Category: Maternal Health

New Series in the American Journal of Public Health Identifies 1,000-Day Window as Untapped Potential to Improve Health of Families

Opportunities, Challenges Identified for Pregnant People and Babies 0-2

(WASHINGTON D.C.) Over the last two decades, science has shown that the 1,000-day window, the time between a pregnancy and the baby’s second birthday, is most critical for brain development and when good nutrition has the greatest influence on future health. Today, on the heels of the first White House Conference on Hunger, Nutrition, and Health in more than 50 years, The American Journal of Public Health released a special series that identifies opportunities to unlock the untapped potential of this critical time by closing data gaps, enhancing promising programs, strengthening policies and uniting around this powerful window of growth.

“Prioritizing the health of babies, younger children, and mothers will reap significant returns on investment, setting the foundation for the health of our nation,” said Ambassador Susan Rice, White House Domestic Policy Advisor, in one of the editorials in the series. “Everyone has a role to play—the private sector; state, local, tribal, and territory governments; civil society; academia; philanthropy; and other partners.”

The 70-page series with more than 15 authors outlines the role of Early Childcare and Education (ECE) settings to strengthen overall support systems for low-income families and influence the healthy growth and development of children; how to improve breastfeeding outcomes without leaving anyone behind; new analysis on COVID’s impact for people who gave birth during the height of the pandemic; investments needed to achieve nutrition security; and new opportunities for pediatricians to better support families in their care with nutrition advice and access.

“This special issue sets the stage for what we know about nutrition in the first 1,000 days in the U.S. and what is needed to move forward. Unfortunately, nutritious foods are not uniformly and equally available to all. This has unique relevance to the first 1,000 days as inequities in childhood growth and development due to poor nutrition can have long-term effects on cognitive development and health throughout that child’s life,” said Dr. Ruth Petersen, MD, MPH, Director of the Division of Nutrition, Physical Activity and Obesity at the Centers for Disease Control and Prevention (CDC), guest editor of the series and an author (R. Petersen).  The series identifies:

  • Gaps in data of nutrition status and eating behaviors through pregnancy, infancy and toddlerhood (H. Hamner), including micronutrient deficiencies such as iron status, which leaves women vulnerable to poor maternal outcomes (M.E. Jefferds).
  • Steps to improve nutrition of pregnant people, including how to realize the potential benefits of breastfeeding so no one is left behind (R. Perez-Escamilla).
  • Impacts of early disparities from historically underserved communities, especially racial disparities that stem from systemic racism in food access, education, housing, health care and employment that have been exacerbated by the COVID-19 pandemic (S. Bleich).
  • Efforts to counter repeated exposure of marketing of unhealthy foods and drinks (J. Harris),  and address overconsumption of ultra-processed food through government policies (J. Krieger).
  •  Opportunities to leverage federal and state programs and policies, such as ECE funding streams, state licensing regulations, state quality improvement programs, and accrediting organizations to strengthen nutrition security in childcare settings. (C. Dooyema).
  • Actions key sectors can take immediately, including childcare, healthcare and the philanthropic sector, as well as policy recommendations for the U.S. government (B. Thomas).  

“What happens in the first 1,000 days sets the foundation for every day that follows. How well or how poorly mothers and children are nourished and cared for during this time has a profound impact on a child’s ability to grow, learn and thrive,” said Blythe Thomas, initiative director of 1,000 Days, an initiative of FHI Solutions. “Achieving nutrition security during the first 1,000 days will ultimately require multisector collaboration, advocacy, and action to fully support families where they live, learn, work, play, and gather. We invite all to join us in prioritizing and realizing the opportunity presented by this AJPH supplement.”

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Multiple micronutrient supplements versus iron-folic acid supplements and maternal anemia outcomes: an iron dose analysis

Published: February 25, 2022

Publication: MMS in Pregnancy Technical Advisory Group, New York Academy of Sciences

Authors: Filomena Gomes, Rina Agustina, Robert E. Black, Parul Christian, Kathryn G. Dewey, Klaus Kraemer

Background

  • The World Health Organization currently recommends 30 to 60 mg of iron during pregnancy, with higher doses recommended in areas of high maternal anemia
    • Multiple micronutrient supplement (MMS) and iron folic acid (IFA) are both used to deliver iron during pregnancy
  • Comprehensive analysis was conducted examining 19 studies to address concerns related to 30mg of iron through MMS vs. 60mg of iron through IFA, with regard to maternal anemia outcomes in low- and middle-income countries (LMICs)

Summary

  • Of the 19 studies that were screened for inclusion, 11 were included and were part of the analyses of the three outcomes of interest:
    • Effect of MMS vs. IFA on maternal anemia in the third trimester
    • Effect of MMS vs. IFA on hemoglobin in the third trimester
    • Effect of MMS vs. IFA on iron deficiency anemia in the third trimester
  • When compared to 60 mg of IFA, MMS providing 30 mg of iron did not result in an increased risk of anemia, nor lower levels of hemoglobin, or increased risk of iron deficiency anemia
  • The included studies found that MMS with 30 mg of iron is comparable to IFA with 60 mg of iron with regard to these above-mentioned outcomes
  • MMS is known to have additional benefits in the risk of infant mortality at 6 months, low birthweight, preterm birth, born small-for-gestational age, and reduction of stillbirth. Greater reductions are found among anemic pregnant women so the data suggest that transitioning from IFA with 30 or 60 mg of iron to MMS with 30 mg of iron would not increase the risk of maternal anemia and has additional maternal/child health benefits.

Key Quotes

  • “Because MMS with 30 mg of iron influenced hemoglobin with clinically comparable results to IFA with 60 mg iron, and because MMS significantly improves fetal growth and survival, especially in anemic women, we suggest that policymakers in LMIC proceed with the transition from IFA to MMS.”

Read the original article here

Effect of multiple micronutrient supplements vs iron and folic acid supplements on neonatal mortality: a reanalysis by iron dose

Published: April 25, 2022

Publication: MMS in Pregnancy Technical Advisory Group, New York Academy of Sciences

Authors: Filomena Gomes, Rina Agustina, Robert E. Black, Parul Christian, Kathryn G. Dewey, Klaus Kraemer

Background

  • Multiple micronutrient supplements (MMS) are a cost-effective method of delivering iron to a mother and fetus, as well as reducing adverse pregnancy and birth outcomes, including anemia
  • However, there are concerns that MMS may increase the risk of neonatal mortality as compared to the use of iron and folic acid supplements (IFA), a similar prenatal vitamin

Summary

  • The study aimed to assess the effect of MMS vs. IFA on neonatal mortality stratified by iron dose in each supplement
  • The study authors updated the neonatal mortality analysis of the 2020 WHO guidelines to calculate the effects of MMS vs. IFA on neonatal mortality in subgroups that provided the same or different amounts of iron – varying amounts of MMS and IFA
  • The study found that there were no significant differences in neonatal mortality between MMS and IFA within any of the subgroups therefore, neonatal mortality did not differ between MMS and IFA regardless of iron dose in either supplement.

Read the original article here

Maternal and child undernutrition: consequences for adult health and human capital

Published: January 2008 

Publication: The Lancet 

Authors: Prof. Cesar G. Victora, M.D., Prof. Linda Adair, Ph.D., Prof. Caroline Fall, D.M., Pedro C Hallal, Ph.D., Prof. Reynaldo Martorell Ph.D., Prof. Linda Richter Ph.D., Prof. Harshpal Singh Sachdev, M.D., for the Maternal and Child Undernutrition Study Group 

Background

  • Previous studies have indicated that pre- and post-natal malnutrition can result in long term changes to the structure and functionality of the brain, impairing memory and learning in childhood and adolescence
    • There has been less emphasis on researching how malnutrition in the first year of life affects intellectual capacity across the lifespan
    • The “Barbados Nutrition Study” assessed IQ and academic skills in adults in Barbados who were born with a moderate birth rate, but experienced moderate to severe malnutrition in their first year of life
    • Individuals were enrolled in a nutritional health intervention program and monitored until they were at least 12 years of age to ensure they were in good health
    • The control group consisted of healthy individuals from the same neighborhoods and classrooms who did not experience malnourishment in their first year of life

Summary

  • Malnutrition in pregnancy and childhood can cause generational health problems 
  • Undernutrition in pregnant mothers and children was strongly associated with… 
    • Shorter adult height 
    • Less schooling 
    • Reduced economic productivity  
    • Lower offspring birthweight in women (birthweight is positively associated with lung function, the incidence of some cancers; undernutrition could be associated with mental illness) 
  • Lower weight and malnutrition in childhood followed by weight gain after two years of age was found to be risk factors for high glucose concentrations, elevated blood pressure and harmful lipid profiles once adult BMI and height were adjusted for, suggesting that rapid postnatal weight gain, after infancy, is linked to these conditions 

Key Quotes: 

  • “Poor fetal growth or stunting in the first 2 years of life leads to irreversible damage, including shorter adult height, lower attained schooling, reduced adult income, and decreased offspring birthweight.” 
  • “Children who are undernourished in the first 2 years of life and who put on weight rapidly later in childhood and in adolescence are at high risk of chronic diseases related to nutrition.” 
  • “We conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations.” 

Read the original article here

Keeping Healthy During Pregnancy & Breastfeeding

During pregnancy and when you’re breastfeeding, nutritious food choices will help fuel your
baby’s growth and keep you healthy.

Watch and learn 6 steps you can take during your 1,000-day window to nourish you and your little
one.

Taking a Prenatal Vitamin

Eating the Rainbow

Limiting Certain Foods

Managing your Weight

Focusing on Good Nutrition

Breastfeeding for the Benefits to You and Baby

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Focus on Nutrition During National Women’s Health Week

By:  Blythe Thomas, Initiative Director, 1,000 Days of FHI Solutions

Minerva Delgado, Director of Coalitions & Advocacy, Alliance to End Hunger

Not nearly enough time or attention is spent discussing and acting upon when “good nutrition” for an individual should start. The answer? Before the individual is even born. This week is National Women’s Health Week and marks an important time for the nutrition and anti-hunger community, individuals, and policymakers, to reflect on what we can do to promote and improve the health of women, children and families. We must focus on supporting policies that build a healthier and more equitable future for all pregnant, birthing, postpartum, and parenting people and their children.  

The 1,000-day window, which spans from pregnancy to age 2, marks one of the most crucial times to provide vital maternal and infant nutrition interventions. The nutrition community has coalesced around this critical window working to ensure mothers, children and families have access to the nutrition they need for vibrant futures. This goal is unfortunately – but unsurprisingly – difficult to achieve across the board. Factors such as race or where a child is born should not affect health and well-being; however, this is a reality in many communities. In particular, families of color and low-income families are more often overburdened with barriers to accessing nutrition and are under-resourced. As a result, there are glaring disparities in the health and well-being of women and children from these households. 

Adequate nutrition is fundamental to the overall well-being of a community because good nutrition impacts more than just physical health. Good maternal nutrition during pregnancy fuels the development of a baby’s rapidly growing brain so by the time that a baby is born, their brain will contain 100 billion neurons. We also know, for example, that children with access to healthier, more nutritious meals are better able to concentrate in school and enjoy better educational outcomes. Similarly, adults who can easily access and maintain a healthy diet benefit from improved health and economic opportunities. Addressing inequities in access to healthy and nutritious foods cannot be ignored. We must prioritize interventions that give every family the opportunity to be healthy.  

To that end, there are a number of programs that merit continued support and strong expansions, such as the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Child and Adult Care Food Program (CACFP). For example, WIC has bridged the gap between medicine, food, and nutrition better than almost any federal program, leading to improved nutrition intake, healthier pregnancies and improved birth outcomes. Congress has temporarily increased the overall value of WIC’s fruit and vegetable benefit (or Cash Value Benefit (CVB)) through the end of September 2022. So far, this has led to better access to nutritious foods for over 4.7 million WIC participants. Making the increased benefit permanent will significantly close nutrition gaps for women and their children. 

Improving nutrition also means supporting programs like the recently expired monthly Child Tax Credit (CTC). The revamped CTC monthly payment proved to have an astonishing impact on lifting children and families out of poverty. In 2021, Congress expanded the CTC and made the full credit available to low-income families who previously did not qualify because their earnings were too low. Families were allowed to receive the credit in monthly increments, which was vital in helping families with their everyday expenses like buying nutritious food. It is estimated that 3.7 million children were kept out of poverty in December 2001 when the last child tax credit payments were made. Further, nearly half of families who received the tax credits used the extra funds to purchase food helping to address nutrition insecurity around the country. In January, the first month without the deposits, those gains were lost and 3.7 million children again fell into poverty. 

But we must support the overall health and well-being of women and families with comprehensive approaches to address the root causes of poverty and malnutrition. Employers must implement family-friendly policies and programs in workplaces and communities to support women at home and at work. This includes providing workers with sufficient paid family leave, as well as ensuring equitable access to the lactation services and support women need to meet their breastfeeding goals. These policies help make the workplace and our society a safe and enabling environment. The recent pandemic and subsequent inflation have highlighted not only the critical nature of poverty and nutrition programs, but also the vulnerabilities and gaps in supporting those who need it most. All future policies must prioritize making programs more equitable and effective. While Congress has many competing priorities, we know that voters across all demographics deeply care about ensuring women and their children have access to the nutrition they need to be healthy. For example, a recent bipartisan poll by ALG Research/McLaughlin & Associates, on behalf of the National WIC Association and Alliance to End Hunger, reveals strong support for WIC among likely 2022 voters – 83% total support for the program, and approximately 75% support for expanding the value of the WIC food package, expanding postpartum eligibility, and modernizing WIC services.  

This week, let’s reflect once again on the fundamental importance of nutrition for women and girls across the country, and urge Congress to make access to healthy foods and investment in nutrition programs a priority. Ensuring the health and well-being of those who are pregnant and their children is critically important to our nation’s future and requires both focus and determination of policymakers and advocates. 

1,000 Days, an initiative of FHI Solutions, fights to win support for policies and investments in the wellbeing of mothers, babies and toddlers in the U.S. and around the world. 

Alliance to End Hunger unites diverse sectors to address today’s hunger and malnutrition needs and to solve the root causes of hunger at home and abroad. 

Paid Family Medical Leave Remains Critical for Low-Income Pregnant and Postpartum Women

By: Daphna Dror, PHD, RD

The lack of national, comprehensive, and paid family medical leave in the United States has significant consequences for low-income women, especially those who are pregnant or have recently given birth. Many women risk their own or their child’s health to continue working throughout pregnancy and the early postpartum period in order to pay bills and provide for dependents. Only seven states and the District of Columbia have passed their own paid leave programs, meaning far too many new mothers must choose between caring for themselves and bonding with their newborn or making ends meet. 

Paid leave:

  • Supports healthier pregnancies. Financial concerns due to lost wages may prevent low-income women from seeking regular prenatal care, which itself is associated with better pregnancy and birth outcomes. Paid leave reduces the risk of preterm birth, low birthweight, and infant mortality (1). 
  • Increases breastfeeding initiation and duration. The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months followed by a combination of complementary foods and breastmilk for at least 12 months (2), yet new mothers who plan to return to work before 12 weeks or to work full time are less likely to opt for exclusive breastfeeding (3). A recently published study of participants in the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) found that amongst women who had worked prenatally, returning to work within 3 months postpartum significantly decreased the odds of breastfeeding for the first year (4). Paid time off can alleviate the financial stress of combining work and breastfeeding (5,6).
  • Improves the physical and mental health of mother and baby postpartum. While postpartum depression (PPD) occurs in approximately 11% of all US mothers, a qualitative study in low-income women found that 35% experienced PPD or sadness (1). Nearly one third of low-income mothers who returned to work reported that employers were not understanding of postpartum needs, most commonly requiring more time off (1). Mothers who have access to paid leave and other work accommodations can minimize financial strain and career disruptions while improving their own health, their baby’s health and their bond with their baby.
  • Reduces maternal and infant racial and ethnic disparities. Women of color are disproportionately affected by lack of access to paid leave, exacerbating perinatal health disparities (7). Compared with Caucasians, African-American mothers in the United States are more than three times as likely to die of pregnancy-related causes (8); infants born to African-American mothers have more than twice the mortality rate of infants born to Caucasian mothers (9). Women of color are overrepresented in part-time, seasonal, and low-wage jobs, employment categories least likely to offer paid leave (7).

Of 41 high- and middle-income countries, the U.S. is unique in lacking nationwide paid maternity leave, paternity leave, or parental leave (10). Only 19% of U.S. workers have access to paid family medical leave, with even lower access amongst those who work part-time, in low-wage industries, at small firms, or who are not unionized (11). Universal access to paid family leave is imperative to ensure that all families in the United States have a healthy first 1,000 days and a strong foundation to thrive.

References

1.     McClanahan Associates, Inc., 1,000 Days. Qualitative Paid Leave Report: Furthering our Case for Paid Leave in the United States.

2.     Eidelman AI, Schanler RJ. Breastfeeding and the Use of Human Milk. Pediatrics. 2012 Mar;129(3):e827-41.

3.     Mirkovic KR, Perrine CG, Scanlon KS, Grummer-Strawn LM. In the United States, a Mother’s Plans for Infant Feeding Are Associated with Her Plans for Employment. J Hum Lact. 2014 Aug;30(3):292–7.

4.     Hamner HC, Chiang KV, Li R. Returning to Work and Breastfeeding Duration at 12 Months, WIC Infant and Toddler Feeding Practices Study-2. Breastfeed Med. 2021 Dec;16(12):956–64.

5.     Rojjanasrirat W, Sousa VD. Perceptions of breastfeeding and planned return to work or school among low-income pregnant women in the USA. J Clin Nurs. 2010 Jul;19(13–14):2014–22.

6.     Johnson AM, Kirk R, Muzik M. Overcoming Workplace Barriers: A Focus Group Study Exploring African American Mothers’ Needs for Workplace Breastfeeding Support. J Hum Lact. 2015 Aug;31(3):425–33.

7.     Goodman JM, Williams C, Dow WH. Racial/ethnic inequities in paid parental leave access. Health Equity. 2021 Oct 13;5(1):738–49.

8.     Howell EA. Reducing disparities in severe maternal morbidity and mortality. Clin Obstet Gynecol. 2018 Jun;61(2):387–99.

9.     Ely DM. Infant Mortality in the United States, 2018: DataFrom the Period Linked Birth/Infant Death File. National Center for Health Statistics; 2020 Jul.

10.     Chzhen Y, Gromada A, Rees G. Are the World’s Richest Countries Family Friendly? Policy in the OECD and EU. Florence, Italy: UNICEF Office of Research; 2019.

11.     National Compensation Survey: Employee Benefits in the United States. U.S. Department of Labor, U.S. Bureau of Labor Statistics; 2019 Mar.

Kicking Off #March4Nutrition – Join Us All Month Long

In honor of National Nutrition Month, 1,000 Days is kicking off our annual #March4Nutrition campaign to amplify the importance of nutrition for moms and babies around the world. We invite you to follow #March4Nutrition on Facebook, Instagram, and Twitter all month long and join the conversation. 

This #March4Nutrition, we’ll get back to basics and focus on good nutrition in the 1,000-day window. Throughout pregnancy, infancy and beyond, families need good nutrition, breastfeeding support, and nurturing care in order to thrive. 

Every week in March, we’ll dive deep into a new theme and explore how nutrition lays the foundation for brighter, healthier futures. Find more information below and check out our social media toolkit full of graphics and messages to share with your online communities!  

Week 1 March 1-8: Women’s nutrition – Access to proper nutrition can help women grow their power. 

Week 2 March 9-16: Benefits of breastfeeding – Breastfeeding has critical benefits for both moms and babies.  

Week 3 March 17-24: Healthy foods and drinks for babies and toddlers – Growing babies need good nutrition to flourish. 

Week 4 March 25-31: Raise your voice – Help us spark action to change the world for moms, babies and families, 1,000 days at a time.  

At 1,000 Days, we believe that every family, everywhere deserves the opportunity to have a healthy 1,000-day window and beyond – and that starts with access to good nutrition. 

Join us this month as we #March4Nutrition for moms and babies! 

Why Nutrition Matters

Nutrition in the First 1,000 Days – Why It Matters

Good nutrition during pregnancy and the first years of a child’s life provides the essential building blocks for brain development, healthy growth and a strong immune system. In addition, a growing body of scientific research indicates that the foundations for lifelong health—including predispositions to obesity and certain chronic diseases—are largely set during this 1,000 day period.

There are three crucial stages in the first 1,000 days: pregnancy, infancy and early childhood. During pregnancy, a mother’s health and eating habits have a significant impact on the development and future well-being of a child. If a mother’s diet is not giving her the nutrients she needs to support a healthy pregnancy and her baby’s development or if it is contributing to excessive weight gain—or both—it can have serious, long-term consequences.

From birth through the first year, breastfeeding provides unparalleled brain-building benefits and gives babies the healthiest start to life. Because of the unsurpassed benefits of breastfeeding, the world’s leading health agencies including the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) recommend that babies are fed only breastmilk for their first 6 months, but many mothers lack the support they need to meet this recommendation.

And, finally, beginning at 6 months of age, children should eat a diverse diet of nutrient-rich foods to help fuel their growth and development and shape their taste preferences for healthy foods. Throughout early childhood, parents and other caregivers should also teach healthy eating habits and make sure that water and other non-sugar-sweetened beverages become a consistent part of a child’s diet. Deficiencies in key nutrients, poor eating habits and unhealthy weight gain during the early years of a child’s life can set the stage for numerous developmental and health problems down the road.

From India to Indiana, Kenya to Kentucky, mothers and children everywhere need good nutrition and nurturing care in the first 1,000 days to thrive. Yet too many families in the U.S. and throughout the world do not get the food, healthcare or support they need. Whether your organization works to end the crisis of malnutrition in low- and middle-income countries, or you’re focused on the urgent needs of families especially in the United States, thank you for working with us to create a healthier and more equitable future for all pregnant and birthing people, parents, and their children.

CDC Guest Post: Journal Series To Spotlight Importance of Early Nutrition for Health

Guest Blog Post from Dr. Ruth Petersen, Director of CDC’s Division of Nutrition, Physical Activity, and Obesity

Good nutrition is essential in keeping current and future generations of Americans healthy across the lifespan. Good nutrition is especially important during the 1,000 days from a woman’s pregnancy through the child’s second birthday. During this time, optimal nutrition is critical for the child’s brain development, their healthy growth, and setting them on a trajectory for lifelong health. 

Yet today, too many families struggle to obtain optimal nutrition during the first 1,000 days. Only a third of women gain the recommended amount of weight during pregnancy and about 16% of pregnant women have iron deficiency. Although most infants receive some breast milk, most are not exclusively breastfeeding or continuing to breastfeed as long as recommended, and 60% of mothers do not breastfeed for as long as they intend to. Among 1-year-olds, on a given day, fewer than half have eaten a vegetable, and 1 in 3 consume a sugary drink. And about 1 in 7 households with children is food insecure, with deep disparities by race and ethnicity.

At the Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity, we promote and support implementation of programs and activities to improve nutrition before pregnancy, during pregnancy, and through a child’s second birthday. This includes optimal breastfeeding and complementary feeding practices. We support state and community partners by providing data, evidence-based strategies, and practical tools.

The American Journal of Public Health (AJPH), in collaboration with 1,000 Days, intends to publish a special issue exploring the importance of the 1,000-day window from pregnancy to age 2 for maternal and child nutrition and health in the United States. Scheduled for publication in early November 2022, the supplement will highlight how policies, systems, and environments affect the nutrition of mothers and children during the first 1,000 days. It will also summarize the state of the science and research needs related to maternal and child nutrition in the United States. View the full call for papers for complete instructions for submission.

This special issue presents an important opportunity to illuminate the challenges and solutions to ensuring optimal nutrition for mothers and young children in the United States, and to highlight proven policies, strategies, and other solutions to eliminate inequities and health disparities.