The first thousand days of development

How does development take place over the life of a human being from the moment of conception? A fascinating new paper published in Global Pediatrics provides a bird's-eye view of the significant moments of this process, covering the first thousand days of life.

Study: The key 1000 life-changing days. Image Credit: bookzv/Shutterstock.com

Introduction

From the beginning of life, events and changes occur constantly that are fundamental to the development of the individual.

This period includes organ formation and growth. The brain undergoes significant change during this window, and multiple factors may impact its development.

The purpose of the current paper was to highlight those points at which the future course of the organism is chiefly affected, the factors that may produce or regulate such impact, and possible methods to prevent or mitigate such adverse effects.

Periods of development

The researchers identified the following as critical periods of development:

1. Preconception and conceptional

Preconceptionally, parents should be in good health to provide the best possible milieu for conception and pregnancy to progress normally.

2. First trimester of pregnancy

Once the embryo has been formed, organ formation begins and progresses rapidly, with most organs being present by the end of the first trimester.

3. Second and third trimesters

Over the next six months, the fetus continues to develop until it becomes mature and grows in size. The mother is recommended to increase her calorie intake by about 350 and 460 kcal/day during the second and third trimesters.

However, this is differentiated by the woman's pre-pregnancy body mass index (BMI) status.

4. Labor-delivery-birth

During the whole process of labor and childbirth, and the month immediately succeeding, women and their babies need a safe and welcoming space and competent personnel to attend to their needs.

5. First month of life

Sleep, nursing, and emotional fulfillment are required for proper bodily and mental development in the first month of a baby's life. Secure psychological attachment is a must to ensure the individual grows up to regulate their own emotions and actions.

Many new mothers also develop postpartum depression, and less frequently, new fathers. If not managed in time, this may cause the baby's withdrawal from the world around them, a difficult temperament, and abnormal behavior.

6. First year of life

Most deaths during the first year of life are due to congenital disabilities due to various factors. For other children, this is when they begin to talk and use their muscles for gross and fine movements.

7. Second year of life

Over the second year, babies typically begin to walk, participate in more situations, and move independently of their parents. They explore the world at this stage but should be supervised even while exposed to rich environmental and social stimulation.

Good food, safety precautions, clean air, water, and surroundings, and protection against abuse or distress are required throughout these years.

Potential interventions

1. Preconceptional and conceptional

Educating the public about the need for preconception health is a significant challenge, as it drives home the point that an individual's health may suffer from active preconception factors.

Indeed, miscarriage, infertility, congenital anomalies, growth restriction, and premature birth are more likely to occur with poor preconceptional health.

Maintaining a healthy weight, good physical activity, folic acid supplementation beginning preconceptionally, and avoiding iodine deficiency, are all essential measures to help prevent such adverse outcomes.

Parents intending pregnancy should also avoid addictive substances, alcoholic drinks, methylmercury-containing foods, smoking, and drugs. All medications should be reviewed.

If chronic diseases are present, including autoimmune disease, or if the woman has gynecologic pathology, their management should include planning for pregnancy and maintaining reasonable disease control while avoiding potentially fetotoxic therapies.

Vaccines against preventable diseases such as rubella, mumps, measles, hepatitis B, and varicella should be current. Parents must also receive counseling about preventing sexually transmitted infections (STIs), such as human immunodeficiency virus (HIV), syphilis, and chlamydia.

2. First trimester

In the first trimester, early antenatal assessment is a must to identify challenges and plan lifestyle changes and healthy behaviors. It is also an excellent time to pick up the mother's worries and anxieties regarding her state of life and to alleviate them.

Healthcare services should be introduced to the parents, grounding them in tests, joint problems, and how to manage them. Mental health surveillance is not to be forgotten, especially when there are high-risk factors such as unwanted or teenage pregnancy, relationship difficulties, or deprivation in the physical or emotional sense.

3. Second and third trimesters

Over the rest of pregnancy, maternal nutrition, weight gain, supplementation, and tests to ensure that the mother is healthy require careful attention. Birth coaching classes are recommended, and local regulations surrounding the event should be informed to the couple.

4. Labor, birth, and first month

During childbirth, beginning from labor and extending into postpartum, a specialist intervention must be available when required.

This includes operative delivery when necessary, help with establishing lactation, promoting bonding, and newborn screening for a spectrum of diseases, many of which would otherwise be missed until they result in impaired development.

5. First year

Exclusive breastfeeding for the first six months of life is the gold standard for promoting infant health worldwide. Identifying and treating depression in either parent should also be a priority of the healthcare worker to avoid adverse results of this condition in the infant, both directly and because of poor attachment.

Guidance on introducing solids, and promoting interactions with the child during the first year of life, are crucial interventions to help develop language and motor skills.

Teaching the child independence is also important, but this requires that the parents know what to expect at each stage of development to appreciate the gains made by the child.

Regular well-child check-ups must be maintained to ensure physical and psychological health and for immunization.

6. Second year

The second year may be the period in which neurodevelopmental disorders become identifiable, thus helping to treat and rehabilitate the child.

For all children, parents should be encouraged and educated to keep their surroundings child-safe, observe preventive rules against disease, provide safe but interactive environments where children are with other people, family or otherwise, and obtain help when required to provide food, medical care, or protection against violence or abuse of the child.

What are the conclusions?

Many countries now have outpatient clinics solely for mother-child assessments. Healthcare workers from all disciplines involved in caring for these dyads are available there, helping to promote health via immunization, a healthy lifestyle, and proper nutrition.

In the future, given the excellent goals and results achieved by the first 1,000-day clinics, this experience should be expanded … so as to reach the entire population, therefore reducing possible inequalities between different regions."

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.