Editorial

Early life 1000 days: opportunities for preventing adult diseases

Juan Juan, Huixia Yang

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
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With the rapid socioeconomic development, improve- diseases.[10] We emphasize and call for more widespread
ments in living standards, and changes in lifestyle, adult attention to early life 1000 days for the prevention of adult
diseases, such as cardiovascular diseases, type 2 diabetes diseases epidemic in China.
mellitus (T2DM), hypertension, obesity, and so on, are
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increasing dramatically over the past decades, which have The Lancet Series of 2018 acknowledged that maternal
caused a huge economic and health burden at both overnutrition and obesity, maternal undernutrition, related
population and individual levels in China.[1] The increased paternal factors, and the use of assisted reproductive
burden of adult diseases has become the main public treatment are the four major factors that contributed to the
health issue, and prevention of adult diseases in China has future health.[2-4] Apart from these, environmental factors
become a formidable task during recent years. In 2016, also play an important role in the health of future life. As
China has put forward the concept of whole life-course there are many factors involved, we mainly focus on the
health and efforts have been made on shifting the focus influence of lifestyle (including nutrition and exercise)
from treating diseases to prevention. In view of the poor during early life 1000 days on the long-term health as well as
effects of prevention of diseases in adulthood, it is the importance of preconception care, prenatal care, and
suggested that prevention and management of adult postnatal care for preventing adult diseases in this review.
diseases should be extended to early life, which is the
critical window for physiological programming and has Preconception care. As we all know, balanced diet and
profound and enduring effects on the whole life-cycle physical activity during pregnancy are crucial for maternal
health.[2-4] In 2018, an article named “To Prevent and child health. However, the importance of preconcep-
Cardiovascular Disease, Pay Attention to Pregnancy tion period is always being overlooked. It is reported that
Complications” published in Journal of the American nutrition status and lifestyle habits of couples with
Medical Association (JAMA) also illustrated that preg- reproductive age before pregnancy also have a lasting
nancy is a window to future health.[5] impact on maternal and child health.[2-4] The preconcep-
tion period presents a period of special opportunity for
As illustrated by the well-known Developmental Origins intervention. Identification of people contemplating
of Health and Disease (DOHaD) concept, factors in early pregnancy provides a window of opportunity to improve
life stages significantly affect the development of diseases health before conception. A sharper focus on intervention
in later life.[6-8] Susceptibility to adult diseases is strongly before conception is needed to improve maternal and child
influenced by intrauterine environment exposure during health and reduce the growing burden of adult diseases.
early development. DOHaD theory provides a new We call for heightened awareness of preconception
conception and perspective for the prevention of diseases healthcare. Health care, balanced diet, and healthy
in adulthoods. Based on this theory, substantial evidence lifestyle should be guaranteed from preconception period
has demonstrated the vital role of early life 1000 days and and continued throughout the life cycle.[11] However,
its importance in later life. Early life 1000 days indicates nowadays women of reproductive age usually overlook
the period from conception to the second postnatal year, preconception period and they do not receive regular
which is crucial for the growth and development of physical examination before pregnancy in China, espe-
offspring.[9] Early life 1000 days is a period where the cially in low-resourced rural area of China. According to a
foundations for optimum health, growth, and develop- population-based cohort study among >6.4 million
ment are established and is a “window of opportunity” women aged 20 to 49 years in China, the awareness rate
with high plasticity to efficaciously intervene and reduce of blood glucose levels and diabetes mellitus status among
the exposure of adverse factors as well as prevent adult reproductive-age women before pregnancy is extremely
low, and the management of pregestational diabetes

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Correspondence to: Prof. Huixia Yang, Department of Obstetrics and Gynecology,
Quick Response Code: Website: Peking University First Hospital, Beijing 100034, China
www.cmj.org E-Mail: [email protected]
Copyright © 2021 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under
the CC-BY-NC-ND license. This is an open access article distributed under the terms of the
DOI: Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND),
10.1097/CM9.0000000000001920 where it is permissible to download and share the work provided it is properly cited. The work
cannot be changed in any way or used commercially without permission from the journal.
Chinese Medical Journal 2022;135(5)
Received: 11-10-2021; Online: 30-12-2021 Edited by: Yanjie Yin

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mellitus (GDM) remains unsatisfactory, even in patients In China, a GDM One-Day Care Program was launched in
who are aware of their diabetes mellitus status, which may May 2011 at Peking University First Hospital to educate
cause serious adverse maternal and perinatal outcomes.[12] GDM patients on the basic knowledge of GDM, weight
Therefore, all women of reproductive age, especially for management, medical nutrition therapy, physical exercise
those with a history of pregnancy complications, should advice, and blood glucose self-monitoring methods by
seek preconception counseling and be encouraged to professional physicians, nurses, as well as clinical nutri-
adopt a balanced diet and lifestyle habits before tionists. This GDM One-Day Care Program sets a good
pregnancy. For instance, women at high risk of overweight model for group management of GDM and has been
and obesity should keep their pre-pregnancy body mass implemented throughout the country as part of the World
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index within a normal range before conception. Women Diabetes Foundation projects and many hospitals have
with diabetes or a history of GDM should be educated on followed and implemented this model.[20] All pregnant
healthy lifestyle, balanced diet, and blood glucose women are encouraged to keep a good lifestyle during
monitoring in the preconception period to improve their pregnancy, and a focus on prenatal care is of great
blood glucose and maintain their blood glucose levels importance for preventing adult diseases.
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within an appropriate level. Healthcare providers should

provide more effective preconception health support for Postnatal care. In addition to preconception care and
women of reproductive age, so as to help them make prenatal care, we should further strengthen the health care
adequate preparations for planned pregnancy and excel- in postnatal period. It is an important period to address
lent pregnancy. In addition, the state and local govern- intrapartum problems and initiate an intervention for
ments should work together at different levels to carry out both mothers and their offspring, who are at high risk of
publicity activities on preconception care, so as to improve diseases in later life. Thus, more attention should also be
people understanding on the importance of preconception paid to postnatal period to promote long-term health. It is
health, and better guide and support couples of reproduc- recommended to conduct the first postnatal care at 6
tive ages through healthy lifestyle, balanced diet, and weeks after childbirth. However, the postnatal care rate is
physical exercise, as well as avoid exposure to environ- relatively low in China currently, which might owe to
mental harmful substances to ensure and improve the multiple barriers, such as lack of self-efficacy and social
health of preconception. support, as well as professional knowledge among health
providers. Therefore, healthcare providers should coop-
Prenatal care. It is well established that a healthy lifestyle erate to provide more support for postnatal care. Lifestyle
during pregnancy, including nutrition and exercise, is crucial intervention, including a balanced diet and physical
for maternal and child health.[13,14] Early-life malnutrition, activity, is also the most fundamental and effective
including both undernutrition and overnutrition, could strategy for postnatal care in preventing adult diseases
significantly increase the risk of diseases in later life. in the future. Weight retention should be limited among
Overnutrition refers to excessive energy intake, which overweight or obese women as postpartum weight
usually leads to overweight, obesity, and excessive weight retention is associated with lifetime obesity risk and
gain during pregnancy. Undernutrition is mainly due to adverse outcomes in the next pregnancy. In addition,
insufficient amounts of macronutrient and/or micronutrient glucose tolerance status should be improved. Lifelong
or unbalanced dietary intake, which may lead to fetal growth screening for the development of T2DM or prediabetes
restriction, low birthweight, and so on. It is important to should be performed every 1 to 3 years among women
recognize that many nutrients exhibit a U-shaped risk curve, with a history of GDM as a history of GDM is associated
whereby inadequate or excessive amounts both place the with increased risk of T2DM for both mothers and their
individual at risk. Balanced nutrition during early life 1000 children.[21] For the infant, Early Essential Newborn Care
days is the guarantee for a good intrauterine environment (EENC), including delayed cord clamping, immediate and
and the health of infants. We must pay attention to it sustained skin-to-skin contact, and so on, has been proved
scientifically and reasonably and strengthen the nutrition to reduce preventable neonatal morbidity and mortality,
education during early life 1000 days. as well as improve newborns’ health. The World Health
Organization and the United Nations International
Studies have shown that a healthy lifestyle is of great Children Emergency Fund (UNICEF) have jointly devel-
significance to ensure appropriate weight gain during oped the Action Plan for Healthy Newborn Infants in the
pregnancy and decrease the risk of pregnancy complica- Western Pacific Region (2014–2020) to promote the
tions, including GDM and gestational hypertension, and so implementation of EENC.[22] A study conducted in 18
on, and further preventing the risk of diabetes and counties in four provinces in Western China showed that
hypertension in later life.[15-18] Women who had gestational the exclusive breastfeeding rate increased from 43% to
hypertension or preeclampsia in their first pregnancy were 2 73% after the implementation of EENC. Therefore, we
to 3 times more likely to later develop chronic hypertension should further strengthen the health education of EENC
compared with women who had normal blood pressure in and give more policy and technical support to the
their first pregnancy. A meta-analysis showed that the implementation of EENC, so as to maximize the
overall relative risk for T2DM was almost ten times higher important role of EENC for newborn health. Moreover,
in women with previous GDM than in healthy controls.[19] breastfeeding can also confer long-term metabolic benefits
Therefore, it is important to prevent and control for and reduce the risk of adult diseases.[23] The UNICEF
pregnancy complications by feasible prenatal care, such as recommended that breastfeeding should be continued
effective and first-line preventive strategies including until the second postnatal year, which is the end of early
nutrition and exercise intervention to prevent adult diseases. life 1000 days. A prospective cohort study showed that
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