Low birthweight and birth preterm are the greatest risk factors for a child being born disadvantaged
Low birthweight and birth preterm are the greatest risk factors for a child being born disadvantaged, including being mentally and physically defective. In a study of 165 women who had delivered low birthweight babies (<2,500g) 1994-98 at the Homerton Hospital; our data show that there was a high prevalence of inadequate nutrition among women who delivered low birthweight babies in the East End, E9 of London. Using a 7 day record of food intake we found no difference in protein intake. The highest proportion of pregnant mothers who failed to meet their Reference Nutrient Intakes was amongst Asian and African-Caribbean women. The failure to meet RNI intake was as high as 77% in the Asian, and 90% in African-Caribbean women, with around half or more insufficient in folate and riboflavin. In contrast only about 5% of Asians and Africans smoked cigarettes. Surprisingly 92% of the African mothers delivered babies preterm. In total 52% were small for gestational age. That was 20 years ago and today the situation and populations will have changed as has food.
However it remains the position that birth defects, learning and behavioural disabilities, have lifelong impacts on individuals and families, and further impose a disproportionately high economic and social cost. For example care costs of a single patient until the age of 18 of a million pounds are not unknown. Higher levels of birth defects will be seen in communities with incomplete nutrient intake including vitamin D and iodine in pregnancy. It was recently reported by the BBC (Link) “The number of babies born with birth defects in Bradford is nearly double the national average, according to a study seeking answers to the higher than expected rates of deaths and congenital abnormalities in the babies of the Pakistani community.”
This report led to a discussion in the phone-in London Broadcasting Company on BREXIT with contributors commenting on the extra costs to the NHS and risk of radicalisation. However, the study’s lead author Dr Eamonn Sheridan, from the University of Leeds, comments that the risk is double for consanguineous marriages the risk is still small – about 6%. Whilst genetic aberrations may factor, a primary cause adverse pregnancy outcomes is likely to be nutritional deficits including Vitamin D pre-conception and during pregnancy. None the less, consanguineous marriages are likely to be an additive layer to adverse pregnancy outcomes.
Nutritional deficits are associated with poor achievement and related behavioural consequences in children and adults, maintaining and reinforcing self-sustaining cycles of poor nutrition, under-achievement and poverty. (Link BBC Story)
Inadequate Iodine, Omega 3 DHA, folic acid and vitamin D all are risk factors in preterm and related birthing outcomes. 800mg of DHA in a study in Australia in a susceptible population resulted in a 50% reduction in preterm births. (Link) Low vitamin D is a recognised issue in the Asian community in Bradford (Link) and indeed in continental India, for example a recent paper looking at vitamin D deficiency in hospital outpatients concluded “Female sex, higher socio economic status, higher educational status of the mother were the factors with strong positive association with hypovitaminosis D.” (Link) Low iodine is recognised as a national issue in the UK.
More worrying is these birth statistics only count the extreme visible derangement from normal healthy development. However these are often the tip of an iceberg. There is no sharp cut off point between visible defect and optimum physical and mental development. There is instead a Gaussian curve often skewed. We also know more widely that improper nutrition preconception, and during pregnancy, as exacerbated by poor nutrition in early school years results in reduced neurological function, and potential propensity to behavioural disorders. Given the necessary societal triggers, inadequate maternal nutrition so health, and the consequent neurological and behavioural deficits, are likely factors in ultimately setting the scene, for future increases in in the sort of human behaviour and violent atrocities which are now becoming so much a matter of course.
Visiting Professor Michael A Crawford, PhD, FRSB, FRCPath,
Surgery and Cancer,
Imperial College, London,
Chelsea and Westminster Hospital Campus, Room 3,34
369 Fulham Road, London SW10 9NH,