt like added on conclusions with no new information. "8 months" started out being about intelligence and then devolved into a general conclusion with ways to move forward with the research discussed in the book. And chapter 9 (9 months) was a short personal conclusion of her having her baby in the middle of a snow storm. I would have preferred more research for chapter 8 and all of the conclusion in chapter 9. Other than that this was an interesting book on science research that has me wanting to quote research stats about things I don't know very well.

[Lily · Rating 4 out of 5]

Lauren--this book was written by the author of the article you posted on how our brains operate on fiction. I like her so much! At one point in the book, she rereads "Brave New World" and relates it to how society currently sets the stage for social inequity starting with prenatal care. Very interesting.

Also, although there is burgeoning interest in how fetal life predisposes individuals to physical, emotional, and psychiatric wellness/illness (and the book is basically a summation of recent studies suggesting the same), there is much, much more research to be done in this field. Paul points out that because the abortion debate is so charged in America, doing research on anything involving the word "fetus" is problematic for scientists here. That means most of the research is being done abroad. Such a shame, because (as Paul also points out), these findings not only enlighten BOTH sides of the debate, but could help us create a better future for our children by nudging us towards more equitable prenatal care to women. We are learning so much exciting information about fetuses that could potentially improve societal health as a whole, and it would be wonderful if more American researchers were brave enough to make this important field of study their own.

[Lynn · Rating 3 out of 5]

This book was great for me personally b/c I am a nerd and I liked the listings of findings from scientific studies, but the book was poorly organized and not particularly well written. I also appreciated the seemingly unintentional irony that the author describes her scheduled c-section birth at the end of the book where she admittedly feels uninvolved. After writing an entire book about how the fetus' experience during pregnancy influences the rest of its life and in light of reputable research about how c-sections may have adverse long term impacts on child development as well, it seems like an oversight not to mention this, but I guess this book was just about the 9 months of fetal development, not everything you can do to make sure your kid turns out okay. Overall, I liked this book a lot, but I admittedly have a high tolerance for poorly written non-fiction books with interesting information.

[Julie · Rating 4 out of 5]

This was a very interesting account of the science surrounding how the nine months before birth impact an individual's life. The author was pregnant at the time that she wrote it, so she incorporates science with her own thoughts and musings, which makes it a little more interesting. It's definitely more in the vein of a Malcolm Gladwell book than a serious work of science, since she incorporates history, science, psychology, and social commentary, but that makes it a little more readable.

The book's hypothesis is that nutrition, environment, serious stress, etc. all experienced by the mother impact the fetus in a way that has long-term repercussions (as in, affects disease proclivities, intelligence, motor skills). It's an intriguing idea and raises some really interesting questions about inequality in our society, since poor women tend to have more restricted access to good nutrition and be more exposed to toxins. Definitely a good discussion book.

[Karen · Rating 3 out of 5]

This is just about equal parts fascinating, guilt-inducing and annoying. Fascinating because there really are lots of tidbits I didn't know about. For example, pregnant mice fed junk food produce baby mice who are way more likely to prefer junk food over rat chow and eat way more calories. And most of the crack babies from the 80s are doing just fine - seems it is much worse to have an alcoholic mother than a crack-addicted one. Guilt-inducing because I didn't know some of this stuff when I was pregnant with Ted. Annoying because the writer is pregnant as she writes and makes it personal. Many reviewers touted this as the best thing about the book, but I found it irritating to hear what an icon of good health she was being.
Highly recommend over or in addition to the stuffy What to Expect books.