Neonatologist Adrienne Gordon helps save the lives of tiny babies in intensive care. They constantly amaze her.
Their unique personalities. How fast they learn. The way they can be so close to death and yet go on to thrive.
Adrienne shares what parents need to know about the first 1,000 days, the critical period from conception to the age of two.
“Some of the most important aspects of life are before you even arrive,” Adrienne says.
The first 1,000 days lay the foundation for lifelong physical and mental health, cognitive abilities, and social and emotional development, and have been linked to heart disease, diabetes, obesity and ADHD in later life.
Adrienne also offers insights into coping with stillbirth and keeping pregnant women safe in extreme heat. And if you’ve been wondering if it’s better to play your unborn baby music by Metallica, Mozart or Taylor Swift, get ready for a surprise.
You can find out more about Adrienne’s research on the University of Sydney website. More information about the Safer Baby Bundle is available on the Stillbirth Centre of Research Excellence website.
Mark Scott 00:01
This podcast is recorded at the University of Sydney's Camperdown campus on the land of the Gadigal people of the Eora nation. They've been discovering and sharing knowledge here for tens of thousands of years. I pay my respects to Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander people.
Kerry Arabena 00:30
In the Gold Coast region they had Elders come in and talk about birthing stories, they went out and visited scar trees and birthing trees, they learned about particular native botanics that were good to use during pregnancy. The men learned carving and actually carved a big coolamon and clap sticks. And then they made kangaroo cloaks for all the babies that were going to be born. And there were choirs singing, there was dancing that happened and then all the babies were welcomed to Country. They all got a smoking ceremony. They were all placed in the coolamon that was made. So it became this really lovely expression of not only considering yourself and your own child, but the village that the child’s going to be born into. And on the day, there were like 45 babies, I don't know where all these babies came from. My name is Kerry Arabena. I'm a very proud descendant of the Meriam people from Murray Island in the Torres Strait, and also on my mother's side, Celtic. I'm the managing director of the First 1000 Days Australia initiative and we're currently based here on beautiful Wurundjeri lands.
Mark Scott 01:55
I've been learning about babies again. Decades after the exhausted fog of having children of our own, there's now a first grandchild, and the family has come to live with us for a while. At nine months, she talks endlessly. She's incredibly curious and engaged. She’s growing fast. And our best researchers are showing that so much of her life's destiny will be set in these first days of life. I'm Mark Scott, the Vice-Chancellor and President of the University of Sydney, and this is The Solutionists. With me is Adrienne Gordon, a baby doctor who spends hours with newborns at the Royal Prince Alfred Hospital, and a clinical professor within the Faculty of Medicine and Health at the University of Sydney. Hi Adrienne. You research the first 1000 days of life. What does that mean? Why is 1000 days important?
Dr Adrienne Gordon 02:53
So that covers from the time of conception when the sperm fertilises the egg, right through pregnancy, which is around nine months for most people, right up until the age of two. So early infancy to early childhood.
Mark Scott 03:07
So it's a time of extraordinary growth. Why do you see it as vital and important?
Dr Adrienne Gordon 03:13
Well, I think there's been a real recognition over the last decade that perhaps some of the most important aspects of life are before you even arrive. In that pregnancy period, the baby actually does more developing of systems and brain and how the cells work than they actually do over the next few years. So even by the time a child reaches one, [their] head is almost the same size as our heads by the time they're one. So that brain has done a huge amount of growing in the first nine months and the first year on the planet than at any other time. So it makes sense that if your brain is doing all of that, anything that happens in that period that is contributing to that folding and growth and volume is potentially going to play out in later life. And we know that we might be better to try and improve health trajectory if we really think about pregnancy or even before you're like a twinkle in your parents’ eye.
Mark Scott 04:15
Talking about the first 1000 days, how important is a mother's health and nutrition?
Dr Adrienne Gordon 04:21
It’s critically important. So we know in periods of starvation, that babies that are developing in utero have the ability to program themselves to deal with reduced nutrition. So they can have metabolic and cellular changes that then when they're born into a world of plenty, that adaptation for thrift doesn't work that well. So we know for example, in areas in Africa that have a kind of boom and bust harvest or in World War Two in occupied areas of the Netherlands, that when you follow up children who have been born to parents who are undernourished at that time, they can have higher rates of metabolic outcomes in later life so hypertension, cardiovascular disease, diabetes [or] obesity for example.
Mark Scott 05:09
Are you saying that the seeds of some of those diseases are evident in the first 1000 days of life?
Dr Adrienne Gordon 05:16
Yes, that doesn't mean they're easy to fix, but we do have a lot of data saying that that kind of intergenerational cycle of chronic disease can begin as a fetus. So we know, for example, that babies born of higher weight are more likely to have metabolic problems in childhood and adolescence, and that that can play into when they become pregnant themselves. So we have really good data actually from a few countries, but particularly from Scotland, looking at maternal pre-pregnancy weight, and then following over decades and decades, and looking at the offspring death related to cardiovascular disease. And we know that there's a dose response risk of dying a cardiovascular death or [of a] heart attack or stroke for example if you were born to a mother with a higher BMI prior to pregnancy.
Mark Scott 06:09
These days, we hear a lot about skin to skin contact, where does that come in?
Dr Adrienne Gordon 06:14
So in years gone past, babies that were born sicker early would have been, you know, very much cared for in an incubator, with all the technology, that's my sort of bread and butter, what I do every day. And as time has gone on, I've realised that really I'm, you know, kind of out of a job, because actually what we should be doing is much less of the technology and much more of the parent-centred care. So some recent really great data shows that if you place preterm babies or small babies skin to skin with their mothers from birth, that you can massively improve their survival. And we also know from the babies years ago that were cared for in the incubators, when you look at their cells and you look at epigenetic changes, so how the genes actually function, how they switch on and off, you can actually see changes in the babies who were born early, who had more separation. And those changes replicate what's seen in animal studies, when they completely just separate like a baboon from the baby baboon. So those changes appear to do things like affect people's stress response, how quickly their cortisol goes up, whether they feel more or less anxious, whether they have things like externalising behaviour disorders for example. So you know things like ADHD and autism, much more common in babies born preterm, sick or early. And some of these might be related to some of these cellular changes, as well as less brain development in utero because you've been born early.
Mark Scott 07:53
New parents feel such a burden of responsibility and I suppose listening to this they think, ‘wow, the baby's life destiny has been carved out by who we are and what we're doing in these early days’. How do you encourage new parents to get their heads around just the simple things that they should be doing to lay the best possible foundation for their baby's future?
Dr Adrienne Gordon 08:14
I guess what babies need and what children need as they’re growing up is attention, nutrition, shelter, all of those really important things. But I think, particularly in current society, I think being there is probably one of the key things, to not miss out on that time. You know, it goes so quickly. I remember when my kids were really small and people would say, you know, you must make sure you remember this time and you go, ‘I am so tired, I can't wait ‘til this time is done’. And you look back and you think, ‘gosh, so many things happen in such a short space of time’, that I think you just have to take every day and be there as much as you can. We do have really good research data around things like music and what sort of music is helpful.
Mark Scott 09:06
And what sort of music is helpful?
Dr Adrienne Gordon 09:07
Well apparently, it kind of depends a little bit on what you were listening to in utero. So you know, if your mother was most relaxed listening to Metallica, you might be more relaxed listening to Metallica than Mozart.
Mark Scott 09:21
I think it means in our household this baby is just another generation of Taylor Swift fans coming. She heard a lot of Taylor Swift in utero as I understand it.
Kerry Arabena 09:36
I have two children, and I've got three beautiful grandchildren. Part of the reason why I got involved in the First 1000 Days was I was a teenage mum. And back in the day it might have looked like I was in a rather desperate situation. But for me, it was the incitement to action. One of the strategies that we had a big conversation about at one particular region included co-sleeping, and there was a big public health push to stop co-sleeping because of the risks to babies during that really important time. And one woman said, ‘but co-sleeping is the only time I get to spend with my child and my husband’. And I went, let's stop right there just for one minute. And this is what it means to try to climb out of poverty, it means that you have both parents working two jobs to try to pay a mortgage and a car and pay all the bills that are necessary to lead a modern life. You take your children to an institution to be cared for, until they can go to the school institution, they go to an aftercare school institutional arrangement. You're engaged with institutions before you can come back home. And so I'm not sure that modernity is actually the best way of living a life in which we can get the chance to be parents. And I too worked that hard. However, I think that in a post-COVID environment, we've got a really strong chance to rethink what this all looks like.
Mark Scott 11:19
We're hearing just how hard many people have to work to give their kids a good start in life. You spent your professional career surrounded by babies, what still surprises you about them?
Dr Adrienne Gordon 11:32
How different they are. I think lots of people think, you know, ‘gosh, a baby's a baby’. But I think how different they are and their responses still fascinates me, how quickly babies learn and pick up what you do and mimic what you do I think is still fascinating. I guess working in the field that I do, in newborn intensive care, I also find it really fascinating what tiny babies go through and how close to death they might have been, and how they get through that. It's a real privilege to work in an area where actually most people do well and where most people end up going home. You know, if you're in adult intensive care most people don't go home. Now people often say ‘how can you do that it must be so sad’. But I think it's a real privilege working in an area where you feel you're making a difference. And I guess that's another area that I do a lot of work in is in stillbirth prevention.
Mark Scott 12:29
And what's your research informed you about that?
Dr Adrienne Gordon 12:33
So I've been working in that area since about 2006. We've learned a lot along the way about risk factors and prevention. But I think what I've learned the most is that when families experience the loss of a baby, it's huge and it has a ripple effect on their family and on the staff and on the people that they know. It's common. So you know about one in 130 families who become pregnant, get past all the first trimester, have all their scans, don't get to take that baby home at the end of the day. So that's about six babies every day in this country. And I think people don't talk about this. And if we move even further back in pregnancy, you know, about one in five people have miscarriage. I think what we've learned from research is that people want to talk about their baby. They want people to acknowledge that their baby had meaning even if they didn't have a life. They want some acknowledgement of the fact that their hopes and dreams were packaged up in this new person who never got to lead what was going to be. And that in terms of thinking about prevention, healthcare professionals, I think, gatekeep the information they give to people because they're worried about upsetting them. And I think that's really important too.
Mark Scott 13:59
I mean, it's unspeakably sad, I suppose, to even contemplate. So are you saying that you think there's an avoidance in discussing with parents to be about this as a reality, ‘this is what the research shows, we can't control everything, but this is what we can control’, having those kinds of conversations?
Dr Adrienne Gordon 14:18
I think that's exactly right. But we have done a lot of work with pregnant women and healthcare professionals and parents who've had lived experience of stillbirth, to create resources around stillbirth prevention. So there's a national program running now called the Safer Baby Bundle. That brings together five already known elements of care that were variably put into practice. So, sleeping on your side in late pregnancy, stopping smoking, not being around secondhand smoke, if you're worried about how your baby's moving, going to see somebody, it's not a waste of their time, they will always see you, trying to work out how better to look at baby's growth. All of those things together are sort of focused on trying to give strategies to clinicians and women about prevention. And then the other thing that's important is planned births. So normally, pregnancies are nine months, but over the whole country, the nine month pregnancy has shifted so that the average time in Australia for somebody to give birth to a baby is 39 weeks now not 40. And that's not biology, that's intervention. Some babies do need to be born earlier because [of] the risk factors for the mother of the baby, but many don't.
Mark Scott 15:34
So are you worried by that trend?
Dr Adrienne Gordon 15:35
I think it's a concerning trend because we know that if babies are born even just before term, so 37 to 38 weeks, then they're much more likely to have poorer educational outcomes at school. And that might be a component of the rise in conditions like ADHD and behaviour disorders etc. That might well be related to the shift across the nation of earlier planned birth. Just because you've been told you're going to have an induction on Wednesday, doesn't mean you shouldn't ask why, that should be a shared decision. It shouldn't just be provider led.
Mark Scott 16:17
Having worked in the school system, I mean, the increasing prevalence of say diagnosis of ADHD is one of the kind of common phenomena. And whether it's causation or correlation, it's hard to know. But what kind of data do we have about this?
Dr Adrienne Gordon 16:33
So we have population-based data from New South Wales from Natasha Nassar, who works here at Sydney Uni, is based at Children's Hospital Westmead and Charles Perkins Centre, actually looking directly at timing by week of gestation, and linked data looking at educational outcomes. So developmental vulnerability, NAPLAN scores, for example, showing that there is this direct link once you account for other factors related to timing of birth. So we've also seen that in Western Australia in the Raine Study, which is the longest running cohort study in this country, also shows the same data. And we've seen similar studies like that also in Canada and in the UK. So I think we already know that this is a contributor to some of the educational outcomes.
Kerry Arabena 17:27
A lot of Aboriginal and Torres Strait Islander peoples in contemporary life can live a long life. If they get to age 55, then it's entirely likely that you'll have the same kind of life expectancy as a non-Indigenous person. However, if mothers are smoking or if their nutrition isn't fantastic, and if you're born into stressful environments or impoverished ones, if you're not taught to regulate your behaviours and participate well in school, then you will have a range of different life experiences that will cause internal stress, and will cause your body to age. So even though you might have an age of 50, the physiology of your body is actually much older than that, which I suspect could be a reason why we die at an early age, that our physiology is much older because of the stressors that have been embedded into intergenerational transmission of trauma, into the deep experiences of colonisation. And so, in First 1000 Days Australia work we do not compare our children to non-Indigenous children at all. Because one was colonised and lost everything in order for the other to have a quality of life experience, whether they’re a newly arrived migrant or not. So there will be some different ways in which the first 1000 days needs to be conceived of for Aboriginal and Torres Strait Islander children and the families who are caring for them.
Mark Scott 19:11
That's Kerry Arabena, whose work applies an Indigenous lens to the first 1,000 days to help close the gap. You know, so much importance around the first 1000 days. Do you think our politicians, our policymakers, understand that, and that the right investment is being made at this vital stage of life in providing supporting infrastructure in the first 1000 days, given that there's a lifetime consequence that comes on the back of this?
Dr Adrienne Gordon 19:44
Yes, that's a really important question and I think until recently and even still recently, there has been a real lack of investment at the beginning of life, you know, women and children have missed out in terms of how researchers designed new medications. For example, I guess the COVID pandemic was a perfect example of pregnant women being excluded from clinical trials of interventions that might save lives, vaccine trials. So I think there definitely needs to be more investment at the beginning. And I think the issue is that, you know, the health system is set up to treat established disease, and billions of dollars treat that established disease. And thinking about prevention for something that might not happen for another 50 or 60 years is a very hard thing to get politicians and health departments to do, particularly when they're changing every few years. So I think it's a very important investment and certainly with regard to things like nutrition and physical activity and education, I think the tide is shifting, but more investment could definitely be made at the beginning of life in terms of prevention.
Mark Scott 20:50
I know one of the things that new parents worry about is the state of the world, and their baby could live ‘til they’re 100, and the world's getting a very complex place in which to live. As we live in a warmer world now, what does that mean for pregnant mothers? And what does that mean for newborn babies?
Dr Adrienne Gordon 21:09
Yeah, so it's an excellent and really important question. So we know that extreme heat measured, albeit imperfectly, in many settings, can lead to higher rates of stillbirth of small babies and of babies who are born preterm. And we also know that that is, on a global scale, likely to play out in a far greater way for women living in low and middle income settings or women living in disadvantage. So in many parts of the world, women do a lot of the farm work, a lot of the labour work, and they'd be doing that right up until when they have a baby. And as the world heats up, those risks are gonna become larger so we're really interested in trying to understand this area a lot better and use that to inform global health policy. So with the heat and health research incubator, we've just recently got a Wellcome Trust grant for something called the heat informed study. And we're running two projects in a combined program. So one is a cohort study across two countries, India and Bangladesh. And the other is a trial in the climate chamber here at Sydney University.
Mark Scott 22:23
With Ollie Jay, friend of the podcast, in his lab?
Dr Adrienne Gordon 22:27
In the lab, yes. So that what we will do is we'll have real time data from in country settings, where we will have personalised temperature sensors that women in the cohorts will wear, and then in the lab we’ll be able to actually look at what happens to maternal temperature, to the baby's heart rate, to the maternal heart rate. And we'll be able to actually replicate particular temperature and humidity in the lab. And I think without doing this work, we can't really say that we're going to be able to look after, or support policy for pregnant women. At the moment, the recommendations for looking at what happens with the body with heat is all based on 73kg men with 14% body fat, so not applicable to women or pregnant women. So hopefully, this will lead to something that will actually be able to inform health for pregnant women into the future.
Mark Scott 23:31
And thinking about AI and all of the mysteries it's helping to unlock, will Google Translate ever be able to tell me what my nine month old granddaughter is talking about?
Dr Adrienne Gordon 23:42
Well, I don't know. Probably! Probably.
Mark Scott 23:46
I imagine she'll be able to string a sentence together by the time the technology reaches there, but still, it's worth thinking about. I'm Mark Scott, Vice-Chancellor of the University of Sydney and many thanks to Dr Adrienne Gordon for her insights today. Adrienne is a neonatologist at the Royal Prince Alfred Hospital and a clinical professor within the Faculty of Medicine and Health at the University of Sydney. And a warm thank you also to Professor Kerry Arabena from the First 1000 Days Australia, a movement for strong families and strong culture. And if you want to find out more about Professor Ollie Jay and his work in the heat lab here at the University of Sydney, you can find the discussion with him at episode one of this podcast. Make sure you're following The Solutionists in your favourite podcast app, so you never miss a chance to meet the brightest minds working to solve the most complex issues, the people who are making change happen. The Solutionists is a podcast from the University of Sydney produced by Deadset Studios.
Did you know that when we sleep, we are brainwashed, literally. Sleep is something we all need, but many of us don't get enough of it and that puts our physical and mental health at risk. So how do we sleep better in our wide world? That's next time on The Solutionists. And if you missed our episode on how to make sure you live longer, but also live well, scroll back in your podcast feed to find it. Your future self will thank you.
The Solutionists is a podcast from the University of Sydney, produced by Deadset Studios.
Keep up to date with The Solutionists by following @sydney_uni on Twitter, Instagram, and Facebook.
This episode was produced by Monique Ross. Sound design by Jeremy Wilmot. The executive producer is Rachel Fountain. Executive editors are Jen Peterson-Ward, Kellie Riordan and Mark Scott.
This podcast was recorded on the land of the Gadigal people of the Eora nation. For thousands of years, across innumerable generations, knowledge has been taught, shared and exchanged here. We pay respect to Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander people.