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Bright Futures

Articles and Updates from Phoenix Children's

May 29, 2021, Richard E. Frye, MD, PhD
Preventing Chronic Childhood Disease Through Healthy Pregnancy
Preventing Chronic Childhood Disease Through Healthy Pregnancy

The prevalence of chronic childhood illness has continued to increase over the past decades with approximately 1 in 3 children suffering from a serious health problem. Common health problems include neurodevelopmental disorders such as attention-deficit hyperactivity disorder (ADHD), learning disabilities, autism spectrum disorder and cerebral palsy and immune disorders such as asthma and allergies as well as nutritional disorders such as obesity.

The rise in the prevalence of these disorders as well as their root underlying cause remains elusive, but these disorders share something in common -- they all seem to arise from complex interactions between genetics and environmental exposures. Scientists have concentrated on the most important environmental influence an individual will experience in their life, the environment they are exposed to while developing in their mother’s womb during pregnancy.

More research is implicating how important a clean environment is to a successful pregnancy and healthy offspring. Exposure to air pollution, particularly related to traffic, during gestation has been linked to an increased risk of many childhood conditions. Small particular matter in the air has been linked to increased risk of autism, asthma, obesity, and prenatal birth. Water is another important source of environmental exposure. A study of Wisconsin suggested that nitrate contamination of drinking water result in as much as $80 million in excessive health care costs annually, including an increase in adverse pregnancy and birth outcomes. Another study demonstrated that the health outcomes from lead contamination of the water supply in Flint, Michigan not only affected eventual neurodevelopment of the children through lead exposure but also through increased maternal stress and smoking. Thus, it is of the upmost important for pregnant women to maintain a clean environment to optimize developmental outcomes.

Environmental exposures are not just about the exposure to toxic substances. One of the most important exposures the growing child can get is proper nutrition. One of the major advances in public health is the fortification of food with folic acid to prevent neural tube defects, a rare birth defect. However, recent research has demonstrated that prenatal folate supplementation also prevents autism and improves cognitive outcomes. Other vitamins and mineral also appear to be important for health pregnancy outcomes. Vitamin D supplementation during pregnancy may reduce obesity, asthma, and dental carries. In adolescents, micronutrient supplementation, in addition to folate and iron, was found to reduce low birth weight and premature birth.  In fact, it appears that it is not so much that the advantages of prenatal vitamins are unknown but that compliance with the recommendation is not universal even with an intervention that is so simple.

Maternal health is also of utmost importance for having a healthy child. Exercise during pregnancy has been linked to higher intelligence and better metabolic and cardiovascular health in the offspring. Diet may be important in reducing the effect of gestational diabetes when combined with exercise. Omega-3 fatty acid supplementation during pregnancy has evidence for reducing allergic disease in the offspring but concerns for contamination in some fish suggest careful moderate fish consumption. Management of stress is important as maternal stress during pregnancy has been linked to obesity in the offspring and maternal resilience to psychological stress may positively impact health of the offspring’s genetics. Sleep is also of the upmost importance as sleep deprivation during pregnancy is associated with increased blood pressure and obesity in children and an increased chance of neonatal intensive care. Lastly, as there is increased awareness in gut health, studies have demonstrated that certain probiotics during pregnancy are associated with a reduced risk of allergic disease in childhood.

Evidence is growing that having a successful healthy pregnancy can decrease the risk of children developing chronic health disorders and there may be some simple way to decrease the risk of chronic health conditions during pregnancy. Organizations such as the Neurological Health Foundation have developed simple guides based on scientific evidence to assist in improving the health of offspring. Although much more needs to be learned about specific recommendations, it is important to appreciate that optimizing the well being and health of the mother during pregnancy can have a profound effect on the long-term health of the child.

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