Chandni Maria Jacob, MSc, Despina D Briana, MD, Prof Gian Carlo Di Renzo, MD, Prof Neena Modi, FMedSci, Flavia Bustreo, MD, Gabriella Conti, PhD, et al. September 21, 2020DOI: https://doi.org/10.1016/S2468-2667(20)30200-0
Summary
Resilient societies respond rapidly and effectively to health challenges and the associated economic consequences, and adapt to be more responsive to future challenges. Although it is only possible to recognise resilience retrospectively, the COVID-19 pandemic has occurred at a point in human history when, uniquely, sufficient knowledge is available on the early-life determinants of health to indicate clearly that a focus on maternal, neonatal, and child health (MNCH) will promote later resilience. This knowledge offers an unprecedented opportunity to disrupt entrenched strategies and to reinvest in MNCH in the post-COVID-19 so-called new normal. Furthermore, analysis of the short-term, medium-term, and longer-term consequences of previous socioeconomic shocks provides important insights into those domains of MNCH, such as neurocognitive development and nutrition, for which investment will generate the greatest benefit. Such considerations apply to high-income countries (HICs) and low-income and middle-income countries (LMICs). However, implementing appropriate policies in the post-COVID-19 recovery period will be challenging and requires political commitment and public engagement.
The life-course implications of MNCH
In the short term, MNCH is measured by maternal and neonatal mortality and other routinely collected outcomes. Although the magnitude and nature of adverse pregnancy outcomes differ within and between HICs and LMICs, in all settings maternal conditions, such as pre-existing obesity and related non-communicable diseases such as diabetes and hypertension, substantially amplify the risks of adverse outcomes.
The medium-term effects of poor MNCH operate largely over the first 1000 days of life, from conception to age 2 years, but establish adverse trajectories that persist across the life course and into the next generation. For example, malnutrition can lead to childhood stunting, overnutrition to obesity, emotional deprivation to altered neurocognitive development, and air pollution to impaired respiratory development. Infants are sensitive to societal factors (eg, family cohesion, parental socioeconomic status, family or societal conflict, and environmental factors (eg, toxins, extreme weather events, and earthquakes). These factors can cause damage directly and indirectly (through anxiety and stress), are exacerbated by poverty and demographic factors, and can amplify pre-existing adverse trajectories.
The medium-term effects of poor MNCH operate largely over the first 1000 days of life, from conception to age 2 years, but establish adverse trajectories that persist across the life course and into the next generation. For example, malnutrition can lead to childhood stunting, overnutrition to obesity, emotional deprivation to altered neurocognitive development, and air pollution to impaired respiratory development. Infants are sensitive to societal factors (eg, family cohesion, parental socioeconomic status, family or societal conflict, and environmental factors (eg, toxins, extreme weather events, and earthquakes). These factors can cause damage directly and indirectly (through anxiety and stress), are exacerbated by poverty and demographic factors, and can amplify pre-existing adverse trajectories.
[Please click here to read more.]
Comments (0)