Lancet nutrition series: Supplementation during pregnancy 'insufficient' to boost offspring health

By Will Chu

- Last updated on GMT

©iStock/ArtTim
©iStock/ArtTim
Micronutrient supplementation started in pregnancy can correct important maternal nutrient deficiencies, but it is not sufficient to improve child health, according to research in The Lancet.

The paper’s​conclusion also believes dietary interventions in pregnancy can limit weight gain, but have proved insufficient in improving pregnancy outcomes.

“Micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies with modest effects on increasing birthweight, but no subsequent improvement in child health outcomes,” ​the paper’s authors commented.

“Although every effort should be made to correct micronutrient deficiencies in women once pregnant, there is a growing consensus that the greatest gain will be achieved through a life-course approach or continuum of improved nutrition in children, adolescents, and young women contemplating pregnancy.”

The conclusion echoes findings from another paper​ in the journal that form a series of work focusing on preconception health.

Here, colleagues from the Universities of Cambridge, Southampton and University College London discuss a number of  interventions to improve women's nutritional status and health behaviours at all preconception action phases.

These include the use of modern marketing techniques to promote a social movement based on an “emotional and symbolic connection”​ between improved preconception maternal health and nutrition, and offspring health.

Private sector partnerships

They added that speedy and scalable benefits to public health could be achieved through strategic engagement with the private sector though it was not without its difficulties.

 “Engaging with the food industry is crucial because of their reach and power to shape consumer behaviour,”​ the paper said.

“A major difficulty with applying the mutual benefit approach to improving preconception nutrition and lifestyle through a relationship with the food industry is their history of malpractice in respect to infant feeding and their role in generating and sustaining an obesogenic environment.”

Despite such considerations, the paper highlighted a campaign by Unilever to market iron-fortified stock cubes to reduce iron-deficiency anaemia in women in Nigeria.

According to the first paper, iron deficiency anaemia remains the most common deficiency globally affecting around 2 billion people and 30–50% of pregnant women including young women in high-income countries.

Although iron supplementation in pregnancy reduces iron deficiency anaemia and improves haemoglobin concentrations at term, other benefits seem limited to a reduction in low birthweight.

Distinctions between high-income countries and low to middle-income countries (LMICs) have become blurred said the paper attributing “demographic and obstetric transition”.

Additionally, populations in high-income countries are already experiencing the LMIC’s shift to high-income lifestyles that foster obesity.

The paper pointed to the link between obesity, poor nutrition and specific micronutrient deficiencies that went unrecognised until pregnancy.

The Mumbai Maternal Nutrition Project

The second paper extended this theme suggesting a series of preconception nutritional interventions include supplementation or food fortification to provide micronutrients, particularly folic acid and iodine.

Details of The Mumbai Maternal Nutrition Project showed that a locally sourced, micronutrient-rich snack, given daily before conception and during pregnancy, reduced the likelihood of gestational diabetes and increased birthweight in a high-risk Indian population (but only among mothers who were not underweight).

“These studies represent the best available evidence for the benefits of preconception nutritional supplementation,”​ said the paper’s authors.

“Effective strategies to improve access to additional calories before conception still need to be identified in contexts where maternal undernutrition is common.”

While evidence from robust and context-relevant trials of preconception nutrition and health behaviour interventions was sparse, the paper did highlight several trials currently underway.

The authors also called for the immediate strengthening of public health strategies to improve nutritional status in children and in adults of reproductive age.

Source: The Lancet
Published online ahead of print: doi.org/10.1016/S0140-6736(18)30311-8
“Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health.”
Authors: Judith Stephenson et al.

Source: The Lancet
Published online ahead of print: doi.org/10.1016/S0140-6736(18)30313-1
“Intervention strategies to improve nutrition and health behaviours before conception.”
Authors: Judith Stephenson et al.

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