To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The concept of the early life developmental origins of health and disease (DOHaD) in adults has stimulated a new approach to understanding disease trajectories, with major public health implications. Indeed, the principle of the 'lifecourse of disease' now influences health policies internationally. Environmental influences during pregnancy and early life that affect lifelong health are well documented, but there is a new focus on the preconception period and the significance of paternal health on the fetus. This fully revised second edition highlights scientific and clinical advances in the field, exploring new understanding of mechanisms such as epigenetics and the increasingly recognised role of external influences, including pollution. The book is structured logically, covering environment, clinical outcomes, mechanisms of DOHaD, interventions throughout the lifespan and finally implications for public health and policy. Clinicians and scientists alike will improve their understanding of the developmental origins of health and disease with this essential text.
Providing the healthiest and safest environment in the first 1,000 days of life is the greatest gift which parents can give to their children. We return to the theme of control over our lives to ask who is in control of this gift, and whether today’s medicine and public health hold the answers. We explore the dilemmas facing today’s governments and the decisions that individuals make in terms of personal responsibility when maternal and child health are not prioritised by health policy-makers. We discuss sexual and reproductive rights, why women’s health has not been prioritised – especially during the pandemic – and reasons for high maternal mortality in some countries. We offer an optimistic close to the book; a call to action. We explain that, while planning for parenthood is important, the actions needed do not have to be sustained over a long period. We emphasise the many opportunities which adolescents and young people can seize as the parents of the future. This hope can generate the resolve to make the first 1,000 days of life as good as possible for the next generation. Knowing the secrets of our first 1,000 days is a vital part of this.
Why is birth so dangerous, even today, with modern medicine? Through historical anecdote and a contemporary case history we explore this question, discussing the process of birth and what can go wrong. By thinking about who is in control of labour – is it the mother or her fetus? – we think about how a couple might prepare for birth. The challenge posed by birth makes us look to human evolution for answers, and we describe the insight it gives into birth in some low-resource settings around the world. We tackle the question of the rising numbers of caesarean sections around the world and the possible consequences. Although it may be widely believed that a smaller baby would mean a less difficult birth, we go on to explore the risks of being small for the survival of the baby alongside new research revealing how the mother’s body limits the growth of her baby inside the womb. We discuss whether the growth of the fetus is set by the genes which the mother or the father have passed on, mother’s size, or her environment. This leads to how the fetus develops and what controls this, the focus of the next chapter.
Here we uncover the mysteries of the baby as it develops in the womb, discussing how fetal development is controlled. We give insights into aspects of pregnancy not widely known, from the fetus starting to breathe months before it is born, to the question of whether it sleeps – and dreams. We discuss the ways in which information about the mother’s life and her environment affect the baby’s development. Although birth may seem the first major milestone for a baby, we emphasise that many other milestones have been passed before that, inside the womb, out of sight but over which parents can have substantial influence. We give insights into new discoveries about how the organs of the fetal body develop in prediction of the world in which that individual ‘expects’ to live, and what happens when the prediction turns out to be wrong. The idea that the fetus is preparing for life after birth will get the reader thinking about the long-term consequences of the way a fetus develops. Each of us is unique as a result of our development – and nobody is perfect. Our unique development starts from the moment of conception, which introduces the next chapter on sex.
None of us can really remember anything about our lives before the age of two years. How much of what makes us what we are has been set by that time? We challenge the widely-accepted idea that what we are is ‘determined’ by inherited genes and we start to explore how interaction with parents/carers establishes our behaviour. We use examples drawn from fiction and the real world to explore how the brain learns from the conditions in early life. We explain why this adaptability underpins development of our senses, our behaviour and our self-control. This introduces control as one of the themes of the book – how much we are in control of our bodies and how control develops based on environmental cues. We question what effect today’s exposure to digital media may have on the developing brain, and explore new ideas about the development of defence mechanisms, from immunity to the gut microbiome. Through the quote from JM Barrie, author of ‘Peter Pan’: ‘You always know after you are two. Two is the beginning of the end’, we ask whether age two is the beginning of the end or the end of the beginning of development.
We provide food for thought on some pressing questions about health inequalities – why some of us maintain good health into old age, and the inequity of infectious and Non-Communicable Diseases, both very relevant now to COVID-19. We use historical perspectives and modern examples to discuss the population explosion, social determinants of health and how development over the first 1,000 days influences later health. Some ideas are likely to be quite novel to the reader, such as the risk of disease being increased by ‘mismatch’ between our developmental environment and where and how we live later. This takes the story across the globe, from high- to low-income countries, where early development is often less healthy but economic progress is changing environments fast. Can young people in such settings escape, or has the anvil on which their bodies were forged in early life left them with unalterable inequalities? We ask who needs to ‘own’ these problems and why solutions to them have been slow to emerge. The wider, global perspective, sets the scene for the final chapter which focuses on what we can all do as individuals now that we know some of the secrets of our first 1,000 days.
Ever wondered why your life and health can sometimes be so hard to control? Or why it seems so easy for other people? Mark Hanson and Lucy Green draw on their years of experience as scientists and educators to cut through the usual information on genetics and lifestyle to reveal the secrets of early development which start to make each of us unique, during our first 1,000 days from the moment of conception. Some surprising discoveries, based on little-known new research, show how events during our first 1,000 days make each of us who we are and explain how we control our bodies, processes that go way beyond just the genes which we inherited. Provoking new ways of thinking about being parents, this book empowers individuals and society to give the next generation the gift of a good start to life and future health.
Sex. We walk the reader through why it matters to generate variation in a species. The mixing of genes from two sexes will be familiar to most readers as the reason for the uniqueness of each of us, right from the moment of conception. But we give insight on the other, less widely understood, ways that the differences between us come about. This leads to explanation of the early ‘conversations’ between the mother and her embryo that take place, and why they matter. We give some current and long-standing examples of mankind’s attempts to control conception or to encourage it, including the eugenic sterilisation agenda, artificial insemination and pregnancy termination after fetal sex determination. We explore one of the most hotly debated areas of medicine, assisted reproductive technologies, to which many people will relate. We encourage the reader to challenge the way they think about the preconception period, and consider why the responsibility seems to fall on girls and women, with its consequences for gender equality. This leads to the next chapter.
There is increasing interest in modelling longitudinal dietary data and classifying individuals into subgroups (latent classes) who follow similar trajectories over time. These trajectories could identify population groups and time points amenable to dietary interventions. This paper aimed to provide a comparison and overview of two latent class methods: group-based trajectory modelling (GBTM) and growth mixture modelling (GMM). Data from 2963 mother–child dyads from the longitudinal Southampton Women’s Survey were analysed. Continuous diet quality indices (DQI) were derived using principal component analysis from interviewer-administered FFQ collected in mothers pre-pregnancy, at 11- and 34-week gestation, and in offspring at 6 and 12 months and 3, 6–7 and 8–9 years. A forward modelling approach from 1 to 6 classes was used to identify the optimal number of DQI latent classes. Models were assessed using the Akaike and Bayesian information criteria, probability of class assignment, ratio of the odds of correct classification, group membership and entropy. Both methods suggested that five classes were optimal, with a strong correlation (Spearman’s = 0·98) between class assignment for the two methods. The dietary trajectories were categorised as stable with horizontal lines and were defined as poor (GMM = 4 % and GBTM = 5 %), poor-medium (23 %, 23 %), medium (39 %, 39 %), medium-better (27 %, 28 %) and best (7 %, 6 %). Both GBTM and GMM are suitable for identifying dietary trajectories. GBTM is recommended as it is computationally less intensive, but results could be confirmed using GMM. The stability of the diet quality trajectories from pre-pregnancy underlines the importance of promotion of dietary improvements from preconception onwards.
Adults who had non-edematous severe acute malnutrition (SAM) during infancy (i.e., marasmus) have worse glucose tolerance and beta-cell function than survivors of edematous SAM (i.e., kwashiorkor). We hypothesized that wasting and/or stunting in SAM is associated with lower glucose disposal rate (M) and insulin clearance (MCR) in adulthood.
We recruited 40 nondiabetic adult SAM survivors (20 marasmus survivors (MS) and 20 kwashiorkor survivors (KS)) and 13 matched community controls. We performed 150-minute hyperinsulinaemic, euglycaemic clamps to estimate M and MCR. We also measured serum adiponectin, anthropometry, and body composition. Data on wasting (weight-for-height) and stunting (height-for-age) were abstracted from the hospital records.
Children with marasmus had lower weight-for-height z-scores (WHZ) (−3.8 ± 0.9 vs. −2.2 ± 1.4; P < 0.001) and lower height-for-age z-scores (HAZ) (−4.6 ± 1.1 vs. −3.4 ± 1.5; P = 0.0092) than those with kwashiorkor. As adults, mean age (SD) of participants was 27.2 (8.1) years; BMI was 23.6 (5.0) kg/m2. SAM survivors and controls had similar body composition. MS and KS and controls had similar M (9.1 ± 3.2; 8.7 ± 4.6; 6.9 ± 2.5 mg.kg−1.min−1 respectively; P = 0.3) and MCR. WHZ and HAZ were not associated with M, MCR or adiponectin even after adjusting for body composition.
Wasting and stunting during infancy are not associated with insulin sensitivity and insulin clearance in lean, young, adult survivors of SAM. These data are consistent with the finding that glucose intolerance in malnutrition survivors is mostly due to beta-cell dysfunction.
The COVID-19 pandemic has shone a spotlight on how health outcomes are unequally distributed among different population groups, with disadvantaged communities and individuals being disproportionality affected in terms of infection, morbidity and mortality, as well as vaccine access. Recently, there has been considerable debate about how social disadvantage and inequality intersect with developmental processes to result in a heightened susceptibility to environmental stressors, economic shocks and large-scale health emergencies. We argue that DOHaD Society members can make important contributions to addressing issues of inequality and improving community resilience in response to COVID-19. In order to do so, it is beneficial to engage with and adopt a social justice framework. We detail how DOHaD can align its research and policy recommendations with a social justice perspective to ensure that we contribute to improving the health of present and future generations in an equitable and socially just way.