(34.3 ± 1.8 and 34.3 ± 1.5 cm, respectively) at birth. Offspring of supplemented primigravidae (n = 370) were heavier (difference, 99.4 g; 95% CI, 5.5 to 193.4) and had larger head circumferences (difference, 0.5 cm; 95% CI, 0.1 to 0.9) than controls; the differences in multigravidae

This review paper highlights mechanisms for nutritional regulation of maternal health and fetal development. Malnutrition (nutrient deficiencies or obesity) in pregnant women adversely affects their health by causing or exacerbating a plethora of problems, such as anaemia, maternal haemorrhage, insulin resistance, and hypertensive disorders (e.g. pre-eclampsia/eclampsia). Maternal malnutrition during gestation also impairs embryonic and fetal growth and development, resulting in deleterious outcomes, including intrauterine growth restriction (IUGR), low birthweight, preterm birth, and birth defects (e.g. neural tube defects and iodine deficiency disorders). IUGR and preterm birth contribute to high rates of neonatal morbidity and mortality. Major common mechanisms responsible for malnutrition-induced IUGR and preterm birth include: (i) abnormal growth and development of the placenta; (ii) impaired placental transfer of nutrients from mother to fetus; (iii) endocrine disorders; and (iv) disturbances in normal metabolic processes. Activation of a series of physiological responses leading to premature and sustained contraction of the uterine myometrium also results in preterm birth. Recent epidemiologic studies have suggested a link between IUGR and chronic metabolic disease in children and adults, and the effects of IUGR may be carried forward to subsequent generations through epigenetics. While advanced medical therapies, which are generally unavailable in low-income countries, are required to support preterm and IUGR infants, optimal nutrition during pregnancy may help ameliorate many of these problems. Future studies are necessary to develop effective nutritional interventions to enhance fetal growth and development and alleviate the burden of maternal morbidity and mortality in low-and middle-income countries.

Evidence from observational studies and randomised trials has suggested a potential association between intake of n-3 long-chain polyunsaturated fatty acids (LCPUFA) during pregnancy and certain pregnancy and birth outcomes. Marine foods (e.g. fatty sea fish, algae) and select freshwater fish contain pre-formed n-3 LCPUFA, which serve as precursors for bioactive molecules (e.g. prostaglandins) that influence a variety of biological processes. The main objective of this analysis was to summarise evidence of the effect of n-3 LCPUFA intake during pregnancy on select maternal and child health outcomes. Searches were performed in PubMed, EMBASE, and other electronic databases to identify trials where n-3 LCPUFA were provided to pregnant women for at least one trimester of pregnancy. Data were extracted into a standardised abstraction table and pooled analyses were conducted using RevMan software. Fifteen randomised controlled trials were eligible for inclusion in the meta-analysis, and 14 observational studies were included in the general review. n-3 LCPUFA supplementation during pregnancy resulted in a modest increase in birthweight (mean difference = 42.2 g; [95% CI 14.8, 69.7]) and no significant differences in birth length or head circumference. Women receiving n-3 LCPUFA had a 26% lower risk of early preterm delivery (<34 weeks) (RR = 0.74; [95% CI 0.58, 0.94]) and there was a suggestion of decreased risk of preterm delivery (RR = 0.91; [95% CI 0.82, 1.01]) and low birthweight (RR = 0.92; [95% CI 0.83, 1.02]). n-3 LCPUFA in pregnancy did not influence the occurrence of pre-eclampsia, high blood pressure, infant death, or stillbirth. Our review of observational studies revealed mixed findings, with several large studies reporting positive associations between fish intake and birthweight and several reporting no associations. In conclusion, n-3 LCPUFA supplementation during pregnancy resulted in a decreased risk of early preterm delivery and a modest increase in birthweight. More studies in low-and middle-income countries are needed to determine any effect of n-3 LCPUFA supplementation in resource-poor settings, where n-3 PUFA intake is likely low. fish oil, pregnancy and birth outcomes, maternal health, infant health. Evidence from observational studies has suggested a potential association between intake of marine foods during pregnancy and certain pregnancy and birth outcomes. Researchers observed in the 1980s that women living in the Faroe Islands, where seafood is commonly consumed, had longer gestational duration and heavier babies than women living in Denmark. Keywords 1,2Additionally, researchers found that Greenland Inuits had lower rates of pre-eclampsia than Danish women. These observations instigated future research founded on the hypothesis that intake of marine foods in pregnancy might influence maternal and neonatal health outcomes.Marine foods are rich sources of the n-3 longchain polyunsaturated fatty acids (LCPUFA) docosahexaenoic acid (DHA, 22:6n-3) and eicosapentaenoic acid (EPA,,...

The potential impact of wheat flour fortification with iron and folic acid was assessed using data about food purchases from the nationally representative 2000 Guatemalan Living Standards Measurement Survey. Of 7265 households, 35% were indigenous and 57% rural; 11% were extremely poor, 35% were poor, and 54% were nonpoor. The percentage of households that purchased wheat flour, sweet bread, French rolls, and sliced bread in the previous 15 d was 10, 88, 59, and 11%, respectively. The median amount of fortified wheat flour equivalents in purchased foods was 50 g/d per adult equivalent; fortified wheat flour equivalents were 7, 25, and 110 g/d for the poverty groups, 16 g/d in indigenous households and 24 g/d in rural households. Wheat flour fortification contributed 2.3 mg/d of iron and 90 microg/d of folic acid per adult equivalent. Assuming 5% bioavailability, wheat flour fortification provided 2% of the recommended dietary allowance (RDA) and 6% of estimated average requirement (EAR) iron levels for women of reproductive age; values were 1, 3, and 12% of EAR levels for the poverty groups, respectively. Wheat flour fortification met 26% of folic acid RDA and 33% of EAR levels for women; values were 5, 16, and 71% of EAR levels for the poverty groups, respectively. In conclusion, the impact of fortification is likely to be substantial for folate status in nonpoor and urban women but limited in the case of iron status among all social groups. The poorest, rural, indigenous populations who suffer the highest burden of nutritional deficiencies likely benefit least from wheat flour fortification.

DHA supplementation during pregnancy decreased the occurrence of colds in children at 1 month and influenced illness symptom duration at 1, 3, and 6 months.

Soil-transmitted helminths (STHs), primarily Ascaris, Trichuris and hookworm, inflict a substantial morbidity burden on poor populations living in tropical and subtropical regions. Chronic STH infections can cause intestinal blood loss and nutrient loss and/or malabsorption, which can result in or exacerbate iron deficiency, anaemia and other nutritional deficiencies. More than 1 billion people are infected with at least one STH, and at least 44 million pregnant women are infected with hookworm alone. Pregnant women are especially vulnerable to the harmful consequences of these parasitic infections due to increased nutritional demands during pregnancy. We aimed to determine the effect of antihelminthics in pregnancy on maternal, newborn and child health (MNCH) outcomes. A systematic review was conducted using online databases, and relevant articles were hand searched. We included four observational studies in the general review and four randomised controlled trials (RCTs) in the meta-analysis (total n = 3777 for the meta-analysis). Antihelminthics in pregnancy had no overall benefit on maternal anaemia In all four trials, antihelminthics in pregnancy significantly decreased the prevalence of STH infection. Three observational studies showed that antihelminthics in pregnancy improved maternal iron status, two studies reported beneficial effects on birthweight, and two studies found a beneficial effect on infant survival. Although few RCTs to date have failed to collectively demonstrate a clear beneficial impact of antihelminthics in pregnancy on maternal, newborn and child health outcomes, findings from observational studies suggest a potential benefit on maternal anaemia, birthweight and infant mortality. This meta-analysis was limited by a dearth of evidence from RCTs, and further trials examining the effect of antihelminthics starting in the second trimester of pregnancy in poor, STH-endemic regions with high rates of anaemia are needed. Antihelminthics, helminth infection, pregnancy, anemia, maternal and child health. Soil-transmitted helminth (STH) infections are common worldwide and contribute to a high burden of malnutrition and morbidity in poor tropical and subtropical regions, where environmental control measures such as adequate sanitation are limited. The most common STH parasites, Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm), and Ancylostoma duodenale and Necator americanus (hookworms), infect more than 1 billion people worldwide, cause the annual loss of 39 million disability adjusted life years, and infections with these three parasites are designated Neglected Tropical Diseases. 1-3 An estimated 44 million pregnant women are infected with hookworm and the prevalence of infection is highest in very poor, rural populations in sub-Saharan Africa, South-East Asia and China. 1,4 Co-infection with multiple species of STHs occurs often, and co-infection with Plasmodium falciparum (P. falciparum) in malariaendemic regions is common. Keywords:Transmission of geohelminths is m...

Maternal undernutrition affects a large proportion of women in many developing countries, but has received little attention as an important determinant of poor maternal, newborn, and child health (MNCH) outcomes such as intrauterine growth restriction, preterm birth (PTB), and maternal and infant morbidity and mortality. We recently evaluated the scientific evidence on the effects of maternal nutrition interventions on MNCH outcomes as part of a project funded by the Gates Foundation to identify critical knowledge gaps and priority research needs. A standardized tool was used for study data abstraction, and the effect of nutrition interventions during pregnancy or of factors such as interpregnancy interval on MNCH outcomes was assessed by meta-analysis, when possible. Several nutrient interventions provided during pregnancy have beneficial effects on MNCH outcomes, but are not widely adopted. For example, prenatal calcium supplementation decreases the risk of PTB and increases birthweight; prenatal zinc, omega-3 fatty acids and multiple micronutrient supplements reduce the risk of PTB (<37 weeks), early PTB (<34 weeks) and low birthweight (LBW), respectively. Among currently implemented interventions, balanced protein-energy and iron-folic acid supplementation during pregnancy significantly reduce the risk of LBW by 20-30% in controlled settings, but variable programmatic experiences have led to questionable effectiveness. Early age at pregnancy and short interpregnancy intervals were also associated with increased risk of PTB, LBW and neonatal death, but major gaps remain on the role of women's nutrition before and during early pregnancy and nutrition education and counseling. These findings emphasize the need to examine the benefits of improving maternal nutrition before and during pregnancy both in research and program delivery.

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