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

Weighing the Future: Race, Science, and Pregnancy Trials in the Postgenomic Era is the first book of its kind to examine the social, political, and health implications of prenatal trials in the United States and the United Kingdom that study associations between gestational weight gain and childhood weight gain. Most, if not all, evidence-based medicine is funded and designed in North America and Europe, with the aim of enabling the generalizability of data and results globally. This book is based on years of massive qualitative data collection from which Natali Valdez draws her analyses: archival research on health and related policies, participant observation of hundreds of prenatal clinical trial visits with patients, and attendance at national and webinar conferences on obesity and pregnancy trials. Valdez also conducted interviews with clinical trial staff members, PIs, and research collaborators in the United States and the United Kingdom. Lest you think this book is dry reporting, Valdez sprinkles each chapter with theoretically rich concepts of racial surveillance biocapitalism connected to scientific knowledge production. She outlines capitalism’s reliance on ideas of individual responsibility, which leads to a disinvestment in public health and investment in privatization of medical research. Topics such as medical surveillance and its propensity to translate human experiences into behavioral data, its ties to racism, and its consideration of environmental factors are also interwoven into each chapter analysis. Readers learn that medical recommendations about whether to monitor pregnant women’s weight and the amount of weight gain that is ideal has shifted historically and cross-culturally between the United States and the United Kingdom. Presently, monitoring weight gain is the idea du jour, and there are currently more clinical trials that target pregnant people for lifestyle interventions than ever before. These trials focus on speculation to predict and prevent future health problems, and Valdez aptly notes, ‘‘Those who are in the position to speculate . . . on future remedies are not the ones who suffer the consequences of failed predictions’’ (p. 14). What is problematic, Valdez argues, is that individual lifestyle interventions are symptomatic of systemic racism and ignore social-environmental factors that affect people’s lives and health, therefore making the interventions ineffective. The ideology behind the clinical trials and their interventions assume that certain people’s pregnant bodies are risky and that these people have the ability to modify their bodies and behaviors, which also feeds into the gendered assumption that mothers are solely responsible for their children’s health. These bodies then become subject to interventions. These prenatal trials are conducted in the current postgenomic era, which refers to the period following the completion of the human genome project at the turn of the twenty-first century. Through the human genome project, scientists discovered that genes alone do not explain human variation and development. Thus, although these prenatal trials draw from theories on epigenetics (the gene-environment connection) and the developmental origins of health and disease, their design and proposed solutions to current and future health problems do not focus on disease-causing environmental factors that disproportionately afflict communities of color. Valdez notes that having diverse samples in medical research often results in comparing health outcomes across racialethnic groups rather than examining how racism affects health. In essence, pregnancy trials fail to recognize the multitude of factors that affect maternal and fetal environments. As Valdez writes, despite the mandate from the National Institutes of Health to include more diversity in clinical research, the intended goal of reducing health disparities across racialized groups has not been realized. Perhaps because of the narrow focus of explanatory variables in pregnancy trials, no pregnancy trial to date has confirmed Reviews 385