Part 3 – The Research Base

The Evidence is now Compelling

After more than four decades of transformational research in neuroscience, molecular biology, epigenetics and genomics, along with parallel advances in the behavioural and social sciences, the time has come for a coordinated effort among policy makers, basic scientists, paediatric and primary care clinicians, social care and child development professionals to develop more effective strategies for addressing the origins of country, social class, racial, and ethnic disparities in health and development. The evidence from many countries is now compelling, as per the following quotes from several studies (sources below):

Brain development and its impact on future generations

  • During pregnancy and to age 18 months, it has been calculated that connections in the brain are created at a rate of 50,000 per hour! The earliest experiences shape a baby’s brain development, and have a lifelong impact on that baby’s mental and emotional health.1
  • Advances in neuroscience, molecular biology, epigenetics and genomics have concluded that early experiences are built into our bodies. Significant adversity during pregnancy can produce physiologic disruptions or biological memories that undermine the development of the body’s stress response systems and affect the developing brain, cardiovascular system, immune system, and metabolic regulatory controls. These physiologic disruptions can persist far into adulthood and lead to lifelong impairments in both physical and mental health.2
  • 25% of infants of depressed mothers were born prematurely compared to 7 % of non-depressed mothers. Thirty four percent of infants of depressed mothers were low birth weight compared to 14 percent of non-depressed mothers. Higher maternal depression during pregnancy results in elevated cortisol and norepinephrine levels, prematurity, and low birth weight.3
  • Everything that the mother experiences, eats, drinks, or inhales is passed to her unborn child through the umbilical circulation in the same way her hormones are passed. A study at 32 weeks’ gestation demonstrated a strong correlation between plasma levels of the stress hormone cortisol in the mother and in the fetus. Large concentrations of cortisol can lead in the brain to cell migration to the wrong destination resulting in the formation of faulty circuits and destruction of neurons and synapses. When this occurs in the amygdala and hippocampus it will interfere with memory, and when it occurs in the hypothalamic and reticular activating system it will interfere with internal states such as sleep and digestion and Inhibition of dendritic branching.4

Conditions during early childhood have lifelong health implications

  • Advances across the biological, behavioural, and social sciences support clear and powerful messages for leaders who are searching for more effective ways to improve the health of the nation. The foundations of health are formed in the prenatal and early childhood periods.
  • Significant reductions in chronic disease could be achieved across the life course by decreasing the number and severity of adverse experiences that threaten the wellbeing of young children and by strengthening the protective relationships that help mitigate the harmful effects of toxic stress.5
  • A vital and productive society with a prosperous and sustainable future is built on a foundation of healthy child development. Health in the earliest years—beginning with the future mother’s well-being before she becomes pregnant—lays the groundwork for a lifetime of the physical and mental vitality that is necessary for a strong workforce and responsible participation in community life.6
  • A recent prospective analysis of comprehensive preconception care found that every for every $1 spent on preconception care, $1.60 is saved in maternal and fetal care costs. Other studies have shown that preconception care can save as much as $5.19 for every $1 invested. Cost-savings mainly result from the reduced rate of neonatal intensive care unit hospitalisations among infants born to mothers who received preconception care.7
  • Taken together, perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK. This is equivalent to a cost of just under £10,000 for every single birth in the country. The cost to the public sector of perinatal mental health problems is 5 times the cost of improving services.8

A child that is not ready for pre-school could fall behind and be unlikely to complete their education

  • New scientific research (epigenetics) shows that environmental influences can actually affect whether and how genes are expressed. Thus, the old ideas that genes are “set in stone” or that they alone determine development have been disproven. In fact, scientists have discovered that very early experiences can determine how genes are turned on and off and even whether some are expressed at all. Therefore, the experiences children have early in life—in the womb, and the environments in which they have them—shape their developing brain architecture and strongly affect whether they grow up to be healthy, productive members of society. This growing scientific evidence supports the need for society to re-examine the way it thinks about the circumstances and experiences to which young children are exposed. Early prenatal or postnatal experiences and exposures influence long-term outcomes by chemically altering the structure of genes.9
  • A critical time to shape productivity is from birth to age five, when the brain develops rapidly to build the foundation of cognitive and character skills necessary for success in school, health, career and life. Early childhood education fosters cognitive skills along with attentiveness, motivation, self-control and sociability—the character skills that turn knowledge into know-how and people into productive citizens.10
  • The highest rate of return in early childhood development comes from investing as early as possible, from pregnancy, birth through age five, in disadvantaged families as well as for all mothers because pregnant mothers are ‘vulnerable’. Starting at age three or four is too late.11
  • Analysis during a Chicago Child–Parent Center study estimated $48,000 in benefits to the public per child from a half-day public preschool for at-risk children. Participants at age 20 were estimated to be more likely to have finished high school—and were less likely to have been held back, need remedial help or have been arrested. The estimated return on investment was $7 for every dollar invested.12
  • Data show that one of the most effective strategies for economic growth is investing in the developmental growth of at-risk young children. Short-term costs are more than offset by the immediate and long-term benefits through reduction in the need for special education and remediation, better health outcomes, reduced need for social services, lower criminal justice costs and increased self-sufficiency and productivity among families.13

Anti-social behaviour has a very high cost to society and has its roots in early childhood

  • The groundwork for good citizenship occurs during pregnancy and the first years of life. A society which delivers this for its children creates a strong foundation for almost every aspect of its future. A society which fails to deliver it generates enormous problems for the future in terms of social disruption, inequality, mental and physical health problems, and cost. At its starkest, preventing these adverse childhood experiences could reduce hard drug use by 59%, incarceration by 53%, violence by 51% and unplanned teen pregnancies by 38%.14
  • 80% of women referred to a community psychiatric service with mood disorders had been maltreated in childhood. The strongest predictor of this maltreatment was previous maltreatment to the parent and was in turn a very strong indicator of poor outcomes right up to adulthood. This suggests an inter-generational cycle.15
  • Evidence show that up to 22% of the variance in several behavioural problems is linked with prenatal anxiety, stress, or depression. Mothers in the top 15% for symptoms of antenatal anxiety have a doubled risk for ADHD in their child at age 7. Women who were depressed while they were pregnant were four times as likely to have children who were violent by the age of 16 than the control group of mothers.16
  • Research has demonstrated recurring cycles of violence, abuse, disadvantage and dysfunction, which run from generation to generation. Multiple studies have identified the factors which can cause these cycles to persist – as well as to break them. Protective factors – such as being loved or cared for by someone empathetic, or family support – can help people to break free of these cycles.17
  • By improving cognitive and socio-emotional development, investments in early childhood education may reduce involvement with the criminal justice system. Lower crime translates into benefits to society in the form of lowered costs of the criminal justice system and incarceration, as well as reductions in victimisation costs.18

Mother-friendly Childbirth practices

  • Prematurity is a major cause of newborn death and disability globally. Each year, preterm complications account for over 1 million deaths, or 35% of all neonatal mortality. Kangaroo Mother Care (KMC), including continuous skin-to-skin contact has been proven to reduce newborn mortality, but only a very small proportion of newborns who could benefit from KMC receive it. Accelerating the adoption of KMC could avert up to 450 000 preterm deaths each year by 2015 if near-universal coverage is achieved.
  • Decades of neglect of the role of midwives, either because of the over-medicalization of pregnancy care or a lack of resources, has left a legacy of high rates of maternal and newborn mortality in developing countries. While these rates have fallen in recent years, more progress must be made in Asia and sub-Saharan Africa, where fewer than 50% of all births are assisted by a skilled birth attendant.19
  • The birth doula, has been the subject of over 23 studies from 16 countries and more than 15,000 women in a variety of settings. The statistical data supporting birth doula care is stunning. Women who have (doula) labour support are 28% less likely to have a caesarean section, 31% less likely to have medical augmentation to speed up their labour, 9% less likely to use any pain medication and 34% less likely to rate their childbirth experience negatively.20
  • ‘Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Exclusive breastfeeding goes a long way toward cancelling out the health difference between being born into poverty and being born into affluence.’21

References:

1 – The 1001 Critical Days Report, 1001 Critical Days, UK Cross-Party Children’s Initiative, 2013

2 – Excessive stress disrupts the architecture of the developing brainCenter on the Developing Child, Jack P. Shonkoff, M.D., Chair of the Center on the Developing Child, Harvard University, 2014.

3 –The impact of stress in pregnancy Professor Vivette Glover, MA, PhD, DSc – Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom, 2015.

4 – Prenatal depression effects on the fetus and the newborn, Field et al. Infant Behavior & Development 27, 2004. 

5 – The Lifelong Effects of Early Childhood Adversity and Toxic Stress, The American Academy of Pediatrics, Jack P. Shonkoff, Andrew S. Garner, 2012.

6 – The Foundations of Lifelong Health, Center on the Developing Child at Harvard University, 2010.

7 – Healthy Pregnancy and Healthy Children: Opportunities and Challenges for Employers – The Business Case for Promoting Healthy Pregnancy – National Business Group on Health, USA. 2013

8 – The costs of perinatal mental health problems, Report Summary. London School of Economics, 2014.

9 – Early Experiences Can Alter Gene Expression and Affect Long-Term Development, Center on the Developing Child at Harvard University Jack P. Shonkoff, 2010
The Pre- and Perinatal Origins of Childhood and Adult Diseases and Personality Disorders Thomas R. Verny 2012

10The Heckman Equation, Invest in early childhood development, 2013.

11 The Economics of Early Childhood Investments – Office of the President of the United States, Council of Economic Advisers, Gov. of USA. 2015

12 – The Heckman Equation, Invest in early childhood development.
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13 – The Heckman Equation, Invest in early childhood development.

14 – Building Great Britons Report, Wave Trust, 2015

15 – Building Great Britons Report, Dr Alain Gregoire, Psychiatrist, Chair of the Maternal Mental Health Alliance, 2015

16 – Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child, A Review.  Bea R.H. Van den Bergh, Eduard J.H. Mulder, Maarten Mennes, Vivette Glover, 2005.

17 – Building Great Britons Report, Dr Susan Pawlby, Institute of Psychiatry, Kings College, London. Antenatal depression and offspring psychopathology: the influence of childhood maltreatment’ British Journal of Psychiatry, 2015.

18 – The Economics of Early Childhood Investments  Office of the President of the United States, 2015

19 – More midwives needed to improve maternal and newborn survival, Bulletin of the World Health Organization, 2013

20 – Continuous support for women during childbirth. Hodnett, E. D., S. Gates, et al. US National Library of Health, Cochrane database of systematic reviews: CD003766, 2012.

21 – Global strategy for infant and young child feeding, World Health Organisation, Maternal, newborn, child and adolescent health, 2003

22 – Consensus on kangaroo mother care accelerationThe Lancet, 2013
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