Weighing the Future: Race, Science, and Pregnancy Trials in the Postgenomic Era

By Natali Valdez

Epigenetics, the study of heritable changes in gene expression, has been heralded as one of the most promising new fields of scientific inquiry. Current large-scale studies selectively draw on epigenetics to connect behavioral choices made by pregnant people, such as diet and exercise, to health risks for future generations. As the first ethnography of its kind, Weighing the Future examines the sociopolitical implications of ongoing pregnancy trials in the United States and the United Kingdom, illuminating how processes of scientific knowledge production are linked to capitalism, surveillance, and environmental reproduction. Natali Valdez argues that a focus on individual behavior rather than social environments ignores the vital impacts of systemic racism. The environments we imagine to shape our genes, bodies, and future health are intimately tied to race, gender, and structures of inequality. This groundbreaking book makes the case that science, and how we translate it, is a reproductive project that requires feminist vigilance. Instead of fixating on a future at risk, this book brings attention to the present at stake.

• Language: English
• Publisher: University of California Press
• Release date: Dec 14, 2021
• ISBN: 9780520380158

Natali Valdez

Natali Valdez is Assistant Professor of Women’s and Gender Studies at Wellesley College.

Book preview

Weighing the Future

CRITICAL ENVIRONMENTS: NATURE, SCIENCE, AND POLITICS

Edited by Julie Guthman and Rebecca Lave

The Critical Environments series publishes books that explore the political forms of life and the ecologies that emerge from histories of capitalism, militarism, racism, colonialism, and more.

1. Flame and Fortune in the American West: Urban Development, Environmental Change, and the Great Oakland Hills Fire, by Gregory L. Simon

2. Germ Wars: The Politics of Microbes and America’s Landscape of Fear, by Melanie Armstrong

3. Coral Whisperers: Scientists on the Brink, by Irus Braverman

4. Life without Lead: Contamination, Crisis, and Hope in Uruguay, by Daniel Renfrew

5. Unsettled Waters: Rights, Law, and Identity in the American West, by Eric P. Perramond

6. Wilted: Pathogens, Chemicals, and the Fragile Future of the Strawberry Industry, by Julie Guthman

7. Destination Anthropocene: Science and Tourism in The Bahamas, by Amelia Moore

8. Economic Poisoning: Industrial Waste and the Chemicalization of American Agriculture, by Adam M. Romero

9. Weighing the Future: Race, Science, and Pregnancy Trials in the Postgenomic Era, by Natali Valdez

Weighing the Future

RACE, SCIENCE, AND PREGNANCY TRIALS IN THE POSTGENOMIC ERA

Natali Valdez

UNIVERSITY OF CALIFORNIA PRESS

University of California Press

Oakland, California

© 2022 by Natali Valdez

Library of Congress Cataloging-in-Publication Data

Names: Valdez, Natali, 1986– author.

Title: Weighing the future : race, science, and pregnancy trials in the postgenomic era / Natali Valdez.

Other titles: Critical environments (Oakland, Calif.) ; 9.

Description: Oakland, California : University of California Press, [2022] | Series: Critical Environments : Nature, Science and Politics ; 9 | Includes bibliographical references and index.

Identifiers: LCCN 2021021912 (print) | LCCN 2021021913 (ebook) | ISBN 9780520380134 (cloth) | ISBN 9780520380141 (paperback) | ISBN 9780520380158 (epub)

Subjects: LCSH: Clinical trials—Social aspects—United States. | Clinical trials—Social aspects—Great Britain. | Clinical trials—Political aspects—United States. | Clinical trials—Political aspects—Great Britain. | Pregnant women—United States—Case studies. | Pregnant women—Great Britain—Case studies. | Epigenetics—United States. | Epigenetics—Great Britain. | Human reproduction—Environmental aspects—United States. | Human reproduction—Environmental aspects—Great Britain. | BISAC: SOCIAL SCIENCE / Anthropology / General | HEALTH & FITNESS / Pregnancy & Childbirth

Classification: LCC R853.C55 V35 2022 (print) | LCC R853.C55 (ebook) | DDC 610.72/4—dc23

LC record available at https://lccn.loc.gov/2021021912

LC ebook record available at https://lccn.loc.gov/2021021913

Manufactured in the United States of America

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Para Natali, la niña.

Juntas encontramos una salida.

Contents

List of Illustrations

Acknowledgments

Introduction: Weighing the Future

PART I

1. Epistemic Environments: Reproducing Solutions to Past, Present, and Future Maternal Health

2. Un/Altered: The Durability of Individualized Interventions for Multidimensional Illness

PART II

3. Politics of Recruitment: How Fatness, Race, and Risk Shape Contemporary Pregnancy Trials

4. Pregnant Narratives: Experiencing Lifestyle Interventions

PART III

5. Environmental Animations: What Counts as the Maternal Environment?

6. Prospecting Pregnancies: Data, Time, and Speculative Value

Conclusion: The Afterbirth of Foreclosure

Epilogue: [The Future] Is Composed of Nows

Notes

References

Index

Illustrations

TABLE

1. Key Terms, Methods, and Concepts

FIGURES

1. Schematic summary of potential determinants, consequences, and effect modifiers for gestational weight gain addressed by IOM (1990)

2. Schematic summary of potential determinants, consequences, and effect modifiers for gestational weight gain, modified from IOM (1990) guidelines in IOM and NRC (2009)

3. Photograph of sculpture from a recruitment clinic

4. Pregnancy wheel for measuring gestational age

Acknowledgments

You are holding this book in your hands thanks to time, labor, care, and love. I am grateful to the people and systems that financially, intellectually, and emotionally supported me. Financial support through graduate and postgraduate fellowships (including the NSF-GRFP, Eugene-Cota Robles, Fondation Brocher, and Wenner-Gren research grants) gave me time, resources, and the opportunity to build a supportive network. And when systems failed to meet my needs, my friends, family, and mentors provided the safety net.

The PhD program in anthropology at the University of California, Irvine allowed me to explore many different projects and even supported me in taking time away from my PhD to study in the School of Public Health at UC Berkeley for a year. That experience was so valuable. It allowed me to be curious and deeply explore various aspects of my research. I am grateful to my communities in graduate school who sustained me throughout the peaks and valleys: Leksa Lee, Lydia Zacher Dixon, Véronique Fortin, Cheryl Deutsch, Georgia Hartman, Kavior Moon, Justin Perez, Daina Sanchez, and Raphaëlle Rabanes. I am also thankful to all my mentors at UC Irvine.

During the first few summers of graduate school I attended STS camp, in northern California. Not only was it a gorgeous nature retreat, but it was a fun way to connect with an extended network of scholars that supported me through my various projects, including Joe Dumit, Kate Darling, Marine Lappé, and Anna Jabloner. During my field research, I received so much support and encouragement from all of the staff members at the SmartStart and StandUp trials. Without their generosity, this project would not exist. I was supported by multiple writing groups to complete the first draft of this project in the final years of working on my PhD. Risa Cromer and Dána-Ain Davis were valuable members of the Race and Reproductivities group.

After earning my PhD, I had more time to conceptualize the book project during a two-year postdoctoral fellowship at Rice University in the Center for the Study of Women, Gender and Sexuality. The CWGS and the Department of Anthropology supported my reading groups, talks, and book workshop. I am especially grateful to Andrea Ballestero, Cymene Howe, Rosemary Hennessey, Brian Riedel, Eugenia Georges, Shannon Iverson, and Rachel Afi-Quinn. During my postdoc, I had time to create and attend meaningful conferences, including the Race and Reproduction Conference funded by Wenner-Gren that Daisy Deomampo and I organized, which brought together a wonderful group of scholars and mentors. Through the generous invitations of colleagues, I attended conferences where I was able to connect with more feminist mentors in reproduction and STS, including Charis Thompson and Rene Almeling.

I am fortunate to have had inspiring colleagues who support my work, like the entire Women of Color faculty group at Wellesley, Susan Ellison, and Eve Zimmerman. The countless walks and meditation classes that Eve and I did together nourished my soul.

My East Coast writing and support network expanded further in the last two years. I am eternally grateful to Banu Subramaniam, who has guided me through my book process and mentored me so graciously. She also connected me to brilliant feminist scholars through the Feminist STS reading group. At a workshop hosted by Jennifer Hamilton and Charlotte Kroløkke, Hannah Landecker generously read and provided vital feedback on what is now chapter 6 of this book. I also participated in a variety of queer faculty of color writing groups with Vivian Huang, Moya Bailey, and Chanda Prescod-Weinstein, all of whom have generously supported my process. The entire Nutrire CoLab was so helpful in navigating the publishing process and reviewing my writing, including Alyshia Gálvez, Megan Carney, and especially Emily Yates-Doerr (who generously read this entire book with her graduate students and gave me feedback on every chapter).

Rebecca Herzig pushed me to ask myself, at a personal level, why I was writing a book. It became clear that the lifegiving motivation for me was the relationships I built in the process. I owe a special thanks to Justin Perez for providing copyediting along with loving affirmation; Risa Cromer for seeing me in ways I wish to see myself; Leksa Lee for her loyal support and accountability; Maia G’iladi for her unfailing encouragement; and Isabel Gómez for pushing me to write every day and showing me how to find pleasure in the process. The framing of the second-person vignettes throughout the book is thanks to Isabel’s intellectual generosity and brilliance. I am deeply indebted to Shannon Iverson, who was involved in the developmental editing of the entire text. You can thank Shannon for any clarity that comes through in the arguments of these chapters.

I am grateful to Kate Marshal, Enrique Ochoa-Kaup, and the entire team at UC Press for shepherding the book through review and production (during a pandemic) and for believing in the project. I am especially thankful to Dána-Ain Davis and to Rene Almeling, who reviewed the entire manuscript thoroughly and helped me in the revision process. Thank you to Vincanne Adams and the reviewers from MAQ who helped develop chapter 5.

Finally, I am everlastingly grateful to my sisters, Michele and Nicol, my mom and dad, and the extended Valdez clan. I am inspired by mi abuelita, the matriarch of the Valdez family, and mi abuelito, may he rest in peace. Dad, thanks for always having confidence in me; Michele, thank you for all your loyal support; and M&M, thank you for bringing Siënna and Mila into this world. Their births were the best rewards for meeting my writing deadlines during the last phase of a long journey.

Introduction

WEIGHING THE FUTURE

You are pregnant.

You are pregnant, and as your mom explains, heavy set; or as your cousin says, nalgona; or as the tags on your jeans read, curvy; or as your doctor terms it obese; or as you say, fat.

You are pregnant, fat, and you decide to participate in a clinical trial on diet and exercise because your doctor suggested it might help you, and because someone in the waiting room of your prenatal clinic came up to you and gave you some brochures talking about how weight and diet can affect your pregnancy and your child’s health. You don’t want what happened last time to happen again, so you call up the number on the brochure, and the woman on the phone schedules your first clinical trial appointment.

You go to your usual prenatal clinic, and instead of meeting with your doctor or nurse, you meet a staff member from the trial. The first thing she does is tell you to step on the scale, please. She explains that she needs to weigh you twice for accurate measurements. You don’t hesitate for a second because you’re used to stepping on the scale for every single medical appointment.

The woman hands you some paperwork and asks you to fill out a questionnaire. The questions are: Do you ever feel like harming yourself? Have you ever binged or skipped a meal to control your weight? Do you feel less enthusiastic about your usual activities?

You cringe, and your body tightens up.

You’re thinking of your last pregnancy and the loss. You keep sifting through the papers, and the woman starts talking again: "The reason we are doing this trial is to help women gain a healthy amount of weight during pregnancy. Gaining too much weight can put a woman at risk for GDM [gestational diabetes mellitus], increased weight retention, and health problems in the future for both mother and baby."

You don’t pay close attention to the description of the trial because it sounds similar to what you’ve already heard.

You finish the mental health survey, but you tell the woman that the questions are weird because you’re grieving. How are you supposed to answer these questions when you’re grieving, pregnant, and feel tired all the time?

The woman apologizes profusely and thanks you for coming to the appointment.

Then she says, This is an opportunity to be involved in cutting edge research that’s part of a larger consortium across the whole country . . . to be involved in something big!

For a moment you think it sounds exciting.

She goes on to describe the two groups; one is called a control or standard care, which is just like your regular appointments. The other group is more intense; you have to count your steps, count your calories, weigh yourself every day, and take meal replacement shakes.

You interrupt her and ask about the shakes. You’ve been so nauseous you’re worried about having to drink shakes. She explains that you’re given a customized meal plan based on the calories you need to limit weight gain throughout pregnancy. She explains that the US maternal health policy recommends that pregnant women with a high body mass index (BMI) should only gain about half a pound per week.

You think this sounds a bit extreme, but your doctor suggested it might help, so you stay and listen to the woman describe the assessments: Both groups have to complete assessments three times during pregnancy, then twice after delivery. The assessments include 7 teaspoons of blood, urine sample, blood pressure, hip, arm, thigh circumference measurements, an oral glucose tolerance test, and weight measurements.

She asks, Have you ever done an oral glucose tolerance test for gestational diabetes? You start to explain that in your last pregnancy you had a miscarriage at twenty-four weeks, so you never took a diabetes test.

The woman pauses in recognition, then moves on to review more information about the trial. She explains that someone from the trial will come to your house or to the hospital within seven days of your delivery to collect weight and height measurements. She says something like unidentified biological samples like blood and urine are stored at repositories. Then she asks how you are feeling.

You feel a lot of different things. But first you tell her that you’re a weird case because you had so many complications in your last pregnancy and had so much blood taken throughout. You feel traumatized, but you say that you feel really nervous about blood. You say that you need to check in with your doctor once more before deciding. You go home without signing the consent forms.

A week later, you get a call from the woman from the trial. You’re busy with work, so you don’t respond. After running it by your doctor one more time, who confirms that it is safe to participate in this type of clinical trial while pregnant, you decide to enroll. Another week passes and she calls again, and you decide to set up the next appointment.

You meet at the same place, and this time you sign all the papers, even the one that says you consent to having genetic tests done on your blood samples and on the cord blood samples collected at birth. But you make one final request: Please make sure that my personal ID is not going to be associated with this trial, I don’t want to be famous.

•     •     •     •     •

Why do I place you, the reader, as the pregnant person in this narrative? It is to make you feel, understand, and empathize with the process involved in participating in a pregnancy trial. This narrative, and book, are about the tensions between the social, political, and lived experiences of maternal environments and the scientific view of such environments. The maternal environment in pregnancy trials is defined as individual pregnant bodies and behaviors. With such definitions in hand, however, is the maternal environment at fault for childhood obesity or toxic chemical exposure? The key provocation of this book is that while science and society may frame pregnant people as uniquely and totally responsible for the welfare of growing fetuses and children, pregnancy and reproduction are not individual processes. We all encompass the maternal environment. We all collectively participate in reproduction, regardless of sex, race, gender, orientation, ability, or fertility.¹ We all contribute to the social, institutional, and environmental circumstances that shape each pregnancy, birth, and child.

How the maternal environment is operationalized in science and society is a political project; framing the maternal environment as only pregnant bodies and behaviors, rather than understanding it as everything that could influence a growing fetus including systems of poverty and racism, engenders social and material consequences for everyone, and particularly for vulnerable populations. Taking our reproductive entanglements seriously and broadening the scope of what counts as the maternal environment is an intervention in individualistic and ineffective approaches to our present and future health.

As the first ethnography of its kind, Weighing the Future examines the sociopolitical implications of ongoing pregnancy trials in the United States and the United Kingdom, illuminating how processes of scientific knowledge production are linked to capitalism, surveillance, racism, and environmental reproduction. The maternal environments we imagine to shape our genes, bodies, and future health are tied to race and gender, as well as to structures of inequality. I make the case that science, and how we translate and imagine it, is a reproductive project that requires anthropological and feminist vigilance. Instead of fixating on a future at risk, the book brings attention to how the present—the here and now—is at stake.

The pregnancy trials, also known as prenatal trials, that I study draw from the fields of epigenetics and developmental origins of health and disease (DOHaD) to link pregnant people’s behavioral choices, like diet and exercise, with future health risks. Epigenetics, or the study of gene-environment interaction and regulation, is a field of science that examines the inheritance of changes to genetic expression without changes to the DNA sequence itself. Importantly, epigenetics has ushered in a renewed interest in the environment, which can include the molecular junk surrounding DNA, sugar levels in a pregnant body, and carbon dioxide levels in the atmosphere. DOHaD is a field of study that examines how exposure during critical periods like pregnancy and early development impact health across the life span. Contemporary science frames pregnancy as a critical period of development because it encompasses multiple generations in one: the pregnant body is the first generation, the fetus is the second generation, and the reproductive cells in the fetus represent the third generation.

New research programs across epigenetics and DOHaD are increasingly characterizing postgenomic science. Postgenomics marks a shift away from gene-centered approaches to inheritance and genetic expression.² The postgenomic era refers to the time period following the completion of the human genome project at the turn of the twenty-first century.³ Chapter 1 outlines the fields of postgenomics, epigenetics, and DOHaD by examining their role in pregnancy studies. Epigenetic and DOHaD logics suggest that maternal behaviors and environments in the present can impact both genetic expression and future health outcomes. In a postgenomic era, pregnant people are uniquely made responsible for the health risks of future generations.

The scientific and media interpretations of epigenetics and DOHaD theories individualize the health risks of future generations onto pregnant bodies alone. News articles have emerged with titles such as Pre-pregnancy Diet ‘Permanently Influences Baby’s DNA’ and Bad Eating Habits Start in the Womb.⁴ These interpretations reflect a key aspect of the burgeoning field: pregnant bodies are at the center of epigenetic knowledge production.⁵ Fetuses and reproductive bodies are not only framed as central figures in epigenetics; social scientists even claim that epigenetics is a reproductive science.⁶ Guided by a critical race and feminist lens, I organize such conceptualizations of epigenetics and reproduction into a distinct framework of postgenomic reproduction, explored further later in this chapter.

The introductory vignette draws from hundreds of prenatal trial visits that I observed, listened to recordings of, reviewed through interviews, or conducted myself. My ethnographic and feminist examination of epigenetics, pregnancy trials, and future health shows that despite significant advances in science and technology, the same interventions based on individuals—rather than on structural contexts—are funded, tested, and used to inform contemporary maternal health policy on obesity and diabetes. A key issue with such individualistic approaches to examining the maternal environment is that pregnant people should not be the only ones held responsible and accountable for present and future health risks. Denying our collective participation in reproduction and continuing to promote individual lifestyle interventions draws resources away from much needed systemic and institutional change. It further risks reproducing knowledge that is not only selectively applying and interpreting new science, but ultimately ineffective in addressing health disparities across race, or what some scholars refer to as racist disparities in health.⁷ By examining how contemporary pregnancy trials draw on new science, Weighing the Future addresses the question: How is scientific creativity foreclosed by social and political contexts?

PREGNANCY TRIALS IN THE UNITED STATES AND THE UNITED KINGDOM

There are currently more clinical trials that target pregnant people for lifestyle interventions than ever before.⁸ Lifestyle interventions focus on changing individual bodies and behaviors and include anything from wearing a pedometer to measure steps; to using a virtual online application for diet and exercise accountability; to a variety of nutritional plans, some of which include replacing meals with shakes. In the past two decades the National Institutes of Health in the United States and United Kingdom have invested hundreds of millions of dollars in pregnancy trials aimed at understanding future health risks associated with obesity during pregnancy.⁹ Pregnancy studies have a long history, and only in the past decade or so have maternal health recommendations integrated aspects of epigenetic science and DOHaD to create clinical trials that focus on how food and exercise interventions can impact future health (see chapters 1 and 2).¹⁰

International lifestyle pregnancy trials are similar in that they target large, ethnically/racially diverse sample sizes; focus on individual behavior changes; and are mainly funded, designed, and implemented in the Global North. I use the term Global North in both a critical and practical sense; it reflects how race and empire are materially and conceptually mapped onto grounded networks, resources, and methodologies of scientific knowledge production, and it captures how most, if not all, evidence-based medicine is funded and designed in North America and Europe.¹¹ If you were pregnant and recruited into a clinical trial in the United States or the United Kingdom, there would be some key differences, but the process of moving through each phase of the trial would be similar. One reason for this is that prenatal trials are designed in a standard way to facilitate the generalizability of data and results internationally.

The main differences that emerged as significant in my analysis across the United States and United Kingdom were contexts of health-care infrastructures and distinct histories of racialization. Most of the chapters move across the United States and United Kingdom together, but I specifically address the distinct milieus of racialization in these different countries in chapter 3. In 1993, the National Institutes of Health (NIH) in the United States required that all publicly funded clinical trials include women and minorities.¹² This policy was also taken up in the United Kingdom. As a result, the pregnancy trials that I study in the United States and United Kingdom made a significant effort to recruit ethnically/racially diverse populations, which were distinctly defined and classified in each national context. However, despite the NIH mandate to include more diversity in clinical research, the intended impact of reducing health disparities across racialized groups has not been realized.

Throughout the book I make the case that including diverse groups of people in research and comparing health outcomes across (unstable) categories of race does not ameliorate health disparities because this approach does not effectively examine the role of racism in shaping health outcomes. Diversity and inclusion efforts do not directly address long-term exposure to unequal and unhealthy living conditions. Including more diverse people in clinical research is no doubt a worthy and necessary cause, but I argue that to address issues of equity, evidence-based medicine can and must do better. The conclusion and epilogue provide alternative ways of framing the problems and solutions to future health.

Pregnant people in the United States can access prenatal care through private insurance or Medicaid.¹³ Anyone who receives Medicaid in the United States is also automatically enrolled in multiple forms of state surveillance that are not applicable to privately insured people. The United Kingdom has the National Health Service (NHS), a state-funded system that provides some free health-care options.¹⁴ Prenatal and postpartum care is provided to all UK residents through the NHS. A unique aspect of the NHS is that midwives provide a significant portion of prenatal care. However, who counts as a resident and what health services are available have shifted drastically in the past decade due to anti-immigrant sentiments, Brexit, and massive budget cuts to the NHS.¹⁵

A snapshot of the maternal and infant health outcomes across the United States and United Kingdom reflects a fairly comparable landscape. The United States and United Kingdom both have higher rates of obesity during pregnancy than other high-income nations. The United States has a higher rate of maternal and infant mortality than other wealthy countries, including the United Kingdom.¹⁶ Black women in the United States have two to three times the rate of premature birth and maternal mortality compared to white women. The US racial disparity in premature birth and death has not changed in the past sixty years, and some trace this disparity back further, to slavery.¹⁷ Similarly, Black women in the United Kingdom have a much higher chance of maternal mortality and pregnancy complications than white British women, regardless of the different health-care systems.¹⁸

EPISTEMIC ENVIRONMENTS

To situate pregnancy trials and the relevant stakes within broader social and political milieus, I use the concept of epistemic environments, inspired by the notion of epistemic infrastructures, which Michelle Murphy defines as the ideas, methods, and economic and political structures that shape how science unfolds.¹⁹ My employment of environments instead of infrastructures is related to the empirical material at hand: epistemic environments emphasize the ways in which epigenetics and postgenomics have brought a renewed significance to the concept of environments across reproduction. The environment and what it includes is precisely what is at stake in the production of scientific, medical, and reproductive knowledge in a postgenomic era.

Epistemes refer to the ideas or logics that structure knowledge production.²⁰ Epistemic environments are the ideas and logics that shape contexts of scientific knowledge production. Each chapter in this book sheds light on the epistemic environments that shape the production of contemporary pregnancy trials, situated within postgenomic reproduction. I examine how racism, gender binaries, capitalism (here conceptualized as racial-surveillance biocapitalism), late liberalism (including neoliberalism), future-oriented or speculative frameworks of value and risk, and the postgenomic era collectively contribute to the epistemic environments of scientific knowledge production.²¹ For example, racist hierarchies that undergird categories of ethnicity and race in scientific studies, standards that define health through individually measurable variables like weight and BMI, and heteronormative logics that define the maternal environment only as cis-gendered pregnant bodies and behaviors are all epistemes that structure the production of contemporary pregnancy trials. Ethnographically studying the implementation of contemporary pregnancy trials illuminates the epistemic environments (or milieu of ideas, and logics) that shape the imagined problems and solutions of future health.

By applying the framework of epistemic environments, my analysis of pregnancy trials makes clear that individual lifestyle interventions need to be read as symptomatic of systemic racism, rather than a solution to multidimensional illnesses like diabetes and obesity that disproportionately impact communities of color. This is because the underlying logics of individual lifestyle interventions are cut from the same ideological cloth that assumes poor, fat, and ethnically diverse individuals have risky bodies and are responsible for changing their bodies and behaviors.²² Individual lifestyle interventions are framed as if all bodies live in similar environments and have equal access to healthy opportunities, choices, and material conditions. Pregnant people classified as high risk for diabetes and obesity are targeted for individual lifestyle interventions, while living in racist and poorly resourced environments that make it nearly impossible to comply with the intervention during the trial or to sustain the intervention changes after the trial is completed.

The epistemic environments I characterize in this book collectively shape how science imagines, manages, and apprehends future health. Such contexts and prioritization of future health have life and death consequences in the present. Despite having new knowledge about how social and political aspects of the environment—like racism—can get under our skin and impact health, the trials I examine selectively apply aspects of epigenetics and DOHaD research to justify individual lifestyle interventions during pregnancy. The selective interpretation of new science forecloses the maternal environment to include pregnant bodies and behaviors alone. This is one instantiation of what