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Baby steps

23 September 2016
A baby’s lifelong health outcomes can be affected by what happens pre-conception

The BABY1000 project tracks the progress of babies during their first 1000 days, but significantly, the tracking starts prior to conception. This makes it a rare study internationally, as it works to identify ways to ensure the best lifelong health outcomes for babies.

Dr Adrienne Gordon

Tendencies to some health outcomes can be set before birth. Dr Adrienne Gordon works to understand how to make these outcomes positive. 

Dr Adrienne Gordon (MPH(Hons) ’05 PhD ’12) clearly remembers getting her start as a neonatologist in a Glasgow hospital. “That first day, I had to fight past about 20 very pregnant women, standing at the front door in the freezing cold, all of them smoking.”

It was the 1990s and poverty was part of the Glasgow landscape. Dr Gordon gained powerful insights into how social and economic disadvantage could shape health and wellbeing from early childhood. “A lot was going on there medically,” says Dr Gordon in her bright, Edinburgh accent. “The stories behind who ended up with babies in intensive care were often complicated by social disadvantage.”

“The stories behind who ended up with babies in intensive care were often complicated by social disadvantage,” she says. The Glasgow experience shaped Dr Gordon’s career and world view. Today, she is a recognised authority on risk and prevention of stillbirth and improving perinatal outcomes.

She is a senior lecturer in obstetrics, gynaecology and neonatology at the University of Sydney’s Central Clinical School as well as an NHMRC Early Career Fellow at the University’s Charles Perkins Centre, which is dedicated to stemming the global epidemics of modern lifestyle diseases such as obesity, diabetes, and cardiovascular disease. 

A key focus is the BABY1000 project. The project aims to track the progress of babies for 1000 days. Significantly, the tracking starts prior to conception.

“There are many studies around the world looking at babies at birth or a few weeks after, then following them through life,” Dr Gordon says, “but there are virtually none that start before pregnancy.” 

hugging a baby

The BABY1000 project aims to give every child the potential for a healthy life.

New technologies are showing that the way people respond to health risk factors during their lifetimes can be set prior to conception. Things like undernutrition or over-nutrition in pregnancy, maternal diabetes, maternal stress and anxiety affect how DNA functions. The result can be a child pre-programmed to respond in a certain way.

These effects have already been observed in communities around the world. In Ghana, for example, it has been shown that women who conceive during the wet season have children who live longer and are healthier than those conceived in the dry season, most likely because in the wet season people eat more green, leafy vegetables.

Similarly, around the end of the Second World War, in the occupied Netherlands, food was scarce and severely rationed. Depending on when during her pregnancy a woman was malnourished, her child would have a different tendency towards cardiovascular disease and obesity. 

The BABY1000 project aims to measure such effects in a clinical setting. The ultimate goal is to assess the modifiable risks and interventions for pregnant women and those considering pregnancy, to ensure the best lifelong health outcomes for their babies. It’s about starting preventative medicine extra early. 

This ambitious, cross-disciplinary project involves collaboration across various University sites and faculties, and other external stakeholders. The
 project also includes data linkage
 research and in keeping with its
 emphasis on translating knowledge
 into practice and policy, it will test 
interventions through randomised
 controlled trials.

“The Charles Perkins Centre really wanted to have a flagship longitudinal study that could answer novel questions as well as harness all the scientific infrastructure and people who are at the University,” Dr Gordon says. “But also have a public health and clinical outlook and affect real health outcomes.”

Bod Pod

The Bod Pod measures body fat through air displacement. A smaller version is used for babies.

In many ways, the BABY1000 project combines Dr Gordon’s passion for research-informed practice as well as practice-informed research.

The challenge is connecting with women who are still only thinking about getting pregnant. To do that, Dr Gordon and her colleagues have set up a clinical service centre where, in
 a single visit, prospective mothers see multiple specialists including a dietitian, midwife, and obstetrician. The big hook is that this one-stop shop is free.
“The idea is that if we build it, they will come,” says Dr Gordon. “This will allow us not only to offer a clinical service but a point of recruitment for the BABY1000 project. We plan initially to invite those who attend the service to
 be involved. Then, when we have enough funding, we’ll advertise really widely using social media for the main project to make sure we’re not excluding any part of the population.”

The target is to track 10,000 babies across four Sydney hospitals: Royal Prince Alfred, Westmead, Nepean, and Royal North Shore, where there are a total of 20,000 births annually. This will tap into parental experiences across ethnicities, regions and socioeconomic groups.

Researchers have raised enough money for a pilot study later this year focused on a set of key research questions. The questions have been developed with input from 70 researchers, clinicians, community and health service providers.

The questions include whether a mother’s pre-conception weight loss can improve her baby’s outcomes, what aspects
 of socio-economic disadvantage can be mitigated with information or guidance, and how receptive pregnant mothers are to health messages coming through social media. 

This last point relates to another of Dr Gordon’s projects. She has been collaborating with a charity in the United Kingdom in designing a mobile app called Baby Buddy. “It’s about giving women easy access to information that can help them understand risks. It also embeds with the UK healthcare system,” says Dr Gordon. “We’re now looking at creating an Australian version.”

Early evidence suggests the app 
is reaching people who don’t want to engage with the healthcare system. It also appears to increase breastfeeding rates and antenatal visits.

In an ideal world, Dr Gordon would like to see greater community education about pre-conception health and for that education to begin in high school. “Many people do more to plan their holiday than to plan a baby,” she says. 

Starting her research career with a focus on preventing stillbirths, Dr Gordon quickly came to see the importance of public health approaches in creating healthy parents and pregnancies, which leads to more happy and healthy babies.

“You do make a difference as a doctor. And by doing public health research, you have the ability to make a difference on a much bigger scale,” she says.

Follow Dr Gordon on Twitter at @AdrienneOz

How to get involved

You can help the BABY1000 project as it works to improve health outcomes for babies and communities. If you’d like to offer support or learn more, contact Flora Grant on +61 2 2 8627 4650 or email flora.grant@sydney.edu.au.

To apply to take part in the study contact:

cpc.baby1000@sydney.edu.au

You can also follow @BABY1000study on Facebook and join the conversation on Twitter using #BABY1000.


Photography by Matthew Vasilescu and Victoria Baldwin (BA ’14)

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