Women’s Health: Life course perspective on

Value, relationship “in first 1000 days”

Judith Stephenson

Professor of Sexual & Reproductive Health

UCLP Programme Director, Maternal Health

February 2016.

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Development Origins of

Health and Disease

DOHaD

Heckman et al Science 2006

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ABC project in USA: social experiment with long term follow-up.

“Early childhood investments substantially boost adult health.”

Disadvantaged children randomised to intense two–stage intervention:

Early intervention (starting 4 months) and school age (6-8 years).

Early intervention lasted 5 years: 8 hour day of cognitive and social stimulation

interspersed with care-giving and supervised play.

Nutritional component: two meals and a snack at child care centre.

By mid-30s, blood pressure 143mmHg (control) v. 126 with early intervention.

1 in 4 men had metabolic syndrome (control) v. 0 with early intervention

Small numbers: 57 intervention, 54 controls.

Campbell et al Science 2014

Peri-conceptional effects on fetal programming and disease

Fleming et al. Animal Reproduction Science 2012

Pre-pregnancy diet permanently influences baby's DNA

Dominguez-Salas et al Nature 2014

Start at the very

beginning….a very

good place to start

Distribution of LMUP scores in UK validation

study (Barrett et al 2004)

Distribution of Pregnancy Planning Scores in the UK and Malawi

Barrett G. Why do women invest in pre-pregnancy health and

care? BMC Pregnancy and Childbirth 2015

‘ I don’t know, you just assume that you just

get pregnant and then you go to your GP and

everything falls in place from there.

I didn’t know that there were things that you

should be doing before becoming pregnant.

You don’t really plan it….. although I was

planning it.’

Mother aged 30

M-health interventions to improve preconception nutrition

Awareness of pre-pregnancy

health and care is low

Young women seek

information online

Interactive m-health support

can be useful

1:1 support through ‘healthy

conversation skills’ training?

‘Start at the Beginning’

Improving maternal nutritional status pre-pregnancy

Intensive pre-conception weight management for obese

women planning a pregnancy.

Population: Women in community clinics requesting IUCD removal for pregnancy

Intervention: 24 weeks, low energy liquid diet (8 weeks) then food, + CBT ‘light’

Feasibility Outcomes: uptake, compliance, weight loss

Improving maternal nutritional status pre-pregnancy

In DPP, 5-7% weight loss led to 58% reduction in diabetes; in Swedish cohort 50% fall in neonatal deaths

54% started diet and 43% completed

Average weight loss 7kg.

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‘Value’ from breast feeding

Less infectious disease

Higher intelligence

Possibly less diabetes and obesity

Less breast cancer

Better birth spacing

Possibly less diabetes and

Ovarian cancer

Scaling up could prevent:

823,000 deaths under 5 and

20,000 deaths from breast cancer

Not breastfeeding costs:

$300 billion per year from lower

intelligence and economic losses

Support mothers to secure future public health

Pregnancy planning, good

maternity care and breast

feeding have early and

long term health and

economic benefits

Key part of a broader life

course model for better

women and child health

Barker et al Nature 2013

UK NHS five year forward view:

“radical upgrade in prevention and public health”

by ‘Value’ of investment in first 1000 days?

UCL/H: Dilisha Patel, Jennifer Hall, Paul Hardiman, Lisa

Breckenbridge,

Nick Finer, Rachel Batterham,

Brunel University: Geraldine Barrett

Surrey University: Jill Shawe

UEL: Angela Harden, Susanna Rance

Southampton: Mary Barker, Mark Hanson.

Erasmus University: Regine Steegers-Theunissen

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Thanks to:

Pregnancy prevention and planning under one reproductive health umbrella al

framework: ‘Pregnancy Planning and Prevention’ P3

Hall et al 2015

Bangladesh

NYC

Cuba

UK NHS five year

forward view:

Lessons for Value from international experience

‘radical upgrade

in prevention and

public health?