Follow-up studies of individuals exposed in utero to the Dutch Hunger Winter (1944-45) are often cited as evidence that prenatal nutrition has lasting deleterious effects on adult health. In a systematic review of this literature, we identified 214 papers by PubMed search, yielding 93 empirical studies focused on prenatal exposure to the Hunger Winter. In a final sample of 39 studies testing direct associations between prenatal famine exposure and health outcomes, evidence was most consistent linking exposure to increased risk of psychotic and affective disorders. In contrast, associations with cardiometabolic outcomes were less consistent, with most findings null and varying by study cohort. When significant cardiometabolic relationships were found they tended to indicate worse health in females and better health in males. We argue that this pattern aligns with predictions of the Maternal Nutritional Buffering Model, which proposes that homeostatic features of maternal nutrient storage and metabolism provide a stable supply of energy to the fetus. In contrast, deficiencies in essential micronutrients derived from outside the body (e.g. folate) are less buffered. We conclude with evidence that the mother’s developmental and pre-pregnancy nutrition, more than her diet during pregnancy itself, may drive fetal development and long-term health.
