In her highly anticipated inaugural address, Professor Ute Feucht, a leading expert in maternal and child health who is based at the University of Pretoria (UP), shed light on the importance of the first 1 000 days of life – from conception to age two. Her lecture also highlighted how placental function, maternal health and early childhood factors influence lifelong health outcomes.

Drawing from her research Prof Feucht, who is the Director of UP’s Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, laid out the interconnected risk factors for suboptimal foetal growth and postnatal well- being, particularly the impact of maternal HIV infection on children, even when the children remain uninfected with the virus.

The inaugural address was held at UP’s Senate Hall, with Vice-Principal: Academic Prof Loretta Feris; Dean of the Faculty of Health Sciences Prof Tiaan de Jager; and other deans in attendance, along with Prof Feucht’s family members.

Prof Feucht began her lecture by exploring foetal growth restriction, a condition where a foetus doesn’t reach its genetic growth potential due to placental insufficiency.

“This condition has far-reaching consequences, including stillbirths, neonatal deaths and childhood growth disturbances, as well as conditions that can manifest later in life as non-communicable diseases like diabetes and hypertension,” she explained.

Prof Feucht added that data from the South African mortality auditing programmes in the public sector health facilities shows that most stillbirths occur mainly in apparently low-risk pregnancies, and are coded as “unexplained stillbirths”. In addition, these stillbirths are mostly antenatal, meaning they are not intrapartum, therefore not linked to the quality of care that the mother receives during the delivery.

She also drew data from the Siyakhula study, which examined HIV-exposed uninfected infants in South Africa. The study found that these children, even without vertical HIV transmission, were more likely to suffer from stunted growth due to changes in their intrauterine environment.

“The Umbiflow studies, which used Doppler ultrasound technology to assess placental blood flow, showed the potential for this technology to prevent stillbirths and identify at-risk pregnancies,” Prof Feucht said. “The studies, conducted across South Africa and other low- and middle-income countries, revealed alarming rates of placental insufficiency in seemingly healthy women. The prevalence of abnormal Dopplers – indicating insufficient blood flow to the foetus – was found to be 10 times higher in these low- and middle-income countries compared to high-income settings.”

Scan of fetus in utero

The first 1 000 days

Prof Feucht said that 80% of a baby’s brain growth occurs within the first 1 000 days, the crucial period from conception to a child’s second birthday.

“This is a time of tremendous potential and enormous vulnerability, where the foundation for future health, growth and neurodevelopment is laid,” she said. “Poor foetal growth and development during these early stages, particularly due to conditions like foetal growth restriction, can lead to life-long disadvantages.”

Prof Feucht went on to draw attention to the developmental origins of health and disease hypothesis, which suggest that a foetus makes genetic adaptations in response to its environment. These adaptations, while initially protective, may predispose an individual to chronic diseases in adulthood if the predicted environment doesn’t match reality.

When it comes to postnatal care, particularly for vulnerable infants born to mothers living with HIV, or those experiencing placental insufficiency, Prof Feucht shared findings from the UmbiBaby and UmbiGodisa studies, which track the growth and development of infants up to 24 months. These studies found that children exposed to both HIV and placental insufficiency were at significantly higher risk for stunted growth and cognitive delays.

Going forward

To identify and address these risks, Prof Feucht called for better integration of care for mothers and infants in South Africa’s healthcare system.