The first 1,000 days of life

It all begins when the luckiest and strongest sperm wades through the treacherous cervical mucus to finally meet the eagerly waiting egg in the magical fallopian tube. And thence life begins with the fertilised egg taking another six to 12 days to get home; the uterus, where it grows and changes form in the next nine months, should everything go well.

An excited man and woman will hope that the egg and sperm that will produce their baby are the healthiest options they had; to give their child the best chance possible. Sometimes that’s the case. Other times it isn’t.

Just before the 1000 days begin

For the hopeful father–to-be, his diet and lifestyle influences how the genes are expressed in his sperm. If he is obese, his future daughter is more likely to end up obese too and have difficulty metabolising carbohydrates. If it is a son, he will have issues with leptin hormone, one responsible for regulating body weight and appetite. Additionally, a study published in 2018 in the journal Cell Metabolism suggests that if men are highly stressed or depressed around the time of conception, it might predispose their children to high blood sugar.

For the hopeful mother-to-be, a malnutritioned body, studies say, could cause developmental challenges in the child. When a woman hoping to conceive is obese, her body bears high levels of inflammation and some hormones which affect the quality and development of the egg and embryo, boosting the chances of chronic diseases in the child later in life.

Other measures for both to take include:

·         Increasing iron intake: A 2013 study by McGill University in Canada found iron deficiency in a father’s diet could increase the probability of birth defects (such as craniofacial and musculoskeletal malformations) in their children. It is especially important for women to boost the iron levels in their body before and during pregnancy. Iron is crucial for the development of the neural cord, which later becomes the brain and spinal cord.

·         Avoiding alcohol when trying to conceive: A 2014 study from the University of Pittsburgh School of Medicine found that if the father was drinking heavily around the time of conception, it made it more likely for their male children to be heavy drinkers later in life.

·         Taking folic acid, magnesium, calcium and iodine supplements: “The levels of these nutrients required for a healthy pregnancy may not be achievable through diet alone, hence the need for supplements,” says Dr Elizabeth Sisianoi, a nutritionist at Nairobi Spine and Orthopaedic Centre.

Up your new-born’s chances of survival

The World Health Organisation (WHO) statistics also show that about one third of newborn deaths occur on the day of birth and that close to three quarters of newborns die within the first week of life. The first 24 hours after birth are especially important in ensuring the survival of a neonate. This is why it is recommended for mothers and newborns to stay in the hospital for at least 24 hours after birth. This gives healthcare providers the opportunity to catch any complications that might arise and treat them.

Kenya has one of the highest rates of neonatal deaths in the world, standing at 19/1000 live births. This is just a little better than the collective 28/1000 live births neonatal mortality recorded in Sub-Saharan Africa. This means that Kenya has 29,000 neonatal deaths per year. Broken down further, Kenya has approximately 92 newborn deaths per day.

“In the first 30 minutes to an hour after birth, the baby should be latched onto the breast to initiate breastfeeding. Latching at this time stimulates the mother’s body to start producing colostrum, which contains essential nutrients for the newborn. We advise mothers to exclusively breatfeed for the first six months. But in case of unavoidable circumstance, babies can be fed on formula milk. In cases where the parents can’t afford formula, they can feed the baby on diluted cow milk,” Dr Sisianoi advises.

In the first 24 hours, newborns should receive:

·         Thermal protection (such as through skin-to-skin contact)

·         Hygienic umbilical cord care

·         Early and exclusive breastfeeding

·         Assessment for any signs of serious health problems

·         Immunisation and Preventative care (BCG, Hepatitis B, and Polio vaccines, Vitamin K and other prophylaxis)

Training their immune system

“We think there’s a window of time, which contains the first 100 days, the first three months of life when you may need the right bacteria to train your immune system. We have observed that if those bacteria are not there, in the training, that seems to be linked to asthma,” says scientist Stuart Turvey in a 2015 published study.

He explained that breastfeeding is the best way to keep babies’ gut microbiota as healthy as possible. “Breastfeeding is protective and helps mitigate other health problems,” he said. He also cautioned against the use of antibiotics in a baby’s first three months. “We should minimise the use of antibiotics, just make a proper and thoughtful use of antibiotics.”

Parents shouldn’t be overzealous about protecting their infants from the world. “Of course, another thing families can do is simply let the children be out in the world. It is not helpful to not expose them to anything. We should be comfortable to let them go and live and explore the environment.”

Breastfeeding for at least the first two months after birth also helps cut the risk of sudden infant death syndrome in half, according to a study published in 2017. This study didn’t find exclusive breastfeeding to provide more protection than partial breastfeeding.

Duration of breastfeeding impacts motor function of the child

A study done on 133 babies ranging between 10 months and four years showed that babies who had been breastfed for at least three months showed advanced brain development in areas linked with language, emotional function and cognition compared to those fed on a mix of breast milk and formula and those fed on just formula.

Additionally, those who were breastfed for longer than one year showed more advanced motor function.  

“…the exclusively breastfed group had the fastest growth in myelinated white matter … with the increase in white matter volume becoming substantial by age two. The group fed both breast milk and formula had more growth than the exclusively formula-fed group, but less than the breastmilk-only group,” reads the study in part.

To wean or not to wean at six months?

In the 1990s the age range of 4-6 months was considered ideal for weaning babies. But in 2001, WHO recommended exclusive breastfeeding should continue until six months of age.  A study by WHO found that babies who were fed exclusively on breast milk for the first six months had fewer infections and experienced no growth problems.

Dr Sisianoi advises against weaning a baby before the sixth month. “At this point, a baby might not be developed enough to comfortably swallow solid food. Additionally, early weaning may increase the risk of health problems such as obesity, diabetes, and celiac disease,” she says.