A Grand Challenge: Can Vitamin D Improve Growth During Pregnancy?

The world has made great strides in improving child health in the last few decades. But, for us, the fact that more than a third of all child deaths are still attributable to undernutrition is unacceptable. For many children in the developing world who do make it beyond their fifth birthday, undernutrition can lead not only to stunted growth but also puts them at risk for infectious diseases and long-term mental and physical problems.

A big priority for the Gates Foundation is for all children to have the nutrition and health care they need for a healthy start to life.

Current approaches to improve a child’s growth and development are important but even universal application of these tools during pregnancy and infancy would only decrease stunted growth by one third. We need new research to better understand the underlying biological reasons that cause physical and cognitive damage early in an undernourished child’s development.

An example of some of the challenges we are faced with in the two thirds of children with malnutrition not due to simple nutrition security is embodied in a very sweet little girl we met with Melinda Gates on a site visit to Mirpur, Dhaka, Bangladesh last year. We met little Srabonti, a patient in the Malnutrition Enteric Disease study; an only child whose mother was aware of the importance of breastfeeding, cleanliness and diet but who was concerned that her daughter was very small and short in stature (Srabonti was 22 months old with the stature of a 15 month child). Srabonti’s problem of 'stunting' is shared by up to 45% of children in Bangladesh and is of concern because it means that these children are not only short in stature but face the potential of decreased physical development and, of greater importance, mental development and school performance as a life-long disadvantage. Srabonti presents us with a moral and scientific challenge to understand the causes of her stunting-malnutrition and to reverse or prevent those changes so she can realize her full life potential.

Stories like these impress upon us the urgency to better understand how nutrition or exposure to infection impact health in infancy, childhood, and later in life.

That’s why we were particularly excited to launch two new grant programs within the Grand Challenges in Global Health initiative. The first, Discover New Ways to Achieve Healthy Growth, seeks to better understand the biological mechanisms that cause faltering growth in utero and during a child’s first 2 years of life, a key 1000-day developmental window that can have lifelong consequences. The second, Biomarkers of Gastrointestinal Function and Health, seeks to identify indicators of impaired gut function that might negatively impact growth. Armed with biomarkers as tools and new knowledge of the underlying causes of unhealthy growth, we will be better able to design, prioritize, and monitor new ways to prevent or reverse stunted growth and how it affects children in the long term.

We are happy to announce today seven grants for each of these two programs, over $21 million to 14 research teams in six countries. Here are four of those which illustrate various ways in which we are approaching this problem:

• Daniel Roth and colleagues at the Hospital for Sick Kids in Canada will test the role of Vitamin D in improving growth during pregnancy. We’ve known for a long time that Vitamin D is important for bone growth, but we know surprisingly little about its role in fetal growth.
• Robin Bernstein and colleagues at George Washington University in the United States will examine the effects of epigenetic and hormonal factors on growth during the first 1,000 days following conception. They will test the idea that that early growth in babies does not happen in a continuous manner but in spurts of rapid growth with periods of no growth in between. This project will follow a cohort of Gambian children very closely – taking measurements every other day – to understand why some children grow while others fail to grow.
• Christopher Duggan and colleagues at Children’s Hospital, Boston in the United States will test whether indicators of gut dysfunction can accurately predict impaired neurological development and stunted growth by working with an at-risk group of young Tanzanian children.
• Richard Guerrant and colleagues at the University of Virginia in the United States will study samples of urine, plasma and feces to identify gastrointestinal biomarkers that could identify children at risk of chronic malnutrition and possible developmental impairments.

Please visit the Grand Challenges in Global Health grants awarded site to read summaries of all the funded projects. We hope this research will guide the development of new approaches to dramatically reduce the number of lives lost to undernutrition and to ensure that all children have the opportunity for a healthy start to life.

If you are interested in applying for grant programs like these, please visit the Grand Challenges website. If you are interested in learning more about undernutrition, please visit 1,000 Days.