Work supported by the Foundation has pinpointed the importance of maternal health and nutrition, both before and during pregnancy. Our latest research suggests that the outcome of pregnancy is mainly decided before conception.
This does not mean that good health and nutrition has no impact during pregnancy, of course. What it does mean is that the principal biological decisions regarding pregnancy outcome – e.g. whether the baby is born too early, too small or in bouncing health – is all down to maternal health and nutrition in the months leading to conception. Indeed, it also suggests that the health and nutrition of the adolescent girl during puberty when her reproductive system is developing may also be of significance. This evidence makes common sense and has great public health implications.
Low birth-weight and maternal nutrition in East London
The Mother and Child Foundation research has made significant progress in understanding the cause of brain damage and chronic ill-health in low birth weight infants. Studies by Wendy Doyle in East London demonstrated that:
- Maternal nutrition independent of smoking, social class and ethnicity was directly associated with low birth weight for 43 micronutrients which tracked with birth weight up to but not above 3,270g.
- The majority of women who had a low birth weight baby would enter their next pregnancy with blood levels of specific nutrients below safe levels. This explains the high risk of a second low birth weight baby.
- That micronutrient supplementation during pregnancy enhanced maternal and neonatal status for the essential omega-3 fats needed for infant brain development.
- A randomised controlled trial of micronutrient supplement designed for the needs of pregnancy resulted in a 2.3 fold reduction in the babies born small for gestational age (Louise Brough et al., 2010).
Funding is now needed for a clinical trial of the essential fatty acids with and without micronutrients. Intervention is required for:
- Women who have had a low birth weight baby before the next conception, as they are thought to have a high (1 in 3) risk of a further low birth weight or preterm birth.
- Babies born very preterm, to replace the essential fats that would have been delivered by the placenta. This is presently not being done, and yet it is the time of greatest demand for essential fats required for the final brain growth thrust.
- A reduction in the number of low birth weight babies, better health and school performance and ultimately employment prospects and harmony.
- Less brain-damaged children.
- Potential applications to prevent behavioural disorders such as ADHD, autism and childhood epilepsy. There is also a possibility of long term beneficial impacts on diabetes, heart disease, stroke and Alzheimer’s disease.
HIV in pregnancy
Trish Moodley (Archbishop Desmond Tutu Fellow), with Professor Ovrang Djahanbakhch at Newham General Hospital, made the surprising discovery that one third of all lipids in the membranes responsible for immune cell interactions, at birth, is arachidonic acid (AA). This is surprising because much research is being done to down-regulate arachidonic acid because it stimulates immune cell activity.
This approach may be flawed. Certain COX2 inhibitor drugs, designed to down regulate inflammation, have now been blamed for many deaths. It seems the intention of nature is the opposite, i.e. a robust immune function at birth. However, babies born at less than 30 weeks preterm have less than half the AA and their immune function is poor. Treating immune cells with AA improved function. Where the mother is infected with HIV, the new born infant’s immune cells are similar to those of the very preterm infant in composition and function.
Conclusion and future work
The immune system is seriously compromised in those born very preterm or from a mother with an HIV infection. This new data offers the possibility of rescuing the immune system and helping to protect the mother and newborn where HIV infection is involved. This suggestion does not replace the need for anti-viral drugs, but could act synergistically. as seen in other situations.
Expected outcome and aims
- Improved maternal immune health with better ability to cope with HIV and opportunist infections.
- Improved maternal longevity and a reduction in the number of orphans, especially in South Africa and developing countries.
- Protection of the fetal brain from cognitive and emotional impairments, resulting in enhanced health and learning abilities in the child.
Diabetes in pregnancy and prenatal programming of vascular disease
Professor Lucilla Poston at the Fetal Research Unit of St Thomas’s Hospital discovered vascular dysfunction in small arteries obtained at caesarean section from pregnant women who had developed gestational diabetes. She replicated the vascular abnormality in pregnant rats simply fed a high-fat diet with or without diabetes. Blood vessel dysfunction then was found in the newborn. Dr. Dimitrios Bitsanis of the London Metropolitan University’s Institute of Brain Chemistry found the membrane lipids of the arteries of the affected animals were depleted of essential fatty acids simply by the high-fat diet of the mothers. The vascular dysfunction and membrane abnormalities persisted into adulthood despite normal diets being followed. Drs. Yoeju Min and Beverly Thomas discovered similar membrane abnormalities in the red cell plasma membranes of women with type1, II and gestational diabetes.
Insulin resistance and vascular dysfunction is associated with perturbations of cell membrane composition. This diet-induced abnormality influences the developing fetus and child permanently through genetic programming.
Expected outcome and aims
The research group led by Professor Kebreab Ghebremeskel at London Metropolitan University won a €1.3 million EU grant to investigate the possibility that a membrane defect causes insulin resistance, and that correction of the defect will protect the fetus and newborn child from restriction of brain development and risk of developing insulin resistance, vascular disease and diabetes.
70 million people affected in Bangladesh by arsenic poisoning from drinking water
With good intentions, millions of dollars were spent by international aid agencies to dig tube wells for clean drinking water, to prevent water-borne diseases. The National Environmental Research Council in the UK gave the wells a clean bill of health but did not check the water for heavy metals.
A few years after the wells were dug, sporadic cases of skin disfigurements, ulceration and cancers turned into an epidemic. It was then discovered that the tube well water contained arsenic, affecting 70 million people. Strenuous efforts have been made to dig even deeper wells which might be safe; some are, but they are expensive.
It can be said that while South Africa sits on gold, Bangladesh sits on arsenic. Seventy million people in Bangladesh are at risk of arsenic poisoning. With good intentions the World Bank and Water Aid agencies dug tube wells to provide clean water, but did not check for heavy metals. The arsenic causes skin to become discoloured and then develop ulcers, which become cancerous. An examination of the arsenic content of maternal and fetal-cord blood at birth showed that arsenic was being transferred to the unborn child from its mother. Educational projects to show people how to harvest rainwater are urgently needed.
Jay Rahman from Bangladesh has been documenting the levels of arsenic in the original and the new tube wells, and measured arsenic in the blood of pregnant women and their babies at the time of birth. The measurements revealed that the arsenic is not only in the blood of pregnant women but is also transferred to the fetus.
Fetal health in Bangladesh is exposed to unsafe levels of arsenic.
Bangladesh is facing a time bomb as the children poisoned in utero grow. Urgent attention is needed to target families, safely, harvest rainwater and take nutritional steps to counteract the arsenic already in their bodies.
Changing diet in China
Collaboration with Professor Junshi Chen of the Chinese Health Protection Agency has demonstrated the importance of traditional fish from the coast and aquaculture for good health. Analysis of the lipid markers of heart disease from 65 Counties in China showed that there was an inverse relationship with red cell membrane DHA, antioxidant enzymes, and the trace elements on which they depend, with death from heart disease and almost all other chronic diseases.
The export to China from the EU of subsidised European foods rich in saturated fats, sugar and salt, as seen above, are undermining traditional foods and health.
These studies covered 65,000 people and provide robust evidence for the health benefits of seafood and aquaculture.
It is essential to study the changing diets in the cities in relation to the increase in colon cancer, heart disease and other chronic illnesses of western society. Because of the importance of marine fats for brain development and cognition, newborn children in the cities should be studied. Knowledge on what we already know should be put into action to prevent the further degradation of health.
Hope for sickle-cell anaemia sufferers
Sickle cell disease is the world’s most common hereditary blood ailment. Little research has been done on this disease, even though it affects millions of people worldwide. It is a major public health problem in Africa and many other countries. In Nigeria alone, there are about four million sufferers. Over 10,000 babies are born with the disease every year. In the United Kingdom there are approximately 10,000 sufferers and 200 babies born with the condition annually. Sickle cell anaemia results in painful crises with devastating effects, including degenerative pathology of cardio- and neuro-vascular systems, hepatobiliary and other vital organs. It causes serious brain injury and strokes. It is also associated with fetal and neonatal growth restriction and cognitive impairments. In chronic cases, it can lead to blindness, mental deterioration, birth defects and death.
Preliminary studies by Professor Ghebremeskel and Hongmei Ren with Dr. Iheanyi Okpala at St Thomas’s Hospital are meticulously examining not just the sickling of the red cell, but the generation of molecules causing blood elements to stick to the blood vessel walls, so blocking the circulation at the specific site.
It should be possible to relieve suffering by down regulating the adhesion molecules with a special combination of omega-6 and omega-3 fatty acids.
A randomised clinical trial resulted in a 60% reduction in veno-occlusive events. These are the cause of the painful crises. However, when they occur in the brain the local cessation of blood flow causes what is in effect a small stroke. In sickle cell disease the children suffer from many of these repeatedly, which stunts brain development and reduces their IQ and cognitive function.
Burmese refugees in Thailand
Our studies on delayed visual maturation of babies born in the refugee camps of Thailand show a need for special nutritional support for young women and mothers in refugee situations. This support should overcome the emotional and nutritional risk that is responsible for the increased maternal and infant mortality seen in refugees.
Dr. Lily Dubowitz of Imperial College, jointly funded with the Wellcome Trust, discovered delayed maturation of the visual system of children born in the camps in Thailand. In collaboration with several research groups, the work revealed no evidence of malnutrition of the mother or of nutrient defects in the milk of Burmese mothers.