Low Birthweight – A Global Emergency

Prof Michael Crawford Preterm birth research
Professor Michael Crawford

Low birth weight is an issue at the very heart of our health as  species.

I have just returned from a working trip to Hyderabad, Pakistan. I was speaking at the 22nd National Psychiatric Conference, titled “Promotion of Mental Health-Building Partnerships”. The people I met over there were wonderful; but the country is undergoing a real problem with mental health.

Along with Professor Mohamed Iqbal Afridi of Jinna Sindh Medical University, and Dr. Afzal Javed of Coventry and Warwickshire NHS and Warwick University, in my address to the conference I emphasized that prevention is better than cure. This adage is true for the bulk of mental ill-health, much of which we can attribute to disorder of prenatal brain development.

32% of children in Pakistan are born at low birthweight, many of them premature – born before the brain has finished its prenatal development. This high percentage of low birthweights has a radical impact on the health of the population. It results in children and then adults with limited abilities, the consequences being poor job opportunities, poor social skills, and anti-social behaviour. The extremes of this are violence, suicide and murder.

A Global Crisis

The problem is by no means limited to Pakistan – this is a worldwide phenomenon and a global tragedy. The USA and UK carry their share of the burden. In fact the UK has the highest incidence of low birthweight of all western European countries.

Some of the consequences have labels, such as learning disabilities, ADHD, epilepsy, autism and cerebral palsy, all of which are more prevalent at low birthweight and prematurity.

The problem is expressed starkly in the rise in mental health costs – now the foremost burden of ill health in many countries. In 2007 it cost the UK £77 billion; in 2013 it cost £113 billion – greater than heart disease and cancer combined. Simon House, one of our trustees has estimated the true cost to be nearly double that, as the assessment did not include violent behaviour.

I predicted this way back in 1972, in the book What We Eat Today. In reviewing it, Graham Rose wrote in the Sunday Times that unless action is taken “we will become a race of morons”.

Professor Stephen Hawking recently said that we will need to leave the planet by 2117, as we have reached the limit of Earth’s resources. And he reached that conclusion without reference to the mental health issue, the addition of which paints a very gloomy picture indeed. The continued escalation of mental ill-health makes Homo sapiens unsustainable.

brain-specific fatty acids
Photo credit: A Health Blog via Visual Hunt / CC BY SA

One of the main problems is that the brain has been taken for granted, and the evidence of the vital part played by omega-3 DHA essential fatty acid in brain structure and development has been largely ignored. There has also been a stigma about mental ill-health, which has prevented the problem being addressed properly.

Research and food policy, meanwhile, has been focused on protein, not essential brain nutrients – even though human milk has the least amount of protein of any large mammal. It is, however, rich in the essential fats needed for completing brain development after birth the brain being 60% fat).

The physiology speak for itself. Protein is for body growth, (hence its importance in the field of animal nutrition where people want cows, pigs, sheep and poultry to grow fast), and essential fats are for brain growth.

Mother and Child Foundation Research

The research sponsored by the Mother and Child Foundation has defined poor maternal nutrition as a risk factor for low birthweight and its attendant mental health problems. This is independent of socio-economic status, ethnicity and smoking. This conclusion was confirmed when a randomised clinical trial of a micro-nutrition supplements during pregnancy reduced the proportion of babies born small for gestational age 2.3 fold.

We have now conducted a randomized trial at the Chelsea and Westminster Campus of Imperial College involving a supplement of brain-specific fats. Our research shows that the nutritional condition of the mother in the months before conception is the primary factor in deciding the success or failure in achieving a full term baby. We have discovered a biomarker which predicts preterm delivery with a better than 90% confidence level.

Taking the supplement during pregnancy also had a detectable effect on the brain development – in boys but not girls. Boys are more susceptible to deficiency of essential fats, even prenatally, and therefore more likely to suffer if deprived of them. Boys are generally larger than girls too, and therefore the brain has a higher requirement for sensors throughout the greater surface areas of their bodies.

Preterm delivery means the baby is born before the completion of prenatal brain development. It is well known that any distortion or incompleteness of brain development before birth has lifelong consequences. Moreover these are difficult if not impossible to correct later in life.

Our research evidence calls for a new initiative in prevention. It would be impossible to over-emphasize the supreme importance of maternal nutrition before conception. If we do not act, and mental ill-health continues to escalate, then our children and theirs face a bleak future.

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