Potential for growth?

Proper nutrition in the womb and in the first two years of a baby's life is the foundation of a healthy life, writes RONAN McGREEVY

IT HAS long been established that the fate and health of a child can be determined even before they are born. Many children are born with huge disadvantage simply because of the environment of the womb. The link was first established in 1986 by a British doctor, David Barker, who found the link between birth weight and coronary disease in later life.

Barker believes the body is complete by 1,000 days and the determinants are set for a healthy life. Since then many epidemiological studies worldwide have shown an association between low birthweight and later life hypertension, diabetes and cardiovascular disease.

The fate of children is particularly acute in the developing world. Millions of children are born into the world with stunted growth because their mothers are malnourished and their disadvantage is compounded by poor nutrition after they are born.

The Concern Worldwide campaign entitled 1,000 Days of Baby Nutrition, which was launched by the Minister for Foreign Affairs Eamon Gilmore last week, is an attempt to give children in some of the poorest parts of the world a better start in life. The 1,000 days covers the nine months of pregnancy and the first two years of a child’s life where so much of their future is determined.

Concern Worldwide is raising awareness of the importance of the earliest years of a child’s life, particularly the terms of the Copenhagen Consensus which found proper nutrition in those critical years is the most cost-efficient way of ensuring development.

The effects of malnutrition are lifelong and startling. Speaking at the launch last week, Prof Fionnuala McAuliffe, an obstetrician based at the National Maternity Hospital in Holles Street, who specialises in infant nutrition, cited a Lancet report from 2008 about the first 1,000 days of life. It found that some 13 million children are born with intrauterine growth restriction where they are at least 10 per cent below the minimum safe weight for birth usually as a result of maternal undernourishment and a further 112 million babies are born underweight.

In tandem with physical abnormalities, many also have impaired brain development making it more difficult for them to succeed at school and in the workplace. In Zimbabwe, children who were stunted at preschool age started school seven months later, missed more school and earned 12 per cent less during their lifetime.

The problems of poor maternal nutrition are often intergenerational with undernourished women giving birth to undernourished children and the cycle continues.

McAuliffe said the problems were compounded by the low levels of breastfeeding in developing countries. The World Bank recommends breastfeeding for the first six months of life to aid nutrition, but in Africa and Asia, less than 50 per cent of babies younger than two months are breastfed and this falls to 30 per cent for babies who are breastfed up to six months. In countries where sanitation and clean water are at a premium, this can have fatal consequences.

McAuliffe said mortality rates among those who are not breastfed increases tenfold and even only partial breastfeeding is associated with increased mortality in developing countries.

It is not just children in the developing world who are affected by poor nutrition, she told the conference. Based on the mothers who pass through Holles Street, there is a considerable amount of basic under-nutrition and in some cases over-nutrition, she said. Only 16 per cent had their recommended daily allowance of calcium, 14 per cent iron and folates were at just 4 per cent.

The hospital has also found a link between elevated levels of blood sugar in the mother’s blood and the size of the child. Mothers, whose sugars were at the upper range of normal, were at risk of delivering larger than normal babies – children who are at a significant risk of obesity, diabetes and cardiovascular disease later in life.

She said anything over 4.2-4.5kgs (nine to 10 pounds) has an elevated risk of childhood obesity, but she stressed that many of these children turn out to have normal growth. “There are problems about being too small at birth and too big at birth. It comes down to your growth potential,” she said.