Thinking Differently Together - First 1,000 Days Of Life

The epigenetics of pregnancy and impact of childbirth Teri explained that epigenetics is the study of how behaviours and environment can cause changes that affect the way our genes work. This means a person’s health during pregnancy can affect the future health of the child. Ideally everyone who is planning a baby would be ‘match fit’, ready in the best way for pregnancy and to give birth, but of course this is not always possible. External factors We know that in pregnancy the external environment impacts the internal environment. Maternal adversity, which includes deprivation, stressful events, anxiety and depression, and malnutrition, can cause biological changes that impact on the baby’s genes. Later in life, for some adults these changes may be displayed in neuro-behavioural outcomes such as anti-social behaviour, autism, schizophrenia, depression and anxiety. Smoking Smoking creates changes in the genes involved in placental and foetal development. In pregnancy in-utero exposure to nicotine disrupts placental cells, leading to placental abruption and difficulties in placental implantation in the uterus, which can lead to miscarriage. Smoking increases the risks of preterm birth, stillbirth and low birth weight, which as discussed above is a particular issue in our area given the high rates of smoking in pregnancy locally. In babies, nicotine exposure can lead to higher risk of Sudden Infant Death Syndrome, metabolic disorders, cardiovascular disorders and neurobehavioral disorders. Research also suggests smoking in pregnancy is linked to a 50% increased risk that the child may be overweight or obese. Obesity in pregnancy Obesity has strong links with social deprivation, and Black British and South Asian women have a significantly higher incidence of obesity. 52% Between 2017-19 of women who died in maternity were obese or overweight Source: MBRRACE-UK - Saving Lives, Improving Mothers’ Care 2021 In pregnancy, obesity is associated with an increased risk of miscarriage, gestational diabetes and pre-eclampsia. People who are obese are less likely to go into labour and so there is a higher likelihood of increased interventions such as induced labour or caesarean birth. There is also an increased risk of bleeding during or after birth. Research found that those who have experienced gestational diabetes in their first pregnancy have a 30% to 84% risk of it recurring in a later pregnancy. For babies, there is an increased risk of respiratory infections and metabolic disorders among babies born by caesarean section. Research in the USA also found 15.7% of children born by caesarean section were obese compared with 7% born vaginally. Birth interventions and long-term childhood illness We don’t all have a choice about how we give birth, but it is important to recognise that birth interventions can impact on long-term illnesses for the child. Researchers analysed linked population and health data of 491,590 healthy women and their Teri Gavin-Jones, Clinical Lead Midwife, Suffolk & North East Essex Local Maternity & Neonatal System 7 | Suffolk and North East Essex Integrated Care System