Keeping track of pregnancies from the very beginning. Not just one, but ten thousand at a time: that’s Generation R/Next, a unique longitudinal study conducted by Erasmus MC. Research at this scale has never been done before. The goal is simple - a healthy new generation of Rotterdammers.
NAME: Vincent Jaddoe
STUDY: PhD Epidemiology/Pediatrics, Doctor of Medicine Leiden
CAREER: Professor of Pediatric Epidemiology, Pediatrician
A separate wing at Erasmus MC-Sophia Children’s Hospital is dedicated to Generation R. Families register in the waiting room, while down the hall, the office of project leader Professor Vincent Jaddoe awaits. Generation R has been up-and-running for fifteen years. Of the ten thousand children that initially were signed up, some seven thousand are still going strong. Researchers have been taking stock of their health from the fetal stage to this day, hoping to find out how to improve children’s health in general, and which factors come into play. The waiting room still features a play corner with toys, but the seven thousand participants are approximately thirteen years of age by now. They’re more likely to be on their smartphones, sitting in that waiting room. ‘Generation R enters puberty!’ says the website, www.generationr.nl. All findings up until now are also accessible online.
The wish to have a baby
As it turns out, parents’ health and lifestyle early in pregnancy and even before conception may influence a child’s growth and development. Sometimes the connection doesn’t become clear until later on. ‘We know half of all women still consume alcohol every now and then during pregnancy. You won’t notice the effects at birth, but sometimes you will many years later,’ Vincent Jaddoe explains. That’s why this new study, Generation R/Next, focuses on early pregnancy. Several 3D ultrasounds are made during the first trimester, and questionnaires are done to gain information about the health and lifestyle of the parents-to-be. Currently, some six hundred women trying to get pregnant have signed up for the pilot. The goal is to follow ten thousand women and their partners in total. By monitoring pregnancies closely from the earliest stages, as well as following up on children once they’re born, researchers hope to draw more accurate conclusions about infant health and a child’s subsquent development. And speaking of getting pregnant, why is it so easy for one woman and so hard for the next? Any study with this amount of participants over such an extended period of time is unique in the world. Research with the premise of Generation R/Next has never before been conducted successfully at this scale.
Free 3D ultrasounds
Jaddoe is quite convinced he will find those ten thousand women willing to sign up. ‘Our big advantage is that we can ride on the coattails of the previous study, Generation R. Also, Sophia Children’s hospital is ideally located, in the middle of town. And we’re already collaborating with obstetricians.’ Participants who wish to get pregnant will receive extra tests and ultrasounds from the start of their pregnancy, for free, and for many, that will be a strong incentive to enroll. Research physician Dionne Gootjes is involved with the ultrasounds facility. ‘We do ultrasounds at various points in time, ahead of conception as well as during the seventh, nineth, eleventh and thirtieth week. We plan to keep track of growth and development from the earliest stage. We’re not replacing regular prenatal care, we’re extra. Many women who take part in the study often tell us they love the fact that they get to see their baby more often and earlier than they would normally through their obstetrician.’ The goal is to gain a clear picture of the parents’ health in relation to the development of their (unborn) child. Gootjes: ‘During an ultrasound we’re not specifically looking for abnormalities. With a longitudinal study, you don’t know in advance which factors you’ll end up looking into. At this stage we’re mainly collecting data. But if we see something suspicious, we’ll be able to confer with a gynaecologist immediately, of course.’
‘Many women tell us they love the fact that they get to see their babies more often, thanks to the additional ultrasounds’
Early days matter
‘In the end, interventions will be part of the process,’ adds Vincent Jaddoe. He eleborates: some people believe consuming alcohol has very little influence in the early stages of pregnancy, whereas in fact those first twelve weeks are crucial. ‘During the early stages, two cells morph into a miniature organism. Every organ is created during the first twelve weeks. Problems which we run into during birth, such as hypertension and obesity, can sometimes be traced back to those early beginnings. That’s why this study matters and that’s why we’ll want to intervene. By relaying specific advice to women who hope to get pregnant, the future health of their children may be improved. We’ll start with these interventions after a year– think: one group provided with regular care, and one group provided with special advice.’ It’s hard to tell people to change their lifestyle or eating habits, both researchers admit, but if you could pinpoint one moment where people likely would be more susceptible to advice, it would have to be around a pregnancy. Jaddoe: ‘In the end, everyone prefers a healthy baby.’
So, what constitutes health? From the thousands of jigsaw puzzle pieces involved when it comes to a family’s health, four themes were distilled in relation to Generation R/Next which are suitable for interventions. The first one is lifestyle, in particular the most detrimental (known) influences such as alcohol, smoking, and drug use. Then there’s the second theme: nutrition. Jaddoe: ‘From previous research findings we know that too much glucose – sugar – can damage an unborn child; it will simply adjust.’ The third theme that deserves attention is stress. Intervention will involve mindfulness training. Depression and anxiety also have adverse effects on a baby’s health. Theme number four only comes in to play after delivery: raising the child and everyday interactions. Professor Jaddoe: ‘If we wouldn’t deal with stress while paying attention to all the other factors, it would still be ineffective. It really takes a comprehensive approach.’
Rotterdam, a challenge
Rotterdam is an interesting area, because, according to the researchers, it’s a challenging city. Think about all the different types of cultural backgrounds, about ethnic as well as social diversity, about inequality. In some families problems appear to cluster, with reduced access to healthcare, smoking, alcohol consumption, and a tendency not to act on the obstetrician’s advice. Vincent Jaddoe: ‘Apparently all of us as a society are still incapable of reaching a certain group of women. We’d like to change that. We want to reach exactly those women who are most vulnerable. So that we may influence their health and, consequently, their children’s health in positive way.’
Believing without seeing
The Erasmus Trustfund played an important role in financing the first study, Generation R. Today, more than enough sponsors acknowledge the importance and the power of the study, meaning Generation R can stand on its own legs. Generation R/Next means a renewal of that challenge of finding money. Jaddoe: ‘It’s not easy to get research such as this funded, where first results can only be expected four to five years from now. As soon as things get off the ground, sponsors will collaborate. But to get something like this off the ground, which doesn’t generate results right away – that requires people who believe in it. We need people who recognise how important this is for Rotterdam, for the university, and for healthcare in general.’ You don’t have to ask the researchers how crucial it is. Vincent Jaddoe continues: ‘Here in Erasmus MC, I see babies being born every single day, with all the issues that sometimes brings along. I want to contribute to the prevention of those issues.’ As for the university - here’s a unique chance to distinguish itself from its peers, because a study like this has not been conducted anywhere else in the world. Research physician Dionne Gootjes adds: ‘To me it’s very special that I get to work on a study which will lead to new insights, and healthier children in the future.’
TEXT: Pauline Bijster
ILLUSTRATION: Erik Kriek
PHOTO Vincent Jaddoe: Erasmus MC ©