and KeywordsPoor maternal nutrition during pregnancy may predispose to intrauterine growth restriction (IUGR), immunological and metabolic adaptations which manifest as low birth weight and increase the risk of adult non-communicable disease. This study examined the relationships between maternal nutritional status, food intake and pregnancy weight gain (PWG) which may account for risk of low birth weight (LBW) in Nepal.A prospective cross-sectional study was undertaken in rural and urban Nepalese population using simple random sampling to select eligible subjects. A questionnaire designed for data collection including retrospective data from records and dietary intake were assessed using Food Frequency Questionnaire and 24 Hour Dietary Recall.Three hundred and seventy six women were recruited. A high prevalence of LBW (27.9%) and pre-term (14%) delivery were observed. LBW was higher in rural than urban subjects (p<0.05). Birth weight was related to period of gestation (r=0.609, p<0.05) (r=0.49, p<0.001), energy intake (r=0.061, p<0.001) and maternal protein intake (r=0.501, p<0.001). Low PWG (8.11 kg) was also observed and was associated with protein (r=0.499, p<0.01) and energy intake (r=0.396, p<0.01) and were lower among mothers in rural areas (p<0.05). Calcium intake was related to crown heel length (r=.399, p<0.001). Lipid, zinc and folate intake were significantly different in rural and urban subjects although the latter was adequate in both.Findings demonstrate the impact of maternal nutrition on birth outcomes in relation to specific nutrients and components of the diet. Targeted interventions are supported by the findings of this study in both rural and urban areas of Nepal.

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Intrauterine growth restriction predisposes to immunological and metabolic adaptations (1) and manifests as low birth weight (LBW) with implications for child survival. Lacks of access to antenatal services and poor maternal nutrition during pregnancy (2) have been associated with high rates of LBW in Nepal. Recently, attempts have been made to increase accessibility to antenatal services and mitigate the problem (3) . The objective of this study was to assess incidence of LBW in rural and urban Nepal. A sample of 400 pregnant women were recruited from rural (n = 200) and urban (n = 200) areas of Nepal. A cross-sectional retrospective and prospective approach was employed to obtain pre-pregnancy information including usual food intake (via FFQ), and prepregnancy maternal weight and height. Repeat 24 hr recall, tracking of weight gain and antenatal clinic attendance were recorded. Relationships between maternal weight and outcome of pregnancy were compared using correlation co-efficient and significance tested using independent t-test or Mann-Whitney U test and Chi Square test for non-parametric data. Total LBW incidence was 27.9 %, higher than previously reported in this population. The incidence was higher in rural (34.8%) compared to urban (21.2 %) areas (c 2 , p < 0.05). Mean pregnancy weight gain from first trimester was 8.11 (°2.04) kg (median = 8 kg) ranging from 4 kg to 16 kg and a rural:urban difference of Mean = 7.85°1.69 kg v. Mean = 8.36°2.32 kg (p < 0.05). Subjects showed wide variations in energy and protein intake. Mean energy intake was 8.04 MJ/d (SD, 1.77; median, 7.85 MJ/d); mean protein intake was low (48.5 g/d; SD 14.45 g; median, 46.2 g/d). Birth weight was associated with energy (r = 0.61, p < 0.001) and protein (r = 0.501, p < 0.001) intake.Pre-pregnancy maternal stunting and dietary intake during pregnancy were major contributory factors in the progress and outcome of pregnancy despite improved access to antenatal services with rural dwellers experiencing the worst outcome.