A lot of children are about to be born in Ukraine. Will the war affect them for life?

When Russia attacked Ukraine in late February, Ukrainian civilians were immediately caught in the crossfire. Over the last month, people have been fleeing to neighboring countries, waiting out the nights in bomb shelters, and getting by without running water or electricity.

Pregnant people are among those caught in the middle. Some of the most horrific images from the war so far have come from a maternity hospital in Mariupol that was bombed by Russian troops in mid-March. The upheaval spurs a troubling question: Could the stress and condition of war affect a fetus in the womb?

Research suggests that the answer is possibly, yes. Certain factors, like the nutrition and mental health of a pregnant parent, can potentially influence the development and eventual health of their child, a concept known as fetal programming.

“It’s basically thinking about what happens during the 9 months of pregnancy that can help program, and help determine, the lifelong health of the offspring,” says Karen Lindsay, an assistant professor of pediatrics in the College of Health Sciences and researcher who specializes in maternal nutrition in pregnancy at the University of California, Irvine. “And that can be in a positive or a more negative direction.”

The Importance of Nutrition

Malnourishment during pregnancy can impact a child throughout their life. “Our research over the last 70 years or so has shown that those babies who are maybe malnourished during fetal development and born small, they actually have an increased risk of obesity and heart disease later in life,” Lindsay says.

The Effects of Stress

Research also suggests the mental health of the pregnant parent can influence a child’s development, and increase their risk for developing mental health issues later in life.

Scientists have looked specifically at the effects of stress from major disasters or conflicts on pregnant parents and their babies. For example, an analysis of seven natural disasters, including the 2011 Queensland Flood in Australia, the 1998 Quebec Ice Storm in Canada, and the 2010 earthquake in Haiti, found experiencing these events was linked, perhaps not surprisingly, to higher rates of stress in pregnant people. This stress in turn was associated with certain physical and mental development outcomes for their babies, including higher BMI and worse cognitive and behavioral outcomes after birth. Another study found people exposed as fetuses or early childhood to the Chinese Famine between 1959 and 1961 were at higher risk for cognitive decline in adulthood.

Stress and nutrition are related, Lindsay says. Not only can feeling stressed influence what people eat, but stress may also affect how their bodies metabolize certain foods, she says. A pregnant person might eat a meal they think is healthy, but because they are eating while feeling stressed instead of calm, the healthy meal could potentially boost their blood sugar level higher than expected. This in turn could influence how the fetus receives nutrition from the parent, she says.

Scientists also think some of the effects from stress and nutrition could be happening at the molecular level, inside a child’s DNA. Factors like anxiety or malnourishment could influence the chemicals that determine whether or not certain genes are switched on or off, Glover says. While there’s a lot of research interest around this idea, the evidence is still fairly sparse. “I wouldn’t say the epigenetic evidence is the strongest, by a long way,” Glover added.

Only a small percentage of children are impacted by high stress during pregnancy in this way, says Glover of her research. In one study, for example, 12% of the children born to the most anxious or depressed parents (ranking in the top 15% of all the parents surveyed) had double the risk of a probable mental disorder at age 13. In contrast, only about 6% of the children born to the remaining parents had a similar risk. “We’re talking about increasing risk and it really matters … but most children aren’t affected.”

Care During and After Pregnancy

For many people, it may be impossible to avoid stress during pregnancy, whether that stress is from work and daily life, an ongoing mental health condition like depression or anxiety, or from a geopolitical conflict, like the war in Ukraine. What’s more, not all parents have access to highly nutritious foods; perhaps they live in a food desert or are just struggling to survive. This isn’t the fault of the pregnant person, Glover says. “We must support them as a society,” she says.

The good news is, research indicates many of the effects of stress during pregnancy can be reduced after birth, Glover says. Paying special attention to these children, ensuring they feel securely attached to their parents or caregivers, and breastfeeding can all help mitigate the impacts of stress, she says.

The same holds true when it comes to malnourishment, Lindsay says. A child’s susceptibility to a condition like diabetes could be alleviated with proper nutrition, activity, and other interventions, she says. A susceptibility is not an inevitability (That said, some physical defects, like neural tube defects, cannot be rectified later).

In Ukraine, the shelling around major cities like Kyiv continues and people live life on high alert. In Mariupol, families who can’t escape the artillery are running out of food and water. “The stress going on in Ukraine must be tremendous,” Glover says. While it’s impossible to say exactly how the war will impact children born during the Russian invasion, past disasters have shown the effects could be lifelong, perhaps manifesting as early mental decline, depression, or increased risk for heart disease. Glover says it will be crucially important to take care of these children after birth, in any way possible.