The Biology of the First 1,000 Days

Crystal D Karakochuk, Kyly C. Whitfield, Tim J Green, Klaus Kraemer, Crystal D Karakochuk, Kyly C. Whitfield, Tim J Green, Klaus Kraemer

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781351648998
• Edition: 1
• Topic: Medicine
• Subtopic: Perinatology & Neonatology

The first 1, 000 days, from conception to two years of age, is a critical period of growth and development. Exposures to dietary, environmental, hormonal, and other stressors during this window have been associated with an increased risk of poor health outcomes, some of which are irreversible. The book addresses this crucial interval of early life across biological disciplines, linking concepts related to all biological fields to outcomes during the first 1, 000 days (e.g. fetal growth and pregnancy outcomes) and beyond (e.g. gut microbiome and cardiovascular disease later in life). The strength of this book lies in its cross-disciplinary nature.

Section XEffective Interventions during the First 1,000 Days

24Effectiveness of Nutrition-Specific Interventions in Pregnancy and Early Childhood

Rebecca Heidkamp, Adrienne Clermont, and Robert E. Black

Introduction

Maternal Interventions

Micronutrient Interventions

Iron Folic Acid Supplementation

Multiple Micronutrient Supplementation

Food Fortification

Calcium Supplementation

Balanced Protein-Energy Supplementation

Intrapartum/Neonatal Interventions

Early Initiation of Breastfeeding

Neonatal Vitamin A Supplementation

Delay of Umbilical Cord Clamping

Child Interventions

Breastfeeding Promotion

Promotion of Age-Appropriate Complementary Feeding and Provision of Supplemental Food

Education Only

Provision of Supplement with Energy and Micronutrients

Micronutrient Supplementation

Vitamin A Supplementation

Preventive Zinc Supplementation

Multiple Micronutrient Supplementation

Management of Severe Acute Malnutrition

Management of Moderate Acute Malnutrition

Conclusion

References

Introduction

The 2013 Lancet series on Maternal and Child Nutrition included a comprehensive review of interventions that affect the nutritional status of women and young children in low- and middle-income countries (LMICs). The series’s authors estimated that if 10 known effective interventions were scaled up to 90% coverage, we could eliminate 15% of under-5 deaths and reduce stunting by 21% globally [1]. The objective of this chapter is to review and update this work with the latest research evidence on the effectiveness of these 10 and other nutrition-specific interventions to prevent poor growth and improve child survival during the crucial first 1,000 days of life. We will focus primarily on interventions delivered at scale through the health system. Outcomes of interest include birth outcomes (preterm, small for gestational age, low birth weight), risk of subsequent growth faltering (stunting, wasting), and mortality during the first 5 years of life. We will not consider effects on anemia, developmental outcomes, or overweight/obesity risk, nor will we address the broader range of nutrition-sensitive interventions that affect more distal determinants of nutritional status (including food production systems, water and sanitation, and household socioeconomic status). Others have provided comprehensive reviews of these important strategies [2].

Interventions are presented by the continuum of care from pregnancy through early childhood (Figure 24.1). We will describe each intervention, identify the general biological mechanism through which it is understood to have an effect, and review the latest evidence on effectiveness.

Figure 24.1A conceptual map of interventions, risk factors, and outcomes.

Maternal Interventions

Interventions to improve maternal nutritional status before and during pregnancy can have long-lasting effects on child growth and survival. Several interventions delivered to women before or during pregnancy affect neonatal outcomes (Table 24.1), including the risk of preterm and small for gestational age (SGA) births, as well as neonatal mortality [3]. Babies who are born preterm or SGA are at higher risk of stunting [4] and mortality [5] in early childhood (Table 24.2). Infants in South Asia are at a higher risk of being wasted from very soon after birth than children in other regions [6].

Table 24.1Maternal Intervention Effects

Intervention	Outcome of Interest	Effect Size (95% CI)
Periconceptual folic acid supplementation	Neural tube defects	RR: 0.31 (0.17, 0.58)
Iron supplementation in pregnancy	Iron-deficiency anemia	RR: 0.33 (0.16,0.69)
	Low birth weight	RR: 0.84 (0.69, 1.03)
Multiple micronutrient supplementationa	Low birth weight	RR: 0.88 (0.85, 0.91)
	SGA	RR: 0.90 (0.83, 0.97)
	Stillbirth	RR: 0.91 (0.85, 0.98)
Calcium supplementation in pregnancy	Preterm births	RR: 0.76 (0.60, 0.97)
Balanced energy-protein supplementation in pregnancy	SGA	RR: 0.79 (0.69, 0.90)
	Stillbirth	RR: 0.60 (0.39, 0.94)
	Birth weight	MD: +40.96 g (4.66, 77.26)

Note: RR, relative risk; MD, mean difference.

a Effects are compared to iron or iron-folic acid supplementation.

Table 24.2Impact of Birth Outcomes on Stunting and Mortality

Birth Outcome Group	Relative Risk of Stunting at 12–60 Months (95% CI)	Relative Risk of Neonatal Mortality (95% CI)	Relative Risk of Postneonatal Mortality (95% CI)
Term, not SGA	1 (reference group)	1 (reference group)	1 (reference group)
Term, SGA	2.43 (2.22, 2.66)	3.06 (2.21, 4.23)	2.20 (1.57, 3.08)
Preterm, not SGA	1.93 (1.71, 2.18)	9.44 (5.08, 17.55)...