The first 1,000 days and beyond. Impact on the mother-child dyad

Abstract

The concept of the origins of health and disease in development has made it possible to demonstrate the association between adult diseases and events that occur during the prenatal period and the first two years of life—what we refer to as the first 1,000 days. An individual’s development is determined not only by genetic inheritance but also by the interaction of their genes with the environment. Conditions during pregnancy such as maternal obesity, type 2 diabetes mellitus (T2DM), gestational diabetes mellitus (GDM), preeclampsia (PE), intrauterine growth restriction (IUGR), low birth weight (LBW), and preterm birth (PTB) cause changes in early fetal programming, predisposing the child to a higher risk of developing chronic diseases.

Maternal obesity impairs oocyte quality, alters DNA methylation, and affects placental development, increasing the risk of obesity, T2DM, and cardiovascular disease in offspring. Paternal obesity also has a negative impact. Obstetric conditions cause changes in the mother that persist beyond birth. Hypertensive disorders of pregnancy are associated with an increased risk of ischemic heart disease, arrhythmias, and stroke. In women under 40 years of age, this risk is highest during the first decade following a pregnancy complicated by PE and persists even more than 20 years later. They face twice the risk of cardiovascular disease compared to their peers, especially during the first 10 years, even without having developed type 2 diabetes.

Preterm infants have fewer nephrons and a higher risk of high blood pressure, obesity, type 2 diabetes, and chronic kidney disease, while those born at term also face an increased risk of coronary heart disease and stroke. The first 1,000 days represent a window of opportunity to reduce the burden of noncommunicable diseases. Planning pregnancies is essential. Preconception strategies are cost-effective, but their implementation depends on multiple factors. Perinatal history is relevant throughout life; therefore, we should include birth weight and gestational age at birth in our medical history to provide these high-risk populations with the necessary follow-up care. An interdisciplinary approach during the postpartum period is essential to ensure that these young patients at high cardiometabolic risk receive appropriate care in the fourth trimester.