Maternal malnutrition is a huge problem in poor communities, particularly in low- and middle-income countries. To address this problem, researchers from several countries conducted a study on the effects of nutritional supplements on fetal growth-related birth outcomes. They reported that before conception or late in the first trimester are the optimal times for supplementation for mothers to reduce the likelihood of stunting in infants. Their study appeared in The American Journal of Clinical Nutrition.
Maternal malnutrition is a global problem
The problem of maternal and child malnutrition is widespread and continues to be a major public health issue. In fact, along with micronutrient deficiencies, they affect approximately half of the world's population. While child malnutrition is associated with greater susceptibility to illnesses and mortality under five years of age, maternal malnutrition increases the risk of poor pregnancy outcomes, such as postpartum hemorrhage and low birth weight. Babies that are born with low birth weights tend to suffer from stunted growth and various illnesses throughout their lives or even succumb to death at an early age. (Related: Nutrition Provides Key to Preventing Needless Deaths of Kids World-Wide.)
According to a study, maternal malnutrition is most prevalent in South Asia, particularly in Pakistan and Bangladesh, where more than 30 percent of women of child-bearing age suffer from chronic energy deficiency. In sub-Saharan Africa, only three countries out of 46 show a decline in the rate of severe maternal malnutrition. Key factors that are said to contribute to this include low status in society, less access to information and health services, poor mental health, low self-esteem, illiteracy, lack of female empowerment, and poverty.
Over the years, numerous trials have been made to improve maternal malnutrition due to its direct impact on society and the life of infants and children. While there are many environmental factors that can also cause stunting -- impaired growth and development of children -- and adverse birth outcomes, maternal malnutrition is still considered the primary target for interventions because it can deprive fetuses of the necessary nutrients that drive physical growth. From this, the concept of nutritional supplementation during conception was born. However, the effects of this type of intervention on birth outcomes, especially in resource-poor settings, are poorly understood due to lack of sufficient information and studies.
The optimal period of supplementation to combat maternal malnutrition
To address this gap in knowledge, researchers from different countries launched a collaborative study to determine the benefits of taking supplements prior to conception. They hypothesized that starting on a comprehensive nutrition supplement months ahead of conception could increase newborn length compared to starting the same intervention between the first and second trimesters or not taking any supplements at all.
The researchers conducted their study in rural or semi-rural locations in four countries, namely the the Democratic Republic of the Congo, Guatemala, India, and Pakistan. They recruited participants from 53 global networks and screened them for eligibility in terms of age (between 16-35), parity, contraceptive use, and expectation to conceive. A total of 7,376 women passed the screening and were enrolled.
The researchers provided these women a lipid-based supplement that provided micronutrients, polyunsaturated fats, and modest amounts of energy and protein. The participants in the first group took this supplement three months or more prior to conception. Meanwhile, participants in the second group received the same supplement during their second and third trimesters. Supplementation only ended for both groups after delivery.
The researchers reported that the participants who took the supplement had favorable birth outcomes. Supplementation resulted in greater mean birth size and a 31 percent decrease in the risk of stunting at birth. They also found that women who received the supplements were 22 percent less likely to give birth to an infant that was too small for gestational age, suggesting that proper maternal nutrition is key to eliminating stunting in infants.
On the other hand, the researchers found no significant differences between supplementation prior to conception and during the first trimester, which disproved their hypothesis. Despite this, the researchers were satisfied with the results. Their findings demonstrated that poor fetal growth can be improved even in low-resource countries with adequate maternal nutrition via supplementation. They also succeeded in determining the optimal period to start supplementation in order to avoid the unwanted outcomes of maternal malnutrition.
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