Why Chronic Disease May Begin Before Birth | Leslie Stone, Kalea Wattles & Emily Stone Rydbom

In the modern landscape of reproductive healthcare, a paradigm shift is underway, moving from a reactive, symptom-based approach to a proactive, systems-oriented model that views preconception not merely as a fertility window, but as a critical epoch for lifelong health. A recent installment of the podcast New Frontiers in Functional Medicine, hosted by Dr. Kara Fitzgerald, featured an in-depth discussion with pioneers in this space: Dr. Leslie Stone, Emily Stone Rydbom, and Dr. Kalea Wattles. Their conversation highlighted the mounting evidence that the trajectory of chronic disease—ranging from metabolic disorders to neurodevelopmental challenges—is often established long before a positive pregnancy test, rooted in the complex interplay of epigenetics, maternal nutrition, and environmental exposures.

The Growing Crisis in Reproductive Health

The urgency of this shift is underscored by stark global and domestic health statistics. Despite unprecedented advancements in medical technology, the United States is currently facing a dual crisis: a meteoric rise in infertility rates and an alarming increase in maternal morbidity and mortality. Emily Stone Rydbom, co-founder of the Grow Baby initiative, pointed to a sobering reality: the United States currently reports some of the highest rates of preterm birth in the developed world.

These outcomes are not randomly distributed; they are increasingly linked to social determinants of health and environmental factors. For instance, specific regions, such as those known as "Cancer Alley" in the southern United States, show a correlation between toxic environmental exposures and poor birth outcomes. Dr. Leslie Stone noted that chronic hypertension during pregnancy has doubled over the last fifteen years, creating a "feed-forward" cycle. A mother experiencing a hypertensive disorder during pregnancy increases the risk for her female offspring to suffer from similar cardiovascular issues in her own future pregnancies by as much as 90%. This intergenerational transmission of disease risk illustrates the profound biological legacy of the prenatal environment.

The Developmental Origins of Health and Disease (DOHaD)

Central to this discourse is the Developmental Origins of Health and Disease (DOHaD) theory. This framework suggests that the environment an individual experiences during the earliest stages of development—from preconception through the first 1,000 days of life—programs the body’s metabolic, immunological, and neurological systems.

Dr. Kalea Wattles, founder of Functional Fertility, emphasizes that this timeframe is the most significant opportunity for clinical intervention. By applying a functional medicine matrix, clinicians can identify and mitigate sub-clinical imbalances, such as systemic inflammation, insulin resistance, or nutrient deficiencies, long before they manifest as chronic conditions in either the mother or the child. Wattles argues that what is often labeled as "unexplained infertility" is frequently a reflection of metabolic dysfunction, such as hyperinsulinemia, which can drive androgen excess and disrupt folliculogenesis. By addressing these root causes, the clinical focus shifts from merely achieving pregnancy to ensuring a robust biological environment for the developing fetus.

The Grow Baby Initiative: A Multimodal Clinical Model

The Grow Baby program represents a practical application of these principles within obstetric care. Founded by Dr. Leslie Stone and Emily Stone Rydbom, the model integrates precision nutrition and lifestyle medicine directly into standard obstetric practices. The program’s data-driven approach has produced results that deviate significantly from national averages. In initial cohorts, the program observed a near-zero percent rate of preterm birth and small-for-gestational-age births, compared to national averages of approximately 8% to 10%.

The methodology relies on a "choose-your-own-adventure" approach to patient care, emphasizing cultural dietary patterns—such as the Mediterranean diet adapted to local and cultural preferences—while ensuring adequate macro and micronutrient intake. The program utilizes a collaborative model where functional nutritionists work alongside traditional obstetricians, ensuring that all interventions are complementary rather than conflicting. This model has proven so successful that it is now being expanded through the "ROOT Study" in North Carolina, a five-hundred-pregnancy study funded by Managed Care Organizations (MCOs) and the Department of Health and Human Services. This transition from boutique clinical practice to large-scale, insurance-funded research suggests that the healthcare industry is beginning to recognize the cost-saving potential of preventive care.

The Role of Epigenetics and the Imprintome

The biological mechanism driving these outcomes is largely epigenetic. Emily Stone Rydbom highlighted the importance of the "imprintome," a biological system that dictates gene expression by determining which parent’s copy of a gene remains active or silenced. This process is heavily dependent on one-carbon metabolism, which requires specific nutrients like B vitamins, choline, and folate.

Research conducted by the Grow Baby team, in collaboration with experts like Dr. Randy Jirtle, has underscored that the imprintome has a distinct window of susceptibility. Once these marks are set during early development, they can influence everything from neurodevelopment to long-term risk for psychopathology and metabolic disease. Because these processes are sensitive to the maternal environment, providing targeted nutritional support—often referred to as a "resiliency set point"—during the preconception and early prenatal period can effectively "program" the offspring for better health.

Implications for Lifelong Health and Longevity

The conversation also extended to the broader implications for aging. Dr. Kara Fitzgerald and her guests explored the connection between the cellular mechanisms required for reproduction and the hallmarks of biological aging. Proteins and pathways involved in early fetal development, such as the Polycomb Repressive Complex, are now being investigated for their role in the aging process. By optimizing mitochondrial function and managing systemic inflammation during the reproductive years, individuals may not only improve fertility outcomes but also enhance their own health span and reduce their risk of age-related chronic diseases.

Conclusion and Future Directions

The consensus among these experts is that the window for preconception care is far wider than previously thought. While the immediate goal is a healthy pregnancy, the long-term objective is the reduction of the intergenerational burden of chronic disease. By shifting the clinical focus to the preconception period, practitioners can act as architects of health, using evidence-based interventions to improve outcomes for mothers, infants, and future generations.

As these findings move from niche functional medicine circles into larger, peer-reviewed studies like the ROOT project, the medical community is forced to re-examine the definition of "standard of care." The evidence suggests that a proactive, personalized, and systems-based approach is not just a luxury but a necessity for reversing the current trends in maternal and child health. For the clinician, this means viewing every patient of reproductive age through a lens of prevention, recognizing that the health of the future is being written in the biology of the present.