It is now well established that the health and habits of a pregnant woman modify the development of health (and disease) of her yet-to-be-born baby. The first 1,000 days from conception to the second birthday of the child are thus vital. In this connection, it has been said that “Man is what he eats in the first 1,000 days”. It is during this period that the infant’s body and brain develop at a rapid pace, setting up the stage for the growth and development of the child through adulthood.
The mother-to-be influences the health and happiness of her baby not only through her genes, but also via the message that they carry, through her health condition during pregnancy. If she is anaemic, has diabetes, smokes or drinks a lot, is sick through infection or even with non-communicable diseases, these and related factors affect the health of her progeny even in later life. She thus plays an inter-generational and epigenetic role.
That there are what are called Developmental Origins of Health and Disease (DOHaD for short) has become clear over the last 30 years. DOHaD has become a globally recognised concept, tells us how we can use effective methods to advise, intervene and promote good health in children and mothers. There is, in fact, a professional journal called Journal of DOHaD, started in 2009-10, wherein scientists and health workers analyse conditions that affect pregnant mothers, such as their personal and community environment, nutrition and health and how these tell on their babies. Suggestions are also made in DOHaD on how to modify these so as to ensure appropriate health for the mother and her children.
That the condition and environment in which the pregnant mother lives differ from country to country, or even state to state within a country, is self-evident. What obtains in the US is not the same in Uganda. What obtains in Manipur is different from that in Madurai. Thus one size does not fit all. For example, the eminent diabetologist Dr Chittranjan Yajnik of Pune has shown that Indians store their fat in the abdominal region (rather than all over the body) and thus are not obese but have what he calls the thin fat body phenotype, very different from the western obese type. This thin fat phenotype appears associated with the risk of the epidemic of chronic non-communicable diseases such as diabetes, blood pressure and the like.
Studies of this type, which are context-dependent, are promoted by DOHaD. At the recent meeting of DOHaD, organised by Dr Abdallah Daar of Canada and held in Stellenbosch, South Africa, Dr Shane Norris of South Africa highlighted how in sub-Saharan Africa interventions in early life can effectively promote lifelong better health. The sad fact is, as Peter Byass of Sweden pointed out, maternal mortality and infant mortality in Africa are rather alarming and need to be brought down effectively. Many cost-effective methods were discussed, some of them easily applicable in India. After all, the environmental and economic conditions in several parts of Africa closely parallel those in many parts of India.
One theme that was highlighted by Dr Atul Singhal of London and others at the meeting was the benefits of breast-feeding. Happily enough, mothers in much of rural India (also in rural Africa) still breast-feed their infants (though, alas, many urban mothers tend to prefer formula feeds). World Health Organisation points out how breast feeding promotes sensory and cognitive development, and protects the infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhoea or pneumonia, and helps for a quicker recovery during illness. And one point made in this connection by Soraya Seedat of South Africa was that when an alcoholic (or substance abusing) mother feeds her baby, the negative effects of it on the latter can last until the child becomes 7 years or so old. Counselling and intervention here becomes of great value for the health of both the mother and her offspring.
The first 1,000 days are when the mother-infant interaction is at its highest, and Dinky Levitt of South Africa emphasised its long-term benefits, while Elona Tosca of Oxford pointed out how social interventions help the health outcomes of adolescents and youth. A particularly important and incisive point was made by Andrew MacNab of Canada, who has been running what WHO calls as the Health Promoting Schools, in which school children are taught what is called haptic learning (or learning by doing), in which awareness and practice of healthy habits (use of a toothbrush!) are brought forth. He talked about a new set of 3 “R”s, namely, resilience, relationship and real-time learning.
Counselling, intervention and implementation are the cornerstones of DOHaD. And there are examples that DOHaD offers which can be easily adopted and adapted in many countries including our own. We, in India, have the disturbing situation where as many as 48 million children are stunted - largely due to both real and hidden hunger, both in them and their mothers. Several solutions have been found by our own scientists and health workers, and are being practised. With renewed and consistent efforts, and through what we learn from other countries through DOHaD, there is every chance that such worrisome numbers can be drastically brought down at the soonest.
D. Balasubramanian
dbala@lvpei.org
