In a compelling inaugural address at the University of Pretoria’s (UP) Senate Hall, Professor Ute Feucht, a distinguished authority in maternal and child health and Director of UP’s Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, stressed the critical significance of the first 1 000 days of life—from conception to the age of two.
Her lecture illuminated how placental function, maternal health, and early childhood factors are pivotal in shaping lifelong health outcomes.
The event, which attracted key academic figures including Vice-Principal: Academic Professor Loretta Feris and Dean of the Faculty of Health Sciences Professor Tiaan de Jager, was a testament to the pressing nature of the issues discussed, with Feucht's family also present to support her significant milestone.
Beginning her lecture, Feucht delved into the nuances of foetal growth restriction, a condition borne from placental insufficiency that restricts a foetus from reaching its genetic growth potential. “This condition has far-reaching consequences, including stillbirths, neonatal deaths, and childhood growth disturbances, as well as conditions that can manifest later in life as non-communicable diseases like diabetes and hypertension,” she explained, underscoring the long-lasting repercussions of inadequate maternal and infant health systems.
Her insights were rooted in research data from South Africa, which reveals disquieting trends: most stillbirths occur in low-risk pregnancies that are often classified as “unexplained stillbirths.” Alarmingly, the statistics show that many of these stillbirths are antenatal, indicating they are not connected to the quality of care received during delivery, raising significant concerns about healthcare practices.
Drawing on findings from the Siyakhula study, which focused on HIV-exposed uninfected infants in South Africa, Feucht highlighted that these children are significantly prone to stunted growth due to adverse intrauterine environments, even when they do not contract the virus.
“The Umbiflow studies utilized Doppler ultrasound technology to assess placental blood flow, showcasing its potential to prevent stillbirths and identify at-risk pregnancies,” she noted, revealing troubling disparities in health outcomes. The prevalence of placental insufficiency was found to be ten times higher in low- and middle-income countries compared to high-income settings.
As she moved to outline the critical phase of the first 1 000 days, Feucht articulated, “Eighty percent of a baby’s brain growth occurs within this period. It’s a time of tremendous potential and enormous vulnerability, where the foundation for future health, growth, and neurodevelopment is laid.”
The importance of addressing foetal health during these early days is vital, particularly as adverse conditions like foetal growth restriction can lead to lifelong disadvantages.
Addressing the developmental origins of health and disease hypothesis, Feucht explained how a foetus makes genetic adaptations in response to its environment. While these adaptations might offer initial protective benefits, they can predispose individuals to chronic health issues in adulthood if the anticipated conditions do not align with reality.
Feucht’s findings on postnatal care, particularly for infants born to mothers living with HIV or experiencing placental insufficiency, draw attention to the urgent need for integrated health systems. Her studies, including the UmbiBaby and UmbiGodisa projects, reveal that children in such vulnerable circumstances are at a markedly higher risk of stunted growth and cognitive delays.
In closing, Feucht advocated for a more effective integration of maternal and infant healthcare within South Africa’s existing healthcare framework. “Streamlined, holistic care for both mother and child at primary healthcare centres would reduce the number of visits necessary for family planning, HIV-related care, and routine infant check-ups and immunisations, ultimately leading to improved health outcomes,” she asserted.
Her lecture culminated with a poignant reference to a recent Lancet report that revealed a troubling statistic: “Every fourth baby in the world is born too soon or born too small.” Addressing these issues is not just a matter of healthcare but a critical component for ensuring the future welfare of society as a whole.
As maternal health challenges continue to loom, Feucht's insights not only rekindle the conversation around the first 1 000 days but also call for urgent action to secure a healthier future for generations to come.
Her call for integrated healthcare presents a beacon of hope amid the ongoing struggles for maternal and child welfare in South Africa.