What makes us healthy? Some more research ...

What affects our health?

This blog is an extended version of my column on 20 March 2012. It includes references at the end and further examples.

My core point is that the evidence is that maternal behaviours do have a long-term effect on children and that these, where negative, can have irremediable life-long effects. So I believe that early intervention as presently described is very often already too late. The proposed reports to parents on progress at age 2 are a positive step but still too late.

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The column
Does pre-birth maternal behaviour have a long-term effect on children? This important question seems difficult to answer, with many variables that can impact on long-term health outcomes such as poverty, housing, childhood diseases, and schooling. But it turns out that there is a large population carrying out a controlled test, and for which there is overwhelming evidence of a direct effect, and that relates to fasting during Ramadan. A foetus in its first month with a fasting mother is more than 20% more likely to suffer from visual, hearing or learning disabilities as an adult. And the effect is magnified when Ramadan falls in a summer month, with a longer period of fasting, and also when the mother lives further from the equator, when the day length is greater.

The NHS-supported booklet Ramadan Health Guide say that all those who are pregnant – and some others – are exempted from fasting. They are required instead to make up the days missed later, or give a sum to charity.

This was new to me, but I hope that all those who come into professional contact with Muslim women who may become pregnant during Ramadan are already advising them appropriately. My back-of the envelope calculation indicate that this might improve the long-term life chances of 10,000 people every year in the UK – a very worthwhile outcome for almost no cost.

But I’m also interested in other behaviours that may have a long-term deleterious effect on the unborn child. Foetal alcohol syndrome is characterised by physical damage and cognitive and developmental malfunction. Poor diet is strongly correlated to childhood obesity. And maternal smoking leads to lower average birth weight.

So it seems to be unquestionable that irreparable damage may be done by the time a child is born. I think we need to publish the evidence on all these issues and make it part of the public and professional debate, and then to change our practices to match. And that means education, social care, and health professionals working together with common messages in a sustained way – not just in ante-natal classes or in family education. Unborn children deserve no less from us.

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Over the last few weeks there has been coverage of several published pieces of research that support the thesis of this column:
Daily Telegraph (19 March) ‘Babies fed on demand ‘perform better in class’ ?The Avon Longitudinal Study of Parents and Children showed that in a population of 10,000 children born in Bristol in the early 1990s, feeding on demand was correlated with higher IQ scores at age 8, and better performance in SATs at 5, 7, 11 and 14.

Daily Telegraph (22 March) ‘Pollution link to problem pupils’ In a study by Columbia University, the children of 253 women were studied. The women had been subjected to polycyclic aromatic hydrocarbons during pregnancy [one hopes not deliberately] and there was a significant correlation between the level of pollution experienced by the mothers and levels of anxiety, depression and attention problems among their children.

The Observer (25 March) ‘Happy children ‘are likely to have higher income’ as adults’?Research on 90,000 people carried out at UCL and Warwick University showed a strong correlation between childhood happiness and earnings later in life.

References

If you have not read Freakonomics or Superfreakonomics, don’t be put off by the strange titles, they are both really good a provocative reads, and have some real insights based on published research. They both presnt case studies of fundamnetal importance to children's services.

‘The effects of maternal fasting during Ramadan on birth and adult outcomes’, US National Bureau of Economic Research Working Paper, October 2008 (quoted in Superfreakonomics, Levitt and Dubner, 2009)

‘Ramadan Health Guide’, Communities in Action (supported by the Department of Health), 2007