Impact of Supplementation

Numerous investigators have explored the benefits of energy and/or protein supplementation for pregnancy weight gain and other outcomes. However, relatively few trials have randomly assigned these supplements and used control diets. A statistical analysis was conducted of the 10 such studies that met this criterion in 1995. Most, but not all, of these studies were performed in developing countries. A 5-year controlled trial in The Gambia provided daily prenatal dietary supplements (two biscuits) that contained 4250 kJ energy and 22 g protein. This supplement increased pregnancy weight gain and birth weight during the hungry and harvest seasons. There was a significant but very small increase in head circumference and a significant reduction in perinatal mortality.

It was originally thought that timing of supplementation during later gestation would be most likely to increase birth weight. This hypothesis was supported by data from the Dutch famine, during which women in their third trimester had infants with the lowest birth weights. An increase in low birth weight prevalence was also observed in The Gambia when third-trimester gestation overlapped with the hungry season. Nonetheless, research suggests nutrition interventions initiated earlier in pregnancy will have the strongest effect on birth weight. There are enduring advantages to continued supplementation postpartum (during lactation) and into the ensuing pregnancy. A longitudinal study in Guatemala reported a significant increase (approximately 350 g) in birth weight in the second pregnancy when the mother was supplemented during the previous pregnancy and throughout subsequent lactation and the second pregnancy compared to those who were not supplemented during the prior pregnancy. Overall, it is appropriate for supplementation to begin as early in the pregnancy as possible so that both mother and fetus receive the maximum benefits for optimal health and development. However, this advice is tempered by concerns that supplementation of short Asian women may increase their offspring's risk of diabetes in later life.

See also: Adolescents: Nutritional Requirements. Breast Feeding. Lactation: Physiology; Dietary Requirements. Obesity: Complications. Pregnancy: Role of Placenta in Nutrient Transfer; Nutrient Requirements; Energy Requirements and Metabolic Adaptations; Safe Diet for Pregnancy; Dietary Guidelines and Safe Supplement Use; Prevention of Neural Tube Defects; Pre-eclampsia and Diet.

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