Because obesity, diabetes, cardiovascular morbidity, and neuropsychiatric diseases can all be considered paediatric diseases, disease prevention must start with improved nutrition, argues the First Thousand Days paper, which shows 'the astonishing rate' of development from conception to age two.
"The presence or lack of good nutritional status of the mother and / or child is a critical factor in ‘programming’ the child for healthy development and positive long-term health and well-being outcomes," it states.
It highlights that women who are overweight or obese before pregnancy are at greater risk of complications during pregnancy, and likely to give birth to larger infants, who are at increased risk of developing obesity later in life.
While excessive weight gain during pregnancy can also increase birth weight, inadequate gestational weight gain can increase the likelihood of poor foetal development.
Breasfeeding benefit
After birth, factors such as excessive and rapid weight gain, as well as inadequate sleep, have been shown to contribute to childhood obesity.
"Exclusive breastfeeding has been shown to modestly protect against this, while the initiation and duration of breastfeeding can also influence this. Breast milk has also been found to decrease the likelihood of developing allergies in later life," adds the paper.
Substance use in the first 1,000 days is another critical individual factor that significantly affects child health and well-being.
Exposure to alcohol in the uterus is the leading cause of cognitive impairment and neurodevelopmental disorders, and the most common preventable cause of birth defects, it notes.
"The effects of alcohol on the embryo or foetus produce a spectrum of lifelong disorders that affect physical, learning and behavioural outcomes, the range of which is collectively termed ‘foetal alcohol spectrum disorder’ (FASD). Based on available research evidence, it cannot be stated that light drinking in pregnancy has been established to be safe," the paper warns.
Toxic stress is the third major individual factor that affects health in the first 1,000 days and beyond.
Cognitive development
This impacts the foetal nervous system, and reduces foetal growth and the length of gestation. Poor growth in utero is a major risk factor for a number of subsequent health problems in a child’s later years, including physical and neuromuscular maturation, behavioural and emotional development, and cognitive development.
While the paper stresses that the ability to alter and change the impacts of negative experiences in the first 1,000 days becomes more difficult as a child gets older, it is certainly not impossible to make improvements as children grow and develop.
“After 1,000 days, the different effects on children begin to taper off,” according to lead author Dr Tim Moore.
“It’s not the end of the world, it just becomes harder to change. We don’t want parents to feel like ‘what have I done’; it’s about encouraging everyone to think about the importance of this time period, and how the whole of society should consider this responsibility.”
The report, which considers a whole range of factors beyond nutrition in the first 1,000 days, was prepared by the Centre for Community Child Health and researchers from the Murdoch Children's Research Institute (MCRI), and produced with the support of the Bupa Health Foundation, PwC and ARACY.