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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

Impaired IQ and academic skills in adults who experienced moderate to severe infantile malnutrition: a forty-year study

Published: Nov. 26, 2013

Publication: National Library of Medicine

Authors: Deborah P. Waber, Ph.D., Cyralene P. Bryce, M.D., Jonathan M. Girard, B.A., Miriam Zichlin, B.S., Garrett M. Fitzmaurice, Sc.D., and Janina R. Galler, M.D.

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

  • While previously malnourished individuals were able to catch up physically to their healthy peers, their cognitive and behavioral development lagged behind 
  • IQ scores in the intellectual disability range were 9 times more prevalent in the previously malnourished group 
  • Previously malnourished individuals had lower IQs, lower grades in school, and higher rates of attention problems. They also suffered from intellectual disabilities at a higher rate than their healthy peers. 
  • Malnutrition during the first year of life carries risk for significant lifelong functional morbidity.  

Key Facts: 

  • The estimated difference in IQ between the two groups was 15 points when tested as adolescents and 18 points when tested as adults 
  • 26.3 percent of individuals in the previously malnourished group had IQs indicating intellectual disabilities compared to only 3 percent in the control group 

Read the original article here

Long term consequences of early childhood malnutrition

Published: December 2003 

Publication: International Food Policy Research Institution 

Authors: Harold Alderman, John Hoddinott, Bill Kinsey 

Background

  • Researchers studied the preschool nutritional status (measured by height, given age) of children in Zimbabwe who experienced civil unrest and/or a drought before the age of three
  • Civil war and droughts were used as an indicator of malnourishment
  • Nutritional status was then compared to subsequent health and education achievements of these children to show the effects of early-childhood malnutrition on adult outcomes

Summary

  • The study indicates that early childhood malnutrition can lead to continued stunting and lower school achievement in adolescence as compared to peers who experienced no malnutrition or a lesser degree of malnutrition in childhood
  • Children who measured at median height in preschool were more likely to measure at median height by adolescence and have completed an additional 0.7 grades of schooling than students who measured below median height in preschool
  • This study also indicates that improving preschool nutrition can facilitate growth and higher educational achievement in adolescence
  • Because of the negative impact of “shocks” (i.e. war and drought), interventions should focus on mitigating the impact of these shocks.

Read the original article here

Scaling Up Impact on Nutrition: What Will It Take?

Published: 07 July 2015

Publication: Advances in Nutrition

Authors: Stuart Gillespie, Purnima Menon, and Andrew L Kennedy

Read the original paper here.

Summary:

  • Even though scaling is important to the nutrition community, people have different ideas about what the term means. 
  • If we’re going to successfully scale nutrition interventions, we need a clear and consistent definition of what the word means.
  • This paper analyses 36 scaling frameworks (from multiple sectors), and distills these frameworks into nine “critical elements” for successfully scaling nutrition projects:
  1. Have a vision/goal:  From the beginning, it is important that everyone agrees on what the project is trying to achieve and how you will measure success. 
  2. Focus on evidence-based interventions: only scale interventions that have already been tested and that are effective at a smaller scale.  
  3. Context matters.  Make sure that any programs you try to scale take into account all the challenges and opportunities of the surrounding environment (policies, institutions, culture etc.). If there are big barriers, make sure your intervention can work around them or don’t scale it there. 
  4. Drivers for scale up include high-level political support, an engaged nutrition champion to spark support, national and local ownership of the intervention, and performance incentives for individual frontline workers or  whole organizations.
  5. Identify scaling-up strategy, processes, and pathways: Be clear about exactly what you’re trying to scale and how you’re going to do it. These measures can be quantitative (expansion in geographical coverage, budget, or size), functional (increase in types of activities and integration with other programs), political (increases in political power and engagement), and organizational (strengthened organization capacity)
  6. Make sure there is strategic and operational capacity to scale up.  Capacity can be improved through nutrition leadership and training.
  7. Governance:  Recognize that successful scaling means managing trade-offs (for example between demonstrating short-term success and building sustainable systems) and make sure governments at different levels have a coherent way of working together.
  8. Financing:  Not only do you need to have enough money, but that money needs to be reliable and flexible. Interventions also cost different amounts depending where you are, so wherever possible make sure your budget is based on local data and prices.
  9. Monitoring, evaluation, learning, and accountability:  We need a lot more evidence on the impact of and lessons learned from scaling. Make sure to collect and disseminate data as you go.

Work at 1,000 Days: Open Positions

1,000 Days leads the fight to build a strong foundation for mothers, children, and families to thrive. The first 1,000 days from pregnancy to age 2 offer a window of opportunity to create a healthier and more equitable future for all pregnant, birthing, postpartum, and parenting people and their children. Join us and help achieve our mission to make health and well-being during the first 1,000 days a policy and funding priority, both in the U.S. and around the world.

The organization is hiring two, full-time, remote positions with office space in the Washington D.C. area available:

Policy and Advocacy Officer (6-8 years experience) The ideal candidate for this position develops, cultivates and leverages great relationships with decision-makers, legislators, fellow nonprofit organizations, policy experts and researchers to deliver on the 1,000 Days’ domestic policy priorities and builds effective coalition efforts and campaigns. The candidate will research, monitor, analyze and respond to federal legislation related to nutrition, paid leave, maternal and child health and healthcare as established in our 2022 Advocacy Agenda. Candidates must be actively interested in working with an organization that is making the needs of vulnerable families a policy and funding priority. The position reports to Solianna Meaza, Director of Policy and Advocacy.

Advocacy and Research Associate (2-4 years experience) The primary role of this candidate is to track and analyze relevant research, reports and policy developments, as well as provide research and writing support around key policies and programs impacting families, including federal nutrition programs, federal dietary guidelines, paid leave and healthcare. The candidate will translate policy and research information for a variety of audiences and produce written materials such as policy briefs, position papers, blog posts, social media posts and reports. The ideal candidate has advanced credentials, such as a Master’s in Public Health, a Registered Dietitian, or similar. The position reports to Blythe Thomas, Initiative Director.

Cultivating a diverse and inclusive team is an essential component of 1,000 Days’ work to advance equity. Candidates of all backgrounds are strongly encouraged to apply. We are committed to fostering a workplace culture that is welcoming and inclusive to staff of different races and backgrounds. We seek to foster an environment where all staff feel a sense of belonging and are affirmed. We actively welcome and value staff with different experiences, backgrounds, attributes, abilities, and perspectives.

We look forward to growing the team of leaders who cares deeply for the health and wellbeing of families here and around the world.

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.