The First Thousand Days
Links between a mother’s health through pregnancy and the health of her baby are well established. Through the Baby1000 program, Professor Adrienne Gordon and her team are pioneering work to discover the early interventions that will improve health for the next generation.
As Professor Adrienne Gordon completed her training as a neonatologist, first in her native Scotland then later in her adopted homeland, Australia, she reached a clear conclusion. The factors that led to the best overall health and survival rates for newborn babies were all those that affected the mother before birth. As Professor Gordon puts it from her home in Sydney, “A healthy pregnancy is the best gift that we can give to an unborn baby.”
In her early days working in a hospital in Glasgow, she saw first-hand how the effects of social disadvantage and the mother’s lifestyle would affect the health of babies, not just as children but throughout their life. Now a senior staff specialist neonatologist in the RPA centre for newborn care and Clinical Professor in obstetrics, gynaecology and neonatology at the University of Sydney’s Central Clinical School, this realisation drew Professor Gordon to the emerging Baby1000 project in early 2015.
Housed at the Charles Perkins Centre (CPC), the Baby1000 program aims to track the progress of babies during their first 1000 days and to identify risks and subsequent interventions to improve future health. Significantly, the groundbreaking Baby1000 program begins its tracking before conception, making it a rarity amongst international studies into pregnancy and neonatal health.
Extensive research using new technologies has shown that a child’s genetic programming from factors such as whether the mother smokes, obesity, nutrition, stress, lifestyle and environment, can be conditioned during or even before pregnancy and can have subsequent health outcomes later in life.
Despite the well-known existence of these connections, a deeper understanding of why and how they occur is yet to be developed. As a result, clarity around which interventions might be effective in improving the health of parents and their babies is still lacking.
Professor Gordon is hopeful that the ambitious Baby1000 program can change this by harnessing the cross- disciplinary expertise within the team at the CPC, along with the study’s emphasis on producing research that can be easily integrated into clinical practice. This perfectly complements Professor Gordon’s passion for bringing the sometimes-distant worlds of public health research and clinical practice closer together.
There are lots of amazing scientists who do incredible work but don’t know how to implement it because they don’t interact with clinicians, and vice versa. Clinical training can be quite siloed. You are encouraged to specialise in one demographic. In reality, public health is not like that – it is about trying to put interventions where there is most benefit.
Professor Gordon aims to treat the mother and baby in tandem and believes this approach has improved both her clinical practice and her research.
One fascinating intervention that the team is currently trialling is to see whether a custom-designed pillow will allow women to sleep more comfortably on their side, rather than on their back, which has a proven association with stillbirth in late pregnancy. Recruitment for a trial providing pregnant women with a side-sleeping pillow is underway, with monitoring of the 400 participants’ sleeping positions due to be conducted via a small wearable device.
The pillowcase is designed to be stuffed with standard pillows or even the mother’s own clothes, reducing production costs and making it an affordable option for women in low to middle-income countries in future.
Meanwhile, in the lab, technological innovation is proving useful. Resembling a small space capsule, a device known as the ‘BodPod’ is a cutting-edge instrument for the measurement of body fat through air displacement. A smaller version, charmingly named the ‘PeaPod’, is used for babies and small children. This technology has been vital to ongoing research into the relationship between maternal weight before conception and newborn health.
Baby1000 also takes advantage of the NSW Health Statewide Biobank, a world-class facility that uses highly sophisticated technology to store and process samples of human tissue, blood, DNA and cells in temperature-controlled systems. The quality of this storage means that the samples gathered during Baby1000 can be preserved and shared with other research projects in future.
The data gathered from the bio-samples includes cortisol analysis of saliva samples to measure maternal stress levels, and analysis of dietary and gut microbiome data, aiming to identify the links between nutrition and gut health in mothers and infants.
The BodPod measures body fat through air displacement. A smaller version, the PeaPod, is used for babies.
The project would not have been possible without the incredible generosity of the late Dr Lynn Joseph, whose contribution towards Baby1000 has been crucial. Dr Joseph, an alumnus of the University of Sydney, developed a passion for maternal and infant health whilst working as a general practitioner (GP) in Maroubra, Sydney, in a period when it was common for GPs to deliver babies. Dr Joseph was such a mainstay at his practice that he eventually came to deliver the babies of babies he had delivered many years before.
The bequest was made in the name of Dr Joseph and his three brothers, Maurice, Neil and Douglas, all of whom graduated from medicine at the University of Sydney and went on to have distinguished careers. The gift leaves a wonderful legacy for the brothers, befitting the family’s extensive involvement in medicine.
The funding from the Joseph family has been amazing,” reflects Professor Gordon. “We simply wouldn’t have been able to do our work without it.
The Baby1000 program continues to make progress, with significant project milestones on the horizon. Children recruited to the program have begun to reach 24 months of age, the endpoint of the first 1000 days.
“It’s inspiring collaborating with talented doctors and scientists,” says Gordon. “We are all working to ensure the best lifelong health outcomes for the next generation. The earlier we can make these preventative interventions, the better.”
Thanks to the generosity of donors like the Joseph family, life-changing research is possible. To make an enquiry about leaving a gift in your will to the University of Sydney, please contact Moira Saunders.
Phone: +61 2 9002 7455
Email: moira.saunders@sydney.edu.au
A healthy pregnancy is the best gift that we can give to an unborn baby.