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The nutritional stress imposed by reproduction affects maternal and fetal outcomes. Maternal nutrient stores can be depleted and fetal growth can be restricted in association with shorter birth intervals. Perinatal nutrition may be improved by adequate spacing of pregnancies with appropriate birth control.

Refusal to participate and drop out from the research program are two significant factors hindering the smooth flow of a study. In Pakistan, the major reason for the refusal by the protocol-eligible pregnant women for participating in a research program is the unwillingness of the family members.

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