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Can the gap in Aboriginal outcomes be explained by DOHaD

  • E. C. McEwen (a1) (a2), T. J. Boulton (a1) and R. Smith (a1) (a2)


In Australia, there are two distinct populations, each with vastly disparate health outcomes: Aboriginal and Torres Strait Islander People and non-Aboriginal Australians. Aboriginal Australians have significantly higher rates of health and socioeconomic disadvantage, and Aboriginal babies are also more likely to be born low birth weight or growth restricted. The Developmental Origins of Health and Disease (DOHaD) hypothesis advocates that a sub-optimal intrauterine environment, often manifested as diminished foetal growth, during critical periods of foetal development has the potential to alter the risk of non-communicable disease in the offspring. A better understanding of the role of the intrauterine environment and subsequent developmental programming, in response to both transgenerational and immediate stimuli, in Aboriginal Australians remains a relatively unexplored field and may provide insights into the prevailing health disparities between Aboriginal and non-Aboriginal children. This narrative review explores the role of DOHaD in explaining the ongoing disadvantage experienced by Aboriginal People in today’s society through a detailed discussion of the literature on the association between foetal growth, as a proxy for the quality of the intrauterine environment, and outcomes in the offspring including perinatal health, early life development and childhood education. The literature largely supports this hypothesis and this review therefore has potential implications for policy makers not only in Australia but also in other countries that have minority and Indigenous populations who suffer disproportionate disadvantage such as the United States, Canada and New Zealand.


Corresponding author

Address for correspondence: E. C. McEwen, School of Medicine and Public Health, University of Newcastle, John Hunter Hospital, Lookout road, New Lambton Heights, NSW 2305, Australia. E-mail:


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1. Malaspinas, AS, Westaway, MC, Muller, C, et al. A genomic history of Aboriginal Australia. Nature. 2016; 538, 207214.
2. Clarkson, C, Jacobs, Z, Marwick, B, et al. Human occupation of northern Australia by 65,000 years ago. Nature. 2017; 547, 306310.
3. Aboriginal Children, Health and History: Beyond Social Determinants. (ed. Boulton J), 2016; Routledge: NY.
4. Australian Bureau of Statistics. Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 2001 to 2026, 2014. Australian Bureau of Statistics (ABS): Canberra; (cat. no. 3238.0).
5. SCRGSP. Overcoming Indigenous Disadvantage: Key Indicators. 2014. Productivity Commission: Canberra.
6. Australian Bureau of Statistics. Estimates of Aboriginal and Torres Strait Islander Australians, June 2011, 2013. Australian Bureau of Statistics (ABS): Canberra; (cat. no. 3238).
7. Australian Bureau of Statistics. Life Tables for Aboriginal and Torres Strait Islander Australians, 2010–2012, 2013. Australian Bureau of Statistics (ABS): Canberra; (cat. no. 3302.0.55.003).
8. Zhao, Y, You, J, Wright, J, Guthridge, SL, Lee, AH. Health inequity in the Northern Territory, Australia. Int J Equity Health. 2013; 12, 79.
9. Anderson, I, Robson, B, Connolly, M, et al. Indigenous and tribal peoples’ health (The Lancet-Lowitja Institute Global Collaboration): a population study. Lancet. 2016; 388, 131157.
10. Australian Bureau of Statistics. Labour Force Characteristics of Aboriginal and Torres Strait Islander Australians, Estimates from the Labour Force Survey, 2011. Australian Bureau of Statistics (ABS): Canberra; (cat. no 6287).
11. Australian Bureau of Statistics. Prisoners in Australia, 2015, 2014. Australian Bureau of Statistics (ABS): Canberra; (cat. no. 4517).
12. Australian Bureau of Statistics. Recorded Crime – Victims, Australia, 2014, 2015. Australian Bureau of Statistics (ABS): Canberra; (cat. no. 4510).
13. Panaretto, K, Lee, H, Mitchell, M, et al. Risk factors for preterm, low birth weight and small for gestational age birth in urban Aboriginal and Torres Strait Islander women in Townsville. Aust N Z J Public Health. 2006; 30, 163170.
14. Hilder, L, Zhichao, Z, Parker, M, Jahan, S, Chambers, GM. Australia’s mothers and babies 2012. Perinatal statistics series no 30. 2014. AIHW: Canberra.
15. McEwen, EC, Guthridge, SL, He, VY, McKenzie, JW, Boulton, TJ, Smith, R. What birthweight percentile is associated with optimal perinatal mortality and childhood education outcomes? Am J Obstet Gynecol. 2018; 218, S712S724.
16. Shah, PS, Zao, J, Al-Wassia, H, Shah, V. Pregnancy and neonatal outcomes of aboriginal women: a systematic review and meta-analysis. Women’s Health Issues. 2011; 21, 2839.
17. Rudd K. Prime Minister Kevin Rudd, MP – Apology to Australia’s Indigenous peoples [speech transcript]; 2008 Canberra: Department of Parliamentary Services [Available from:
18. NAPLAN. Achievement in Reading, Persuasive Writing, Language Conventions and Numeracy: National Report for 2017, 2017. ACARA: Sydney.
19. Australian Institute of Health and Welfare. A picture of Australia’s children. cat. no. PHE 58. 2005. AIHW: Canberra.
20. Janus, M, Duku, E. The school entry gap: socioeconomic, family, and health factors associated with children’s school readiness to learn. Early Educ Dev. 2007; 18, 375403.
21. Sum, A, Khatiwada, I, McLaughlin, J, Palma, S. The Consequences of Dropping Out of High School. 2009.
22. Gluckman, PD, Hanson, MA, Buklijas, T. A conceptual framework for the developmental origins of health and disease. J Dev Orig Health Dis. 2010; 1, 618.
23. Wadhwa, PD, Buss, C, Entringer, S, Swanson, JM. Developmental origins of health and disease: brief history of the approach and current focus on epigenetic mechanisms. Semin Reprod Med. 2009; 27, 358368.
24. Hales, CN, Barker, DJ. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia. 1992; 35, 595601.
25. Francis, JH, Permezel, M, Davey, MA. Perinatal mortality by birthweight centile. Aust N Z J Obstet Gynecol. 2014; 54, 354359.
26. Vasak, B, Koenen, SV, Koster, MP, et al. Human fetal growth is constrained below optimal for perinatal survival. Ultrasound Obstet Gynecol. 2015; 45, 162167.
27. Vashevnik, S, Walker, S, Permezel, M. Stillbirths and neonatal deaths in appropriate, small and large birthweight for gestational age fetuses. Aust N Z J Obstet Gynaecol. 2007; 47, 302306.
28. Steer, P. The management of large and small for gestational age fetuses. Semin Perinatol. 2004; 28, 5966.
29. Dobbins, TA, Sullivan, EA, Roberts, CL, Simpson, JM. Australian national birthweight percentiles by sex and gestational age, 1998-2007. Med J Aust. 2012; 197, 291294.
30. Royal College of Obstetricians and Gynaecologists. Small for Gestational Age Fetus: Investigation and Management. Greentop Guideline no. 31. 2013. RCOG: London.
31. Raznahan, A, Greenstein, D, Lee, NR, Clasen, LS, Giedd, JN. Prenatal growth in humans and postnatal brain maturation into late adolescence. Proc Natl Acad Sci USA. 2012; 109, 1136611371.
32. Matte, TD, Bresnahan, M, Begg, MD, Susser, E. Influence of variation in birth weight within normal range and within sibships on IQ at age 7 years: cohort study. BMJ. 2001; 323, 310314.
33. Roberts, CL, Lancaster, PA. Australian national birthweight percentiles by gestational age. Med J Aust. 1999; 170, 114118.
34. Coory, M. An investigation into the disparity between Australian Aboriginal and Caucasian perinatal mortality rates. Ann Epidemiol. 1995; 5, 393399.
35. Jasienska, G. Low birth weight of contemporary African Americans: an intergenerational effect of slavery? Am J Hum Biol. 2009; 21, 1624.
36. Mohsin, M, Wong, F, Bauman, A, Bai, J. Maternal and neonatal factors influencing premature birth and low birth weight in Australia. J Biosoc Sci. 2003; 35, 161174.
37. Kramer, MS, Ananth, CV, Platt, RW, Joseph, KS. US Black vs White disparities in foetal growth: physiological or pathological? Int J Epidemiol. 2006; 35, 11871195.
38. Currie, J, Moretti, E. Biology as destiny? Short- and long-run determinants of intergenerational transmission of birth weight. J Labor Econ. 2007; 25, 231263.
39. Millennium Development Goals Report 215; 2015. United Nations: New York.
40. Closing the Gap: Prime Minister’s Report 2017. 2017 Australian Government Department of the Prime Minister and Cabinet: Canberra.
41. Ibiebele, I, Coory, M, Boyle, FM, Humphrey, M, Vlack, S, Flenady, V. Stillbirth rates among Indigenous and non-Indigenous women in Queensland, Australia: is the gap closing? BJOG. 2015; 122, 14761483.
42. Mohsin, M, Bauman, AE, Jalaludin, B. The influence of antenatal and maternal factors on stillbirths and neonatal deaths in New South Wales, Australia. J Biosoc Sci. 2006; 38, 643657.
43. Kramer, MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ. 1987; 65, 663737.
44. Kliewer, EV, Stanley, FJ. Stillbirths, neonatal and post-neonatal mortality by race, birthweight and gestational age. J Paediatr Child Health. 1993; 29, 4350.
45. Groom, KM, Poppe, KK, North, RA, McCowan, LME. Small-for-gestational-age infants classified by customized or population birthweight centiles: impact of gestational age at delivery. Am J Obstet Gynecol. 2007; 197, 239.e1.e5.
46. Moraitis, AA, Wood, AM, Fleming, M, Smith, GC. Birth weight percentile and the risk of term perinatal death. Obstet Gynecol. 2014; 124(2 Pt 1), 274283.
47. Morales-Roselló, J, Khalil, A, Morlando, M, Papageorghiou, A, Bhide, A, Thilaganathan, B. Changes in fetal Doppler indices as a marker of failure to reach growth potential at term. Ultrasound Obstet Gynecol. 2014; 43, 303310.
48. Ruan, S, Abdel-Latif, ME, Bajuk, B, et al. The associations between ethnicity and outcomes of infants in neonatal intensive care units. Arch Dis Child Fetal Neonatal Ed. 2011; 97, 133138.
49. Alexander, GR, Tompkins, ME, Altekruse, JM, Hornung, CA. Racial differences in the relation of birth weight and gestational age to neonatal mortality. Public Health Rep. 1985; 100, 539547.
50. Binkin, NJ, Williams, RL, Hogue, CJ, Chen, PM. Reducing black neonatal mortality. Will improvement in birth weight be enough? JAMA. 1985; 253, 372375.
51. Thomson, M. Heavy birthweight in Native Indians of British Columbia. Can J Pub Health. 1990; 81, 443446.
52. Maiti, K, Sultana, Z, Aitken, RJ, et al. Evidence that fetal death is associated with placental aging. Am J Obstet Gynecol. 2017; 217, 441.e1–14.
53. Janus, M, Offord, D. Reporting on readiness to learn in Canada. ISUMA Can J Policy Res. 2000; 1, 7175.
54. Janus, M, Offord, DR. Development and psychometric properties of the Early Development Instrument (EDI): a measure of children’s school readiness. Can J Behav Sci. 2007; 39, 122.
55. Australian Early Development Census: 2012 Summary Report. 2013 Department of Education: Canberra.
56. Brinkman, S, Gregory, T, Harris, J, Hart, B, Blackmore, S, Janus, M. Associations between the early development instrument at age 5, and reading and numeracy skills at ages 8, 10 and 12: a prospective linked data study. Child Indic Res. 2013; 6, 695708.
57. Cordova-Palomera, A, Fatjo-Vilas, M, Falcon, C, et al. Birth weight and adult iq, but not anxious-depressive psychopathology, are associated with cortical surface area: a study in twins. PLoS One. 2015; 10, e0129616.
58. Walhovd, KB, Fjell, AM, Brown, TT, et al. Long-term influence of normal variation in neonatal characteristics on human brain development. Proc Natl Acad Sci USA. 2012; 109, 2008920094.
59. Matthews, SG. Early programming of the hypothalamo–pituitary–adrenal axis. Trends Endocrinol Metab. 2002; 13, 373380.
60. Phillips, DI. Programming of the stress response: a fundamental mechanism underlying the long-term effects of the fetal environment? J Intern Med. 2007; 261, 453460.
61. Simonetta, G, Rourke, AK, Owens, JA, Robinson, JS, McMillen, IC. Impact of placental restriction on the development of the sympathoadrenal system. Pediatr Res. 1997; 42, 805811.
62. Austin, PC, Brunner, LJ. Inflation of the type I error rate when a continuous confounding variable is categorized in logistic regression analyses. Stat Med. 2004; 23, 11591178.
63. Hernandez-Andrade, E, Cortes-Camberos, AJ, Diaz, NF, et al. Altered levels of brain neurotransmitter from new born rabbits with intrauterine restriction. Neurosci Lett. 2015; 584, 6065.
64. Radlowski, EC, Conrad, MS, Lezmi, S, et al. A neonatal piglet model for investigating brain and cognitive development in small for gestational age human infants. PLoS One. 2014; 9, e91951.
65. Duncan, JR, Cock, ML, Loeliger, M, Louey, S, Harding, R, Rees, SM. Effects of exposure to chronic placental insufficiency on the postnatal brain and retina in sheep. J Neuropathol Exp Neurol. 2004; 63, 11311143.
66. Mallard, C, Loeliger, M, Copolov, D, Rees, S. Reduced number of neurons in the hippocampus and the cerebellum in the postnatal guinea-pig following intrauterine growth-restriction. Neuroscience. 2000; 100, 327333.
67. Kelly, YJ, Nazroo, JY, McMunn, A, Boreham, R, Marmot, M. Birthweight and behavioural problems in children: a modifiable effect? Int J Epidemiol. 2001; 30, 8894.
68. Costello, EJ, Worthman, C, Erkanli, A, Angold, A. Prediction from low birth weight to female adolescent depression: a test of competing hypotheses. Arch Gen Psychiatry. 2007; 64, 338344.
69. Grunau, RE, Whitfield, MF, Fay, TB. Psychosocial and academic characteristics of extremely low birth weight (< or=800 g) adolescents who are free of major impairment compared with term-born control subjects. Pediatrics. 2004; 114, e725e732.
70. Liu, X, Sun, Z, Neiderhiser, JM, Uchiyama, M, Okawa, M. Low birth weight, developmental milestones, and behavioral problems in Chinese children and adolescents. Psychiatry Res. 2001; 101, 115129.
71. Heinonen, K, Raikkonen, K, Pesonen, AK, et al. Behavioural symptoms of attention deficit/hyperactivity disorder in preterm and term children born small and appropriate for gestational age: a longitudinal study. BMC Pediatr. 2010; 10, 91.
72. Guthridge, S, Li, L, Silburn, S, Li, SQ, McKenzie, J, Lynch, J. Early influences on developmental outcomes among children, at age 5, in Australia’s Northern Territory. Early Child Res Q.
73. Khambalia, AZ, Algert, CS, Bowen, JR, Collie, RJ, Roberts, CL. Long‐term outcomes for large for gestational age infants born at term. J Paediatr Child Health. 2017; 53, 876881.
74. Hanly, M, Falster, K, Chambers, G, et al. Gestational age and child development at age five in a population-based cohort of Australian Aboriginal and Non-Aboriginal children. Paediatr Perinat Epidemiol. 2018; 32, 114125.
75. Sommerfelt, K, Andersson, HW, Sonnander, K, et al. Behavior in term, small for gestational age preschoolers. Early Hum Dev. 2001; 65, 107121.
76. Malacova, E, Li, J, Blair, E, Leonard, H, de Klerk, N, Stanley, F. Association of birth outcomes and maternal, school, and neighborhood characteristics with subsequent numeracy achievement. Am J Epidemiol. 2008; 168, 2129.
77. Hanushek, EA, Woessmann, L. Knowledge capital, growth, and the East Asian miracle. Science. 2016; 351, 344345.
78. Guthridge, S, Li, L, Silburn, S, Li, SQ, McKenzie, J, Lynch, J. Impact of perinatal health and socio-demographic factors on school education outcomes: a population study of Indigenous and non-Indigenous children in the Northern Territory. J Paediatr Child Health. 2015; 51, 778786.
79. Pearce, MS, Mann, KD, Singh, G, Sayers, SM. Birth weight and cognitive function in early adulthood: the Australian Aboriginal birth cohort study. J Dev Orig Health Dis. 2014; 5, 240247.
80. Malacova, E, Li, J, Blair, E, Mattes, E, de Klerk, N, Stanley, F. Neighbourhood socioeconomic status and maternal factors at birth as moderators of the association between birth characteristics and school attainment: a population study of children attending government schools in Western Australia. J Epidemiol Community Health. 2009; 63, 842849.
81. Low, JA, Galbraith, RS, Muir, D, Killen, H, Pater, B, Karchmar, J. Intrauterine growth retardation: a study of long-term morbidity. Am J Obstet Gynecol. 1982; 142(6 Pt 1), 670677.
82. Westwood, M, Kramer, MS, Munz, D, Lovett, JM, Watters, GV. Growth and development of full-term nonasphyxiated small-for-gestational-age newborns: follow-up through adolescence. Pediatrics. 1983; 71, 376382.
83. Boomsma, DI, van Baal, GC. Genetic influences on childhood IQ in 5‐ and 7‐year‐old Dutch twins. Dev Neuropsychol. 1998; 14, 115126.
84. Boomsma, DI, van Beijsterveldt, CE, Rietveld, MJ, Bartels, M, van Baal, GC. Genetics mediate relation of birth weight to childhood IQ. BMJ. 2001; 323, 14261427.
85. Keltikangas-Jarvinen, L, Elovainio, M, Kivimaki, M, Raitakari, OT, Viikari, JS, Lehtimaki, T. Dopamine receptor D2 gene Taq1A (C32806T) polymorphism modifies the relationship between birth weight and educational attainment in adulthood: 21-year follow-up of the Cardiovascular Risk in Young Finns study. Pediatrics. 2007; 120, 756761.
86. Newcombe, R, Milne, BJ, Caspi, A, Poulton, R, Moffitt, TE. Birthweight predicts IQ: fact or artefact? Twin Res Hum Genet. 2007; 10, 581586.
87. Deary, IJ, Spinath, FM, Bates, TC. Genetics of intelligence. Eur J Hum Genet. 2006; 14, 690700.
88. Petersen, I, Jensen, VM, McGue, M, Bingley, P, Christensen, K. No evidence of genetic mediation in the association between birthweight and academic performance in 2,413 Danish adolescent twin pairs. Twin Res Hum Genet. 2009; 12, 564572.
89. Eriksen, W, Sundet, JM, Tambs, K. Birth weight standardized to gestational age and intelligence in young adulthood: a register-based birth cohort study of male siblings. Am J Epidemiol. 2010; 172, 530536.
90. Strohmaier, J, van Dongen, J, Willemsen, G, et al. Low birth weight in MZ twins discordant for birth weight is associated with shorter telomere length and lower IQ, but not anxiety/depression in later life. Twin Res Hum Genet. 2015; 18, 198209.
91. Delisle, H. Programming of chronic disease by impaired fetal nutrition: evidence and implications for policy and intervention strategies. 2002. WHO: Switzerland.
92. Australian Institute of Health and Welfare. SCSEEC successful school attendance strategies evidence-based project: summary report. 2014. AIHW: Canberra.
93. Chaudhari, S, Otiv, M, Khairnar, B, Pandit, A, Hoge, M, Sayyad, M. Pune low birth weight study - birth to adulthood - cognitive development. Indian Pediatr. 2013; 50, 853857.
94. Lin, MJ, Liu, JT, Chou, SY. As low birth weight babies grow, can well-educated parents buffer this adverse factor? A research note. Demography. 2007; 44, 335343.
95. Okbay, A, Beauchamp, JP, Fontana, MA, et al. Genome-wide association study identifies 74 loci associated with educational attainment. Nature. 2016; 533, 539542.
96. Horikoshi, M, Beaumont, RN, Day, FR, et al. Genome-wide associations for birth weight and correlations with adult disease. Nature. 2016; 538, 248252.


Can the gap in Aboriginal outcomes be explained by DOHaD

  • E. C. McEwen (a1) (a2), T. J. Boulton (a1) and R. Smith (a1) (a2)


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