A lifetime of health: maximising the potential of every baby

'How much did she weigh?' is the first question friends and family ask when a new baby is born. For some babies, particularly in the developing world, the answer is a matter of life or death. 'Small babies are more susceptible to infection, and much more likely to die in the first few days of life', says Stephen Kennedy, Professor of Reproductive Medicine in the Nuffield Department of Obstetrics and Gynaecology. 'And those who survive are more prone to chronic diseases in adulthood, such as diabetes and cardiovascular disease.'

With Professor José Villar, Professor Kennedy directs the Oxford Maternal and Perinatal Health Initiative (OMPHI) at Green Templeton College. Supported by $25m of funding from the Bill and Melinda Gates Foundation, OMPHI is currently coordinating a large-scale, multi-centre, collaborative project called INTERGROWTH-21^st to understand better the growth of infants during the 'first 1,000 days', from conception to the age of two.

It's a common assumption that babies born in countries such as India and China are smaller than those in the UK or US simply because they are genetically different, rather than because the conditions under which they developed before birth were less than ideal. Professors Kennedy and Villar initially set up INTERGROWTH-21^st to find out how babies should grow if there is a 'level playing field' in terms of the mother's health, environment and socioeconomic status.

Partners in the collaboration have used ultrasound to record the growth of foetuses in healthy, well-nourished mothers in Brazil, China, India, Italy, Kenya, Oman, the UK and the USA. They are also monitoring the growth and development of the children born in these centres through the first two years of life. The results are yet to be published, but, says Professor Kennedy, the indications are that 'if the mother's health and environment are optimal, any differences between ethnic groups are smaller than people believe'.

Having established how babies should grow in the best circumstances, Professors Kennedy and Villar have launched a second collaboration, INTERBIO-21^st, to improve understanding of why foetuses grow less well when mothers are exposed to malnutrition and infection, especially in resource-poor settings. 'Babies can be small for many reasons, and yet the medical profession treats them as if they are all the same', says Professor Kennedy. 'In no other branch of medicine would you treat a life-changing condition without proper diagnosis.'

New partners include units in Kenya and Thailand that form part of the Oxford University Tropical Medicine Network. INTERBIO-21^st will begin to tease out why some children are born too small or too early, by collecting data on the mother's diet, lifestyle and environment as well as biological samples to understand how an adverse environment in the womb affects the function of genes involved in fetal growth.

INTERGROWTH-21^st is producing new standards for the assessment of mothers, their developing babies and their newborn infants. 'These are vital tools', says Professor Villar, 'and will ultimately help us to design and deliver personalised treatment programmes that are essential if we are to give every baby the right to a healthy life.'