The first 1,000 days from conception to the end of the second year of a child’s life are a critical period of maximum developmental plasticity, during which experiences and exposures become biologically embedded. Every aspect of development is shaped by experiences and exposures during this time and these include macro-factors such as the social determinants of health and micro-factors such as child characteristics, family features, environment and stress. While the first 1,000 days do not determine future health and well-being, they do make particular outcomes more likely. Subsequent 1,000 days are also influential, but it can become progressively more difficult, time-consuming and costly to make positive changes then. Hence, plans need to be established to ensure that experiences and exposures before, during and after the first 1,000 days are as positive as possible for the mother and child.
Adverse childhood outcomes can have an impact on early behavioural outcomes. Trauma, if not resolved, is not transformed but transferred to the next generation. This process is reversible with proper intervention. This can include decreasing multiple environmental stressors through intensive care coordination, while building parental executive functioning as well as establishing a nurturing, responsive parent-child relationship – which heals trauma and builds resilience.
Service disruption due to factors such as COVID-19 can greatly impact mother and child health. The impact of COVID-19 on maternal mental health can include increased anxiety and stress, limited social support, increased household instability, and decreased mother-child attachment. Of priority is the continuity of maternal health services and support for COVID-19 recovery. These can take the forms of building capability of midwives, stronger family awareness and support for mothers, continuity of essential maternal and newborn health services as well as evidence-based practices to care for the COVID-19 positive mother and child.
Antenatal depression and anxiety impacts on foetal neurodevelopment, with changes in microstructure, functional connectivity, and epigenetic expression which may influence infant temperament and behaviour. It is important to ensure the continuity of maternal health essential services, even during a pandemic. A whole-of-society approach is required to promote, protect and care for mental health. Family members too can play a greater role in supporting the mother-and-child dyad. Community partnerships and interventional programmes play a key role in early identification, screening and addressing the needs of various groups, including vulnerable, at-risk families.