A Summary of Pathways or Mechanisms Linking Preconception Maternal Nutrition with Birth Outcomes

Abstract

Population, human, animal, tissue, and molecular studies show collectively and consistently that maternal nutrition in the pre- or periconception period influences fetal growth and development, which subsequently affects the individual's long-term health. It is known that nutrition during pregnancy is an important determinant of the offspring's growth and health. However, now there is evidence that the mother's nutritional status at conception also influences pregnancy outcome and long-term health. For example, the mother's nutritional status at conception influences the way energy is partitioned between maternal and fetal needs. Furthermore, placental development during the first weeks of gestation reflects maternal nutrition and establishes mechanisms for balancing maternal and fetal nutritional needs. Also, maternal nutritional signals at fertilization influence epigenetic remodeling of fetal genes. These findings all indicate that maternal parenting begins before conception. The following papers from a symposium on preconception nutrition presented at the 2015 Scientific Sessions and Annual Meeting of the ASN emphasize the importance of maternal nutrition at conception on the growth and long-term health of the child.

Understanding the geographical burden of stunting in India: A regression‐decomposition analysis of district‐level data from 2015–16

“…We find, for instance, that low women's BMI explained almost a fifth of the difference between high‐ and low‐burden stunting districts, corroborating results from previous studies that maternal undernutrition before and during pregnancy is a major determinant of poor fetal growth and child stunting (Black et al, ). Accounting for one fifth of the global population with 42% of low BMI prepregnant women (Coffey, ), India faces a critical challenge because preconception undernutrition among women can influence birth outcomes and child growth through influencing early placental and embryonic development, epigenetic effects, and competition for nutrients between mother and baby (King, ).…”

“…Accounting for one fifth of the global population with 42% of low BMI prepregnant women (Coffey, 2015), India faces a critical challenge because preconception undernutrition among women can influence birth outcomes and child growth through influencing early placental and embryonic development, epigenetic effects, and competition for nutrients between mother and baby (King, 2016).…”

World Perspective on the Epidemiology of Stunting between 1990 and 2015

“…Ongoing nutrition-specific preconception intervention trials examining birth length are being conducted in India, Guatemala, Pakistan, and the Democratic Republic of Congo. These trials compare the effect of preconception lipid-based micronutrient supplement with or without a supplement in the last 2 trimesters of pregnancy [27, 28]. Another ongoing study in rural Vietnam is investigating the impact of a nutrient-dense meal rich in iron, zinc, vitamin A, B 12 , and folate beginning at marriage until the time of delivery [28, 29].…”

“…These trials compare the effect of preconception lipid-based micronutrient supplement with or without a supplement in the last 2 trimesters of pregnancy [27, 28]. Another ongoing study in rural Vietnam is investigating the impact of a nutrient-dense meal rich in iron, zinc, vitamin A, B 12 , and folate beginning at marriage until the time of delivery [28, 29]. The results from these studies will provide more information about the impact on quality and timing of diet interventions on the health of the newborn.…”

Neither Preconceptional Weekly Multiple Micronutrient nor Iron–Folic Acid Supplements Affect Birth Size and Gestational Age Compared with a Folic Acid Supplement Alone in Rural Vietnamese Women: A Randomized Controlled Trial

“…Specifically, maternal nutritional status before and during the early weeks of pregnancy may play a critical role in the development of the placenta, which serves as a critical sensor of nutrient requirements and regulates the transfer of nutrients and oxygen to the fetus throughout the course of pregnancy (5,6). Several micronutrients also have been identified as important determinants of pregnancy outcomes.…”