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The Dutch Hunger Winter (Dutch Famine), was a severe nutritional crisis that affected the civilian population in western Netherlands from the winter months of 1944 through the spring of 1945, near the end of World War II. In this region under German occupation, daily food rations for adults were documented to have dropped as low as 400 to 800 calories.【1】 The Dutch Hunger Winter is also significant for studies examining the effects of restricted maternal nutrition during different stages of pregnancy.【2】
The famine dramatically and abruptly altered the demographic structure of the region. At the time, western Netherlands remained under occupation and was home to approximately 4.3 million people. Of this population, a group of 2.3 million, particularly those residing in urban areas of the west, faced severe famine.【3】
Between January 1944 and July 1945, it is estimated that approximately 91,000 excess deaths occurred among the civilian population due to war and famine conditions.【4】 Menstrual cycles among women became widely disrupted (amenorrhea), and fertility rates declined sharply in parallel. Data from the 1944–1945 period show that average life expectancy in the Netherlands in 1945 fell to 61.0 years for women and 50.6 years for men due to increased mortality.【5】 It was reported that pregnant women during the peak of the famine experienced significant weight loss, which affected the birth weights of their infants.
Studies of the “Dutch Hunger Winter birth cohort” have revealed that the effects of inadequate nutrition vary depending on the stage of pregnancy during which exposure occurred (early, mid, or late gestation).
Individuals exposed to famine during early pregnancy were found to have higher rates of coronary heart disease, atherogenic lipid profiles, and obesity in adulthood.【6】 This is explained by metabolic adaptations developed by the fetus to cope with a nutrient-poor environment, which become disadvantageous in a postnatal environment of abundance. In contrast, individuals exposed to famine during late pregnancy and born with low birth weight were found to have a lower tendency toward weight gain throughout life and obesity rates below the population average.
In individuals exposed to famine during early pregnancy, an atherogenic (artery-blocking) lipid profile was observed; specifically, elevated LDL/HDL cholesterol ratios were detected.【7】 Additionally, while fibrinogen concentrations—involved in blood clotting—were higher in these individuals, Factor VII concentrations were found to be lower.
Regarding glucose metabolism, it has been demonstrated that exposure to famine at any stage of pregnancy—early, mid, or late—impairs glucose tolerance in later life and increases the risk of Type 2 diabetes.【8】
Exposure to famine during mid-pregnancy has been associated with microalbuminuria in adulthood, an indicator of impaired kidney function and obstructive airway diseases.【9】 Furthermore, individuals exposed during early pregnancy showed altered physiological responses to stress, with higher blood pressure and heart rate reactions observed during psychological stress tests.
The effects of prenatal undernutrition on the central nervous system produce lasting neurodevelopmental outcomes that vary according to the timing of exposure. Research has shown that individuals exposed to famine during early pregnancy have a significantly increased risk of schizophrenia and schizoid personality disorder, while exposure during mid-pregnancy is more strongly associated with mood disorders such as depression.【10】
In addition to psychiatric risks, early exposure in male individuals has been linked to signs of accelerated brain aging in later life and a more rapid decline in cognitive function. This pattern is attributed to alterations in the fetal programming process, particularly persistent disruption of the hypothalamic-pituitary-adrenal (HPA) axis and stress response mechanisms.【11】
Long-term studies of the Dutch Hunger Winter birth cohort have revealed that prenatal undernutrition has lasting and specific effects on women’s health. Specifically, women exposed to famine during early pregnancy showed a significantly increased risk of breast cancer, while no general increase in other cancer types was observed. These women were also reported to have a higher likelihood of having children, giving birth to more children overall, and higher rates of twin births compared to unexposed women of the same generation.【12】
One of the key biological mechanisms underlying the long-term effects of the Dutch Hunger Winter is believed to be epigenetic changes. Specifically, individuals exposed to famine during early pregnancy exhibited persistent hypomethylation (reduced methylation) of the DNA regulating the IGF-2 (Insulin-like Growth Factor 2) gene, which governs growth and metabolism, compared to their unexposed siblings. Moreover, these effects were not limited to the directly exposed individuals but were also transmitted to subsequent generations; children of women who experienced famine in utero were found to have higher neonatal adiposity and elevated body mass index compared to controls.【13】
[1]
Tessa Roseboom, Susanne de Rooij ve Rebecca Painter, “The Dutch Famine and Its Long-Term Consequences for Adult Health,” Early Human Development 82, no. 8 (Ağustos 2006): syf: 485, Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1016/j.earlhumdev.2006.07.001; Rebecca C. Painter, Tessa J. Roseboom ve Otto P. Bleker, “Prenatal Exposure to the Dutch Famine and Disease in Later Life: An Overview,” Reproductive Toxicology 20, no. 3 (Eylül–Ekim 2005): syf: 346, Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1016/j.reprotox.2005.04.005.
[2]
Susanne R. De Rooij, Laura S. Bleker, Rebecca C. Painter, Anita C. Ravelli ve Tessa J. Roseboom, “Lessons Learned from 25 Years of Research into Long-Term Consequences of Prenatal Exposure to the Dutch Famine 1944–45: The Dutch Famine Birth Cohort,” International Journal of Environmental Health Research 32, no. 7 (2022): syf: 1433, Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1080/09603123.2021.1888894.
[3]
Peter Ekamper, Govert E. Bijwaard, Frans W. A. van Poppel ve L. H. Lumey, “War- and famine-related excess mortality among civilians in the Netherlands, 1944–1945,” Journal of Maps 16, no. 1 (2020): syf: 126, Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1080/17445647.2020.1761466
[4]
Peter Ekamper, Govert E. Bijwaard, Frans W. A. van Poppel ve L. H. Lumey, “War- and famine-related excess mortality among civilians in the Netherlands, 1944–1945,” Journal of Maps 16, no. 1 (2020): syf: 128, Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1080/17445647.2020.1761466
[5]
Peter Ekamper, Govert E. Bijwaard, Frans W. A. van Poppel ve L. H. Lumey, “War-related excess mortality in The Netherlands, 1944–45: New estimates of famine- and non-famine-related deaths from national death records,” Population Studies 71, no. 1 (2017): syf: 113, Erişim tarihi: 06 Ocak 2026, https://pmc.ncbi.nlm.nih.gov/articles/PMC6226247/
[6]
Tessa Roseboom, Susanne de Rooij ve Rebecca Painter, “The Dutch Famine and Its Long-Term Consequences for Adult Health,” Early Human Development 82, no. 8 (Ağustos 2006): syf: 485 (Abstract), Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1016/j.earlhumdev.2006.07.001
[7]
Rebecca C. Painter, Tessa J. Roseboom ve Otto P. Bleker, “Prenatal Exposure to the Dutch Famine and Disease in Later Life: An Overview,” Reproductive Toxicology 20, no. 3 (Eylül–Ekim 2005): syf: 348 (Tablo 2), Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1016/j.reprotox.2005.04.005.
[8]
Susanne R. De Rooij vd., “Lessons Learned from 25 Years of Research into Long-Term Consequences of Prenatal Exposure to the Dutch Famine 1944–45: The Dutch Famine Birth Cohort,” International Journal of Environmental Health Research 32, no. 7 (2022): syf: 1433, Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1080/09603123.2021.1888894; Painter, Roseboom ve Bleker, “Prenatal Exposure to the Dutch Famine and Disease in Later Life: An Overview,” Reproductive Toxicology 20, no. 3 (Eylül–Ekim 2005): syf: 347, Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1080/09603123.2021.1888894
[9]
Rebecca C. Painter, Tessa J. Roseboom ve Otto P. Bleker, “Prenatal Exposure to the Dutch Famine and Disease in Later Life: An Overview,” Reproductive Toxicology 20, no. 3 (Eylül–Ekim 2005): syf: 348-349, Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1016/j.reprotox.2005.04.005
[10]
Rebecca C. Painter, Tessa J. Roseboom ve Otto P. Bleker, “Prenatal Exposure to the Dutch Famine and Disease in Later Life: An Overview,” Reproductive Toxicology 20, no. 3 (2005): syf: 349, Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1016/j.reprotox.2005.04.005; Susanne R. De Rooij, Laura S. Bleker, Rebecca C. Painter, Anita C. Ravelli ve Tessa J. Roseboom, “Lessons Learned from 25 Years of Research into Long-Term Consequences of Prenatal Exposure to the Dutch Famine 1944–45,” International Journal of Environmental Health Research 32, no. 7 (2022): syf: 1438, Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1080/09603123.2021.1888894
[11]
Susanne R. De Rooij, Laura S. Bleker, Rebecca C. Painter, Anita C. Ravelli ve Tessa J. Roseboom. “Lessons Learned from 25 Years of Research into Long-Term Consequences of Prenatal Exposure to the Dutch Famine 1944–45: The Dutch Famine Birth Cohort.” International Journal of Environmental Health Research 32, no. 7 (2022): syf: 1438, Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1080/09603123.2021.1888894; Tessa Roseboom, Susanne de Rooij ve Rebecca Painter, “The Dutch Famine and Its Long-Term Consequences for Adult Health,” Early Human Development 82, no. 8 (2006): syf: 489, Erişim tarihi: 06 Ocak 2026. https://doi.org/10.1016/j.earlhumdev.2006.07.001
[12]
Susanne R. De Rooij, Laura S. Bleker, Rebecca C. Painter, Anita C. Ravelli ve Tessa J. Roseboom, “Lessons Learned from 25 Years of Research into Long-Term Consequences of Prenatal Exposure to the Dutch Famine 1944–45: The Dutch Famine Birth Cohort,” International Journal of Environmental Health Research 32, no. 7 (2022): 1436-1438, Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1080/09603123.2021.1888894
[13]
Susanne R. De Rooij, Laura S. Bleker, Rebecca C. Painter, Anita C. Ravelli ve Tessa J. Roseboom, "Lessons Learned from 25 Years of Research into Long-Term Consequences of Prenatal Exposure to the Dutch Famine 1944–45: The Dutch Famine Birth Cohort,” International Journal of Environmental Health Research 32, no. 7 (2022): syf: 1434 (Tablo 1), Erişim tarihi: 06 Ocak 2026, https://doi.org/10.1080/09603123.2021.1888894
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Demographic Effects, Fertility and Mortality Rates
Effects of Prenatal Famine Exposure on Adult Health
Metabolic Adaptation and Obesity Risk
Cardiovascular System, Lipid Profile and Diabetes
Organ Function and Stress Response
Neurodevelopmental Outcomes (Cognitive and Mental Health)
Women’s Health, Reproduction and Cancer Risk
Epigenetic Mechanisms and Intergenerational Transmission
