Maternal Undernutrition before and during Pregnancy and Offspring Health and Development

Abstract

Maternal undernutrition remains a critical public health problem. There are large regional and within-country disparities in the burden of underweight, anemia, and micronutrient deficiencies across the globe. Driving these disparities are complex and multifactorial causes, including access to health services, water and sanitation, women’s status, and food insecurity as well as the underlying social, economic, and political context. Women’s health, nutrition, and wellbeing across the continuum of preconception to pregnancy are critical for ensuring positive pregnancy and long-term outcomes for both the mother and child. In this review, we summarize the evidence base for nutrition interventions before and during pregnancy that will help guide programs targeted towards women’s nutrition. Growing evidence from preconception nutrition trials demonstrates an impact on offspring size at birth. Preconception anemia and low preconception weight are associated with an increased risk of low birth weight and small for gestational age births. During pregnancy, several evidence-based strategies exist, including balanced-energy protein supplements, multiple micronutrient supplements, and small-quantity lipid nutrient supplements for improving birth outcomes. There, however, remain several important priority areas and research gaps for improving women’s nutrition before and during pregnancy. Further progress is needed to prioritize preconception nutrition and access to health and family planning resources. Additional research is required to understand the long-term effects of preconception and pregnancy interventions particularly on offspring development. Furthermore, while there is a strong evidence base for maternal nutrition interventions, the next frontier requires a greater focus on implementation science and equity to decrease global maternal undernutrition disparities.

Preconception Hemoglobin Concentration and Risk of Low Birth Weight and Small-for-Gestational-Age: A Large Prospective Cohort Study in China

“…Low birth weight (LBW), a proxy for assessing intrauterine fetus malnutrition and growth retardation, is associated with neonatal mortality and morbidity, and even longterm health status into adulthood [6][7][8]. Approximately 20 million infants are born with LBW worldwide each year [9].…”

Sibling rank and sibling number in relation to cardiovascular disease and mortality risk: a nationwide cohort study

“…This could address, for example, the dilution of resources theory 25 of special relevance for disadvantaged girls; epigenetic factors influencing the metabolic syndrome in offspring 26 and maternal health during pregnancy, including the effects of multiple births/child rearing on maternal health and family resources, especially in deprived settings with large families. 27 …”

The Transition From Undernutrition to Overnutrition Under Adverse Environments and Poverty: The Risk for Chronic Diseases

“…Several studies point to the effects of fetal programming and maternal and environmental factors during early life on the development of diseases in adulthood (11)(12)(13)(14)(15)(16). Maternal nutrition even before pregnancy can affect the development of the fetus with later risk for cardiovascular/metabolic diseases (12). Early undernutrition followed by later overweight increases the risk of NCD, imposing a high metabolic load on a reduced or altered capacity for homeostasis.…”