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Maternal Nutrition and Birth Outcomes

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Nutrition and Health in a Developing World

Part of the book series: Nutrition and Health ((NH))

Abstract

There is increasing recognition of the important role maternal nutrition plays in improving birth outcomes. This chapter summarizes the state of current knowledge on the role of maternal nutrition before and during pregnancy in determining birth outcomes especially preterm birth (PTB) and small for gestational age (SGA) that are of considerable public health significance and related to the health, well-being and survival of the next generation, with recommendations for action both for programs and future research. Meta-analyses of intervention trials show that prenatal supplementation with calcium, zinc and n-3 PUFA lowers the risk of PTB, whereas MMN and balanced protein–energy (BPE) supplementation resulted in increased birth weight. Interventions such as iodine and periconceptional folic acid are also important for reducing pregnancy losses and birth defects. Growing evidence supports the importance of ensuring good nutrition for women of reproductive age, but more information on the nature of the intervention and implementation strategies is needed to design effective preconceptional nutrition interventions. There is also a need to identify better ways to overcome barriers to program implementation with improved methods for targeting and measuring program effectiveness for maternal nutrition before and during pregnancy. Finally, nutrition and health programs that focus on improving birth outcomes should strengthen linkages with other sectors such as agriculture, water and sanitation, family planning, education and social protection.

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References

  1. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371(9609):340–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452–77.

    Article  PubMed  Google Scholar 

  3. Fall CH, Sachdev HS, Osmond C, Restrepo-Mendez MC, Victora C, Martorell R, et al. Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration). Lancet Glob Health. 2015;3(7):e366–77.

    Article  PubMed  Google Scholar 

  4. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51.

    Article  PubMed  Google Scholar 

  5. Ramakrishnan U, Imhoff-Kunsch B, Martorell R. Maternal nutrition interventions to improve maternal, newborn, and child health outcomes. Nestle Nutr Inst Workshop Ser. 2014;78:71–80.

    Article  PubMed  Google Scholar 

  6. Ververs MT, Antierens A, Sackl A, Staderini N, Captier V. Which anthropometric indicators identify a pregnant woman as acutely malnourished and predict adverse birth outcomes in the humanitarian context? PLoS Curr. 2013;5.

    Google Scholar 

  7. Nguyen P, Ramakrishnan U, Katz B, Gonzalez-Casanova I, Lowe AE, Nguyen H, et al. Mid-upper-arm and calf circumferences are useful predictors of underweight in women of reproductive age in northern Vietnam. Food Nutr Bull. 2014;35(3):301–11.

    Article  PubMed  Google Scholar 

  8. Kozuki N, Katz J, Lee AC, Vogel JP, Silveira MF, Sania A, et al. Short maternal stature increases risk of small-for-gestational-age and preterm births in low- and middle-income countries: individual participant data meta-analysis and population attributable fraction. J Nutr. 2015;145(11):2542–50.

    Article  CAS  PubMed  Google Scholar 

  9. Rah JH, Christian P, Shamim AA, Arju UT, Labrique AB, Rashid M. Pregnancy and lactation hinder growth and nutritional status of adolescent girls in rural Bangladesh. J Nutr. 2008;138(8):1505–11.

    CAS  PubMed  Google Scholar 

  10. Mission JF, Marshall NE, Caughey AB. Pregnancy risks associated with obesity. Obstet Gynecol Clin North Am. 2015;42(2):335–53.

    Article  PubMed  Google Scholar 

  11. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lee SE, Talegawkar SA, Merialdi M, Caulfield LE. Dietary intakes of women during pregnancy in low- and middle-income countries. Public Health Nutr. 2013;16(8):1340–53.

    Article  PubMed  Google Scholar 

  13. Taren DL, Duncan B, Shrestha K, Shrestha N, Genaro-Wolf D, Schleicher RL, et al. The night vision threshold test is a better predictor of low serum vitamin A concentration than self-reported night blindness in pregnant urban Nepalese women. J Nutr. 2004;134(10):2573–8.

    CAS  PubMed  Google Scholar 

  14. Taren D. Historical and practical uses of assessing night blindness as an indicator for vitamin A deficiency. Panama City, Panama, Geneva: World Health Organization; 2012. 15–17 Sept 2010.

    Google Scholar 

  15. Christian P, West KP Jr, Khatry SK, Katz J, LeClerq S, Pradhan EK, et al. Vitamin A or beta-carotene supplementation reduces but does not eliminate maternal night blindness in Nepal. J Nutr. 1998;128(9):1458–63.

    CAS  PubMed  Google Scholar 

  16. Katz J, Tielsch JM, Thulasiraj RD, Coles C, Sheeladevi S, Yanik EL, et al. Risk factors for maternal night blindness in rural South India. Ophthalmic Epidemiol. 2009;16(3):193–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ramakrishnan U, Grant F, Goldenberg T, Zongrone A, Martorell R. Effect of women’s nutrition before and during early pregnancy on maternal and infant outcomes: a systematic review. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):285–301.

    Article  PubMed  Google Scholar 

  18. Ramakrishnan U, Grant FK, Imdad A, Bhutta ZA, Martorell R. Effect of multiple micronutrient versus iron-folate supplementation during pregnancy on intrauterine growth. Nestle Nutr Inst Workshop Ser. 2013;74:53–62.

    Article  PubMed  Google Scholar 

  19. Imdad A, Bhutta ZA. Effects of calcium supplementation during pregnancy on maternal, fetal and birth outcomes. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):138–52.

    Article  PubMed  Google Scholar 

  20. Imdad A, Bhutta ZA. Routine iron/folate supplementation during pregnancy: effect on maternal anaemia and birth outcomes. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):168–77.

    Article  PubMed  Google Scholar 

  21. Ota E, Mori R, Middleton P, Tobe-Gai R, Mahomed K, Miyazaki C, et al. Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev. 2015;2:CD000230.

    Google Scholar 

  22. McCauley ME, van den Broek N, Dou L, Othman M. Vitamin A supplementation during pregnancy for maternal and newborn outcomes. Cochrane Database Syst Rev. 2015;10:CD008666.

    Google Scholar 

  23. De-Regil LM, Palacios C, Lombardo LK, Pena-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2016;1:CD008873.

    Google Scholar 

  24. Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2015;11:CD004905.

    Google Scholar 

  25. Ota E, Hori H, Mori R, Tobe-Gai R, Farrar D. Antenatal dietary education and supplementation to increase energy and protein intake. Cochrane Database Syst Rev. 2015;6:CD000032.

    Google Scholar 

  26. Lassi ZS, Salam RA, Haider BA, Bhutta ZA. Folic acid supplementation during pregnancy for maternal health and pregnancy outcomes. Cochrane Database Syst Rev. 2013;3:CD006896.

    Google Scholar 

  27. Rumbold A, Ota E, Nagata C, Shahrook S, Crowther CA. Vitamin C supplementation in pregnancy. Cochrane Database Syst Rev. 2015;9:Cd004072.

    Google Scholar 

  28. Pena-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015;7:CD004736.

    Google Scholar 

  29. Gresham E, Byles JE, Bisquera A, Hure AJ. Effects of dietary interventions on neonatal and infant outcomes: a systematic review and meta-analysis. Am J Clin Nutr. 2014;100(5):1298–321.

    Article  CAS  PubMed  Google Scholar 

  30. Taylor PN, Okosieme OE, Dayan CM, Lazarus JH. Therapy of endocrine disease: impact of iodine supplementation in mild-to-moderate iodine deficiency: systematic review and meta-analysis. Eur J Endocrinol. 2014;170(1):R1–15.

    Article  CAS  PubMed  Google Scholar 

  31. Imhoff-Kunsch B, Briggs V, Goldenberg T, Ramakrishnan U. Effect of n-3 long-chain polyunsaturated fatty acid intake during pregnancy on maternal, infant, and child health outcomes: a systematic review. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):91–107.

    Article  PubMed  Google Scholar 

  32. Chaffee BW, King JC. Effect of zinc supplementation on pregnancy and infant outcomes: a systematic review. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):118–37.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Walker N, Fischer-Walker C, Bryce J, Bahl R, Cousens S, Effects CRGoI. Standards for CHERG reviews of intervention effects on child survival. Int J Epidemiol. 2010;39(Suppl 1):i21–31.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Imdad A, Bhutta ZA. Maternal nutrition and birth outcomes: effect of balanced protein-energy supplementation. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):178–90.

    Article  PubMed  Google Scholar 

  35. Carlson SE, Colombo J, Gajewski BJ, Gustafson KM, Mundy D, Yeast J, et al. DHA supplementation and pregnancy outcomes. Am J Clin Nutr. 2013;97(4):808–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Dror DK, Allen LH. Interventions with vitamins B6, B12 and C in pregnancy. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):55–74.

    Article  PubMed  Google Scholar 

  37. López-Flores F, Neufeld LM, Sotres-Álvarez D, García-Guerra A, UR. Compliance to micronutrient supplementation in children 3 to 24 months of age from a semi-rural community in Mexico. Salud Publica Mexico. 2012;54:470–8.

    Google Scholar 

  38. Mridha MK, Matias SL, Chaparro CM, Paul RR, Hussain S, Vosti SA, et al. Lipid-based nutrient supplements for pregnant women reduce newborn stunting in a cluster-randomized controlled effectiveness trial in Bangladesh. Am J Clin Nutr. 2016;103(1):236–49.

    Article  CAS  PubMed  Google Scholar 

  39. Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Zeilani M, Peerson JM, et al. Lipid-based nutrient supplement increases the birth size of infants of primiparous women in Ghana. Am J Clin Nutr. 2015;101(4):835–46.

    Article  CAS  PubMed  Google Scholar 

  40. Thorne-Lyman AL, Fawzi WW. Vitamin A and carotenoids during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):36–54.

    Article  PubMed  Google Scholar 

  41. Girard AW, Olude O. Nutrition education and counselling provided during pregnancy: effects on maternal, neonatal and child health outcomes. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):191–204.

    Article  PubMed  Google Scholar 

  42. Bhutta ZA, Imdad A, Ramakrishnan U, Martorell R. Is it time to replace iron folate supplements in pregnancy with multiple micronutrients? Paediatr Perinat Epidemiol. 2012;26(Suppl 1):27–35.

    Article  PubMed  Google Scholar 

  43. Zimmermann MB. The effects of iodine deficiency in pregnancy and infancy. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):108–17.

    Article  PubMed  Google Scholar 

  44. Ronsmans C, Fisher DJ, Osmond C, Margetts BM, Fall CH. Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on stillbirths and on early and late neonatal mortality. Food Nutr Bull. 2009;30(4 Suppl):S547–55.

    Article  PubMed  Google Scholar 

  45. Imhoff-Kunsch B, Briggs V. Antihelminthics in pregnancy and maternal, newborn and child health. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):223–38.

    Article  PubMed  Google Scholar 

  46. Girard AW, Self JL, McAuliffe C, Olude O. The effects of household food production strategies on the health and nutrition outcomes of women and young children: a systematic review. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):205–22.

    Article  PubMed  Google Scholar 

  47. King JC. A summary of pathways or mechanisms linking preconception maternal nutrition with birth outcomes. J Nutr 2016;146(7):1437s–44s.

    Google Scholar 

  48. De-Regil LM, Pena-Rosas JP, Fernandez-Gaxiola AC, Rayco-Solon P. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev. 2015;12:CD007950.

    Google Scholar 

  49. Hund L, Northrop-Clewes CA, Nazario R, Suleymanova D, Mirzoyan L, Irisova M, et al. A novel approach to evaluating the iron and folate status of women of reproductive age in Uzbekistan after 3 years of flour fortification with micronutrients. PLoS ONE. 2013;8(11):e79726.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Dean SV, Lassi ZS, Imam AM, Bhutta ZA. Preconception care: nutritional risks and interventions. Reprod Health. 2014;11(Suppl 3):S3.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Gibbs CM, Wendt A, Peters S, Hogue CJ. The impact of early age at first childbirth on maternal and infant health. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):259–84.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Potdar RD, Sahariah SA, Gandhi M, Kehoe SH, Brown N, Sane H, et al. Improving women’s diet quality preconceptionally and during gestation: effects on birth weight and prevalence of low birth weight—a randomized controlled efficacy trial in India (Mumbai maternal nutrition project). Am J Clin Nutr. 2014;100(5):1257–68.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Ramakrishnan U, Nguyen PH, Gonzalez-Casanova I, Pham H, Hao W, et al. 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. J Nutr 2016;146(7):1445S–52S.

    Google Scholar 

  54. Young MF, Nguyen PH, Addo OY, Hao W, Nguyen H, Pham H, et al. The relative influence of maternal nutritional status before and during pregnancy on birth outcomes in Vietnam. Eur J Obstet Gynecol Reprod Biol. 2015;194:223–7.

    Article  PubMed  Google Scholar 

  55. Hambidge KM, Krebs NF, Westcott JE, Garces A, Goudar SS, Kodkany BS, et al. Preconception maternal nutrition: a multi-site randomized controlled trial. BMC Pregnancy Childbirth. 2014;14:111.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Tu N, King JC, Dirren H, Thu HN, Ngoc QP, Diep AN. Effect of animal-source food supplement prior to and during pregnancy on birthweight and prematurity in rural Vietnam: a brief study description. Food Nutr Bull. 2014;35(4 Suppl):S205–8.

    Article  PubMed  Google Scholar 

  57. Martorell R, Zongrone A. Intergenerational influences on child growth and undernutrition. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):302–14.

    Article  PubMed  Google Scholar 

  58. Morton SM, De Stavola BL, Leon DA. Intergenerational determinants of offspring size at birth: a life course and graphical analysis using the Aberdeen children of the 1950s study (ACONF). Int J Epidemiol. 2014;43(3):749–59.

    Article  PubMed  Google Scholar 

  59. Addo OY, Stein AD, Fall CH, Gigante DP, Guntupalli AM, Horta BL, et al. Parental childhood growth and offspring birthweight: pooled analyses from four birth cohorts in low and middle income countries. Am J Hum Biol. 2015;27(1):99–105.

    Article  CAS  PubMed  Google Scholar 

  60. Ramakrishnan U, Martorell R, Schroeder DG, Flores R. Role of intergenerational effects on linear growth. J Nutr. 1999;129(2S Suppl):544S–9S.

    CAS  PubMed  Google Scholar 

  61. Shrimpton R. Global policy and programme guidance on maternal nutrition: what exists, the mechanisms for providing it, and how to improve them? Paediatr Perinat Epidemiol. 2012;26(Suppl 1):315–25.

    Article  PubMed  Google Scholar 

  62. Lutter CK, Daelmans BM, de Onis M, Kothari MT, Ruel MT, Arimond M, et al. Undernutrition, poor feeding practices, and low coverage of key nutrition interventions. Pediatrics. 2011;128(6):e1418–27.

    Article  PubMed  Google Scholar 

  63. Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. Lancet Glob Health. 2013;1(1):e16–25.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Duffy M, Lamstein S, Lutter C, Koniz-Booher P. Review of programmatic reponses to adolescent and women’s nutrition needs in low and middle income countries. Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project. Arlington, VA; 2015.

    Google Scholar 

  65. Leroy JL, Gadsden P, Gonzalez de Cossio T, Gertler P. Cash and in-kind transfers lead to excess weight gain in a population of women with a high prevalence of overweight in rural Mexico. J Nutr. 2013;143(3):378–83.

    Google Scholar 

  66. Varea A, Malpeli A, Disalvo L, Apezteguia M, Falivene M, Ferrari G, et al. Evaluation of the impact of a food program on the micronutrient nutritional status of Argentinean lactating mothers. Biol Trace Elem Res. 2012;150(1–3):103–8.

    Article  PubMed  Google Scholar 

  67. Liu J, Jin L, Meng Q, Gao L, Zhang L, Li Z, et al. Changes in folic acid supplementation behaviour among women of reproductive age after the implementation of a massive supplementation programme in China. Public Health Nutr. 2015;18(4):582–8.

    Article  PubMed  Google Scholar 

  68. Kotecha PV, Nirupam S, Karkar PD. Adolescent girls’ anaemia control programme, Gujarat, India. Indian J Med Res. 2009;130(5):584–9.

    CAS  PubMed  Google Scholar 

  69. Vir SC, Singh N, Nigam AK, Jain R. Weekly iron and folic acid supplementation with counseling reduces anemia in adolescent girls: a large-scale effectiveness study in Uttar Pradesh, India. Food Nutr Bull. 2008;29(3):186–94.

    Article  PubMed  Google Scholar 

  70. Rah JH, de Pee S, Halati S, Parveen M, Mehjabeen SS, Steiger G, et al. Provision of micronutrient powder in response to the cyclone Sidr emergency in Bangladesh: cross-sectional assessment at the end of the intervention. Food Nutr Bull. 2011;32(3):277–85.

    Article  PubMed  Google Scholar 

  71. Passerini L, Casey GJ, Biggs BA, Cong DT, Phu LB, Phuc TQ, et al. Increased birth weight associated with regular pre-pregnancy deworming and weekly iron-folic acid supplementation for Vietnamese women. PLoS Negl Trop Dis. 2012;6(4):e1608.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Barber SL. Mexico’s conditional cash transfer programme increases cesarean section rates among the rural poor. Eur J Public Health. 2010;20(4):383–8.

    Article  PubMed  Google Scholar 

  73. Baxter JA, Roth DE, Al Mahmud A, Ahmed T, Islam M, Zlotkin SH. Tablets are preferred and more acceptable than powdered prenatal calcium supplements among pregnant women in Dhaka, Bangladesh. J Nutr. 2014;144(7):1106–12.

    Google Scholar 

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Authors and Affiliations

  1. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA

    Usha Ramakrishnan, Melissa Fox Young & Reynaldo Martorell

  2. Nutrition & Health Sciences Program, Graduate Division of Biological & Biomedical Sciences, Emory University, Atlanta, GA, USA

    Usha Ramakrishnan, Melissa Fox Young & Reynaldo Martorell

Authors
  1. Usha Ramakrishnan
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  2. Melissa Fox Young
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  3. Reynaldo Martorell
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Correspondence to Melissa Fox Young .

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Editors and Affiliations

  1. World Food Programme , Rome, Italy

    Saskia de Pee

  2. School of Public Health, University of Arizona Mel and Enid Zuckerman, Tucson, Arizona, USA

    Douglas Taren

  3. World Food Programme, Nutrition Division , Rome, Italy

    Martin W. Bloem

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Ramakrishnan, U., Young, M.F., Martorell, R. (2017). Maternal Nutrition and Birth Outcomes. In: de Pee, S., Taren, D., Bloem, M. (eds) Nutrition and Health in a Developing World . Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-319-43739-2_22

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  • DOI: https://doi.org/10.1007/978-3-319-43739-2_22

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