SALT LAKE CITY — What your baby eats in the first 1,000 days of life will determine how fast and how well he thinks, what he remembers and even how well he can multitask as an adult, the nation’s leading group of pediatricians said Monday.
In guidance published online in the medical journal Pediatrics, the American Academy of Pediatrics calls for increased attention to nutrition during the most critical window of child development, conception to the child’s second birthday, to avoid "lifelong deficits in brain function."
“The brain’s structural foundation, along with billions of brain cells and trillions of connections between them, are built during this sensitive window of time,” Dr. Sarah Jane Schwarzenberg, lead author of the policy statement and an executive committee member of AAP’s Committee on Nutrition, said in a statement.
Although written as advice to pediatricians, the AAP’s guidance matters most to women of child-bearing age, whose diet may be affecting a developing embryo for weeks before they learn they are pregnant. Nearly half of all pregnancies are unplanned. Yet the first 1,000 days of life comprise the most active period of neurologic development, beginning when the rudimentary structure that will become the brain emerges 18 days after conception, the report said.
Prenatal nutrition affects every brain process throughout life, from learning and memory, to processing speed in middle and old age, the report said. And deprivation of key nutrients — such as protein and long-chain fatty acids — can interfere with the development of parts of the brain that control things such as planning, attention and inhibition.
Moreover, the effects may not be reversible even if the nutritional deficits are corrected, said Dr. Michael Georgieff, a professor of pediatrics at the University of Minnesota School of Medicine and director of the university's Center for Neurobehavioral Development.
"In the past, when babies were born, it was assumed that their brains were just a blank slate and that anything you did afterwards, positive or negative, influenced how that child developed. We now know the baby is not a blank slate; they have that whole fetal experience; they can hear in the mom's womb, starting at about six or seven months' gestation, and they even have memory of events when they're born.
"So the intrauterine environment is part of the continuum, and birth just happens to be something that happens in there. And we now recognize that maternal nutritional health, going into pregnancy and during pregnancy, ultimately influences how that baby’s brain at birth looks, and that process continues afterwards," Georgieff said.
Building blocks of the brain
In its statement, the academy said that calorie intake affects the growth of the developing fetus and the child after birth, but calories alone “are not sufficient for normal brain development.”
The key nutrients for neurodevelopment are protein, zinc, iron, choline, folate, iodine, vitamins A, D, B6 and B12; and long-chain polyunsaturated fatty acids.
But developing babies are adversely affected when their mothers take in too many calories or too much of certain nutrients, the report notes. The authors describe malnutrition as not just inadequate nutrition, but also over-nutrition, excessive calories that may lack essential nutrients.
"It is important to recognize that many nutrients exhibit a U-shaped risk curve, whereby inadequate or excessive amounts both place the individual at risk," they wrote.
The authors cite a study conducted in rural Guatemala between 1969 and 1989 in which pregnant and breastfeeding women, as well as children up to age 7, were given two types of nutritional supplements: one, high-calorie and high-protein, the other low-calorie with no protein. Investigators later found that children who had received the high-protein supplements before age 2 scored higher on academic tests and had faster reaction times in information processing.
The demands of the developing brain are evident in how much energy the brain consumes at different stages of life, Georgieff said. Twenty percent of calories an adult consumes fuel the brain, while 60 percent of calories a baby consumes go to the brain. “It’s a very greedy organ,” he said.
With regard to other kinds of deficiencies, the report says that iron deficiency in the developing fetus can lead to cognitive impairment, and that too little iodine can lead to developmental delays. Inadequate long-chain polyunsaturated fatty acids may cause vision problems and hinder cognitive development.
After birth, the academy stresses the importance of breastfeeding. "Despite ongoing attempts to mimic human milk with infant formula, human milk may contain nutrients, growth factors and cells important for brain development that formula lacks," the authors write. They call for increased support of programs that support breastfeeding, such as the Baby-Friendly Hospital Initiative, and for continued public support of the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants and Children.
'Breast milk, breast milk, breast milk'
Jennifer Margulis, an Oregon mother of four and a former contributing editor at Mothering magazine, applauded the academy's stance on nutrition, although she derided the common practice of pediatricians handing out samples of formula to new mothers while saying that breastfeeding is best.
"The single best thing a mom can do is to eat a diet of real, whole, healthy foods and exclusively breastfeed her baby for the first six months," said Margulis, the author of six books on health and parenting, including "Your Baby, Your Way."
Georgieff also extols the value of breastfeeding, and notes it's not doctors, but the influence of family, that can have the biggest effect on a child's health.
“A mother’s decision regarding nutrition is not influenced by her pediatrician, or even her obstetrician. It’s more about whether her mom breastfed and if her mom is telling her she should breastfeed, and whether her sister did, and so on,” Georgieff said.
In short, to sculpt a better brain for your baby, eat well before and while you’re pregnant. If you’ve been eating junk food and then learn you are pregnant, change your diet immediately, and make sure that you don't have a disease that inhibits delivery of nutrients to the fetus, such as high blood pressure or diabetes.
Then, “Breast milk, breast milk, breast milk. And then transition to healthy foods," once the baby is born, he said.