Strategies for optimizing maternal nutrition to promote infant development

Abstract

BackgroundThe growing appreciation of the multi-faceted importance of optimal maternal nutrition to the health and development of the infant and young child is tempered by incompletely resolved strategies for combatting challenges.ObjectiveTo review the importance of maternal nutrition and strategies being employed to optimize outcomes.MethodsSelected data from recent literature with special focus on rationale for and currently published results of maternal nutrition supplements, including lipid based nutrition supplements.Results1) An impelling rationale for improving the maternal and in utero environment of low resource populations has emerged to achieve improved fetal and post-natal growth and development. 2) Based partly on population increases in adult height over one-two generations, much can be achieved by reducing poverty. 3) Maternal, newborn and infant characteristics associated with low resource environments include evidence of undernutrition, manifested by underweight and impaired linear growth. 4) Apart from broad public health and educational initiatives, to date, most specific efforts to improve fetal growth and development have included maternal nutrition interventions during gestation. 5) The relatively limited but real benefits of both iron/folic acid (IFA) and multiple micronutrient (MMN) maternal supplements during gestation have now been reasonably defined. 6) Recent investigations of a maternal lipid-based primarily micronutrient supplement (LNS) have not demonstrated a consistent benefit beyond MMN alone. 7) However, effects of both MMN and LNS appear to be enhanced by commencing early in gestation.ConclusionsPoor maternal nutritional status is one of a very few specific factors in the human that not only contributes to impaired fetal and early post-natal growth but for which maternal interventions have demonstrated improved in utero development, documented primarily by both improvements in low birth weights and by partial corrections of impaired birth length. A clearer definition of the benefits achievable by interventions specifically focused on correcting maternal nutrition deficits should not be limited to improvements in the quality of maternal nutrition supplements, but on the cumulative quantity and timing of interventions (also recognizing the heterogeneity between populations). Finally, in an ideal world these steps are only a prelude to improvements in the total environment in which optimal nutrition and other health determinants can be achieved.

Adherence to Mediterranean Diet and Maternal Lifestyle during Pregnancy: Island–Mainland Differentiation in the CRIBS Birth Cohort

“…It is characterized by a high intake of whole foods, fruits, vegetables, whole grain cereals, legumes, fish, and nuts and extra-virgin olive oil, low-to-moderate consumption of dairy products, smaller amounts of white meat and red wine, and a minimal consumption of processed food, red meat, animal fats, and sugar [ 3 ]. In this context, the beneficial effects of the Mediterranean diet on the mother’s health during gestation, as well as the importance of maternal health for the child later in life has been well established [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. However, the influence of the maternal diet is also interlinked with many other lifestyle factors, including smoking, body mass index (BMI), education, age, urban versus rural residency etc., [ 11 ].…”

Effect of Adherence to Mediterranean Diet during Pregnancy on Children’s Health: A Systematic Review

“…The Developmental Origins of Health and Disease (DOHaD) hypothesis posits that in utero exposure plays a critical role in the risk of disease in adulthood. Maternal diet during pregnancy contributes to the in-utero environment [1]; nutritional stress/stimulus applied during critical periods of early development permanently influences organism’s physiology and metabolism, with the consequences of this metabolic programming often being observed much later in life [2,3]. Although the DOHaD hypothesis is well documented in animals [4], evidence connecting maternal diet quality during pregnancy and offspring risk factors is scarce and inconsistent in humans.…”

Preconception nutrition intervention improved birth length and reduced stunting and wasting in newborns in South Asia: The Women First Randomized Controlled Trial

“…The goal of this trial was not to evaluate a specific nutrition product or combination of products but rather to use these products to advance our understanding of the extent to which deficits in fetal growth could be corrected by commencing nutrition interventions very early in pregnancy or for a substantial time prior to conception in women of childbearing age in these and similar populations. It is quite possible that greater effects could be achieved with further modifications of the interventions, perhaps especially if guidelines for maternal gestational weight gain could be matched, and that these may be achievable with sustainable solutions including education and dietary improvements [41]. Meanwhile, the results of this trial extend our knowledge of the extent to which fetal growth deficits in poor S. Asian populations are attributable to undernutrition alone and can be corrected with nutrition interventions in women of childbearing age.…”