What are the methodological challenges of exploring corporeal entanglements, or embodied ecologies, in the clinical translation of epigenetics?

A variety of recent approaches in feminist and anthropological studies of the body speak to the concept of embodied ecologies and its exploration of bodily porosity. This scholarship has helped us to imagine a body other than the Cartesian, Lockean, rights-bearing, individually bounded body. Notions of corporeal feminism (Grosz 1994; Balsamo 1996), fluid ecologies (Roberts 2010), and material-semiotic nodes (Haraway 1991) embraced the social, material, and gendered aspects of bodies as permeable and flexible (see also Martin 1994). Black feminists, in particular, reminded us of the political stakes of framing bodies in relation to Eurocentric notions of the human (Spiller 1987; Wynter 2003).

However, this environmentally entangled body proves difficult to measure and evaluate in a clinical trial setting. The epistemological mismatch between epigenetic theories and clinical trial methods carries implications for the production of epigenetic knowledge and reproductive health policies writ large, with consequences for the medical treatment of pregnant women.

I have spent the last seven years ethnographically exploring this process of translation by following researchers and pregnant women through prenatal clinical trials in the United States and United Kingdom. As the study of gene–environment interaction and expression, epigenetics seeks to link pregnant women’s behavioral choices with the health risks of their children and future generations. Nowhere is this link clearer than in the design and implementation of clinical trials that study obesity during pregnancy. These trials frame pregnant women as maternal or intrauterine environments that can impact fetal development, with particular kinds of environmental targets deemed especially important for intervention.

According to scholarship on health across the life course, women who are obese during pregnancy have a higher risk of having children who will develop obesity and diabetes in adulthood. The clinical trials I followed targeted pregnant women for nutritional interventions as a means of understanding epigenetic mechanisms. Both were long-term, multimillion-dollar projects funded by government agencies, cumulatively recruiting 1,850 pregnant women. The biological matter harvested from these women is used in speculative and anticipatory ways to imagine future forms of prenatal intervention and reproductive care.

Although epigenetic effects on fetal development during gestation are influenced by many different environmental factors, such as toxic exposure, past trauma, and poverty, the trials I examined focused on pregnant bodies and behaviors alone. How and when the environment comes to matter in epigenetic science is a political and scientific project that opens up questions of reproductive responsibility (Valdez 2018). Narrowly framing the maternal environment as a pregnant body denies the fact that environmental exposure is unpredictable and uncontrollable. Pregnant bodies, and not only fetuses, are subject to epigenetic risk.

In studying these trials, I have also found that the application of epigenetic ideas to the implementation of prenatal interventions is misaligned with theories inherent to epigenetics. That is, there is mismatch across epigenetic imaginaries, or the ways that scientists and media outlets discuss epigenetics in theory, and the practices that take place in a clinical trial setting. Randomized clinical trials are designed to narrow down variables of cause and effect. However, older models of causation do not fit the on-the-ground realities of exposure, experience, and environmental entanglement. In the clinical setting, scientists selectively consider environmental factors, temporalities, and exposure in order to delineate relations of cause and effect between what a pregnant person eats, how much she weighs, and birth outcomes.

For instance, in the U.K. trial, the environmental target was framed as the maternal metabolic environment, with the intervention aimed at changing participants’ diets, an approach that attended to the metabolism of sugars and saturated fats. In the United States, the intervention targeted the eating behaviors and home environments of the participants. The U.S. intervention was not focused on metabolism, but rather on caloric intake and weight gain. Here, the substance or metabolism of food did not matter as much as the caloric amount of food ingested. These slightly different interventions were shaped by different framings of the maternal environment, which can selectively include anatomical features of the pregnant body as well as that body’s immediate environment. Still other environmental exposures do not “count” at all. Similarly, which biosamples to collect from mothers and infants, when and how to collect them, and what biomarkers to test reflected decisions influenced by research agendas, funding streams, and publication aims.

In addition, the trials’ temporal focus on gestation obscured the possibility that epigenetic modifications could have already been inherited from past generations, which is a hotly debated topic in understanding transgenerational inheritance. These factors, too, remained beyond the scope of a clinical trial. Methodological attention to individual variables in an effort to trace causality produces a partial perspective of environmental epigenetics.

While conceptually, environmental epigenetics holds that bodies are unbounded and permeable, existing methodologies like randomized clinical trials are simply not capable of capturing the entanglement of environmental exposures. The current moment marks a lag between epigenetic imaginaries and the methods that exist to explore them. Studying embodied ecologies thus prompts us to ask: how is this methodological lag navigated on the ground? And, more importantly, how do we shift the experimental gaze away from the pregnant body?