Highlighting the importance of the mother
To better understand the specific needs of the mother, we raised over £6 million to support research on maternal nutrition in China, South Korea, the Sudan, and Thailand/Vietnam. This work has been going on since 1990 and has provided us with a perspective on poor maternal nutrition in the challenge of poverty and the rise in mental ill-health, especially in children.
We hope we can raise further funding to put into practice what we have already learnt. Our trustees wish to develop and apply the principles of the Foundation to poverty and adverse pregnancy outcomes for both the mother and the child.
Josette Sheeran, when CEO of the United Nations World Food Programme (WFP), said in her report to the Board in 2010: “We know now that if children under two do not receive sufficient nutrition they will be sentenced to a lifetime of mental and physical limitations”.
This was the first time the significance of the brain had been acknowledged at this level of political management, and was a very welcome statement. But while she was correct, the most important consideration is the nutrition and health of the mother, as the brain is formed before birth.
Iodine deficiency is the best known cause of mental retardation. Iodine is rich in the marine food web. Hence it exists with other brain foods, notably DHA. Two billion people are at risk of iodine deficiency today. If an individual is deficient in iodine they are also likely to be deficient in DHA. Deficiencies of both impact neurodevelopment and brain function.
The conventional approach to restorative feeding of malnourished women and children does not include the essentials vital for the security of the brain. Having drawn to the attention of the World Food Programme the importance of maternal nutrition and health, as well as to the need for brain-specific fats to secure the future of the child, we all recognise that there is a great deal of work to be done to address this gap.
Helping to prevent disability in the newborn child: cerebral palsy and allied disorders
The cost of an intervention trial to test the prevention of cerebral palsy and allied disorders is about £4 million. That is the cost awarded by the judicial courts for just one case of severe disability.
Common neurodevelopmental disorders include cerebral palsy, epilepsy, autism spectrum disorders, Attention Deficit Hyperactivity Disorder (ADHD), epilepsy, motor, visual and auditory disorders, learning disabilities and behavioural pathologies.
In the UK and US, severe central nervous system disorder such as cerebral palsy occurs in about 2 per 1000 live births. However, the proportion rises as birth weight falls below 2,500g. Below 1,500g you might expect 200 per 1,000 to be born with a severe brain disorder.
There are approximately the same number of babies born with cerebral palsy at normal birth weights as in the low birth weight/preterm group. The point here is that the women are not immune entirely to the nutritional conditions which give rise to a heart attack or stroke. There are different principles responsible for body growth (protein) compared to brain growth (DHA and trace elements). Cerebral palsy is effectively a stroke in the developing brain before birth. There can be bleeding in the brain through a rupture of a blood vessel and/or a failure of blood flow – called ischemia – which can kill a part of the brain or damage the connections irrevocably.
It was previously thought that cerebral palsy occurred due to obstetric mishap. For example, if someone dropped the baby on the floor head first or deprived it of oxygen. However, work initiated by our sister organisation The Little Foundation, under the pediatrician Dr. Martin Bax, who was at Chelsea and Westminster Hospital at the time, found this not to be the case. Martin gathered a group of European neurologists armed with Magnetic Resonance Imaging (MRI) facilities to study the brains of children with cerebral palsy. In so doing they were able to define when the lesion occurred. As they were all well before the time of birth, it meant they could not in the majority of cases have been due to obstetric mishap. Indeed, others such as Professor Paul Polani had studied cerebral palsy for many years looking for a genetic cause and found none. Martin and his colleagues were able to say that the cause had to be due to nutrition and/or infection.
However, cerebral palsy is the tip of an iceberg of other developmental disorders, and even though there is a greater prevalence in the lower socio-economic and poor groups, these disorders are common to all.
Recognising a global problem
The increasing cost of brain disorders in the EU was estimated at €396 billion in 2004. When reevaluated in 2010 it was €789 billion. Having drawn attention to the UK Government, a cost assessment of the EU burden was carried out by Dr Jo Nurse of the Department of Health in 2007, which came out at £77 billion. In 2013 the cost to the UK was £113 billion. The cost in the USA is likely to be close to $1 trillion.
Moreover, the crisis is spreading. The Global Forum for Health estimated that by 2020 the top three burdens of ill-health worldwide would be heart disease, perinatal conditions (adverse pregnancy outcomes) and mental ill-health. All three of these conditions have common ground in poor nutrition, maternal health and the current food production system which operates in favour of mass food production and profit.
We first needed to understand the reason for the existence of neurodevelopmental disorders. The results of our work and a successful double blind clinical trial leaves little doubt about the pivotal importance of maternal nutrition before and around the time of conception. Nature does not leave important actions to the last minute – she prepares in advance.
With the new knowledge we have gained in nutrition and on the specific lipid requirements of the brain, the Foundation is poised to make a major breakthrough in public health and specifically in the prevention of adverse pregnancy outcomes, which include the costly neurodevelopmental disorders and their effects on maternal wellbeing and health.
This is what we will do to address these issues
- Interact with the stakeholders who support the community with regard to what is already known on behalf of maternal health and nutrition, in order to protect mothers and enhance the heath and ability of their unborn children.
- Create a World Charter for Motherhood.
- Organise a major conference on the global crisis in nutrition in 2017/2018.
- Develop action programmes on the prevention of cerebral palsy and autism, and on maternal wellbeing and mental health, to prevent adverse outcomes at home and abroad.
- Address the rise in mental ill-health, which is seen as the most urgent priority in the health-societal sectors.
- Raise funds for research in the cause and prevention of neurodevelopmental brain disorders, mental ill-health and its implications for food security.
- Further implement research programmes in Sudan, China and Nepal.
- Form collaborations in the UK with NHS teaching hospitals and Imperial College London.
- Continue work in neurodevelopmental disorders in children, using sensitive and spatially precise techniques such as magnetic resonance imaging.
- Foster supportive community action, and undertake research on prevention and treatment of disorders, which affect mothers and their children.
- Make cerebral palsy and other developmental disorders of the brain, which include mental ill-health, things of the past.