Supplemental feeding during pregnancy compared with maternal supplementation during lactation does not affect schooling and cognitive development through late adolescence123 Breastfeeding and child cognitive development: new evidence from a large randomized trial. Preconception maternal nutrition: a multi-site randomized controlled trial Associations of Infant Nutrition with Insulin Resistance Measures in Early Adulthood: Evidence from the Barry-Caerphilly Growth (BCG) Study A pilot randomized controlled trial to promote healthful fish consumption during pregnancy: The Food for Thought Study Maternal low glycaemic index diet, fat intake and postprandial glucose influences neonatal adiposity – secondary analysis from the ROLO study Probiotics and dietary counselling contribute to glucose regulation during and after pregnancy: a randomised controlled trial. Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial Prenatal lipid-based nutrient supplements increase cord leptin concentration in pregnant women from rural Burkina Faso. Improving women's diet quality preconceptionally and during gestation: effects on birth weight and prevalence of low birth weight—a randomized controlled efficacy trial in India (Mumbai Maternal Nutrition Project)12345 Energy supplementation in the last trimester of pregnancy in East Java, Indonesia: effect on maternal anthropometry. The effects of dietary supplementation during pregnancy on placental morphology, pathology, and histomorphometry. Effect of a milk-based food supplement on maternal nutritional status and fetal growth in underweight Chilean women. Formulation and evaluation of supplementary foods for Thai pregnant women. Immune function in rural Gambian children is not related to season of birth, birth size, or maternal supplementation status. Prospective study of protein-energy supplementation early in life and of growth in the subsequent generation in Guatemala. Nutrition during pregnancy: the effects of an educational intervention program in Greece. Effects of prenatal nutritional supplementation on the placenta: report of a randomized controlled trial. Energy supplementation in the last trimester of pregnancy in East Java, Indonesia: effect on breast-milk output. The effects of nutritional supplementation on physical growth of children at risk of malnutrition. Effect of food supplementation (WIC) during pregnancy on birth weight. Outcome of maternal nutritional supplementation: a comprehensive review of the Bacon Chow study. Maternal and child nutritional supplementation are inversely associated with fasting plasma glucose concentration in young Guatemalan adults. The effects of nutritional supplementation on the diets of low-income families at risk of malnutrition. Nutritional supplementation and the outcome of pregnancy. I. Birth weight. Effect of nutrition education on the nutritional status of low-income pregnant women of Mexican descent. The Bacon Chow study: maternal nutrition supplementation and birth weight of offspring. Maternal and fetal responses to the stresses of lactation concurrent with pregnancy and of short recuperative intervals. Proportions and concentrations of serum n-3 fatty acids can be increased by dietary counseling during pregnancy The Bacon Chow study: maternal supplementation and infant growth. Dietary protein energy supplementation of pregnant Asian mothers at Sorrento, Birmingham. II: Selective during third trimester only. Prenatal food supplementation fortified with multiple micronutrients increases birth length: a randomized controlled trial in rural Burkina Faso. Dietary supplementation of rural Gambian women during pregnancy does not affect body composition in offspring at 11-17 years of age. Well-being in pregnancy: an examination of the effect of socioeconomic, dietary and lifestyle factors including impact of a low glycaemic index dietary intervention Leaf Concentrate Fortification of Antenatal Protein-Calorie Snacks Improves Pregnancy Outcomes Maternal and childhood nutrition and later blood pressure levels in young Guatemalan adults. Can a Low–Glycemic Index Diet Reduce the Need for Insulin in Gestational Diabetes Mellitus? A randomized longitudinal dietary intervention study during pregnancy: effects on fish intake, phospholipids, and body composition Evidence of infant blood pressure programming by maternal nutrition during pregnancy: a prospective randomized controlled intervention study. A randomized trial to investigate the effects of pre-natal and infant nutritional supplementation on infant immune development in rural Gambia: the ENID trial: Early Nutrition and Immune Development Exposure to a nutrition supplementation intervention in early childhood and risk factors for cardiovascular disease in adulthood: evidence from Guatemala. Maternal body mass index and gestational weight gain and their association with perinatal outcomes in Viet Nam. Maternal multiple micronutrient supplementation has limited impact on micronutrient status of Bangladeshi infants compared with standard iron and folic acid supplementation. The influence of a low glycemic index dietary intervention on maternal dietary intake, glycemic index and gestational weight gain during pregnancy: a randomized controlled trial Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Fermented soyabean and vitamin C-rich fruit: a possibility to circumvent the further decrease of iron status among iron-deficient pregnant women in Indonesia. Maternal protein-energy supplementation does not affect adolescent blood pressure in The Gambia Is relative leg length a biomarker of childhood nutrition? Long-term follow-up of the Hyderabad Nutrition Trial. Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Effects of a nutrition intervention program during pregnancy. Maternal data phases 1 and 2. Identification of those most likely to benefit from a low-glycaemic index dietary intervention in pregnancy. Effects on birth weight and perinatal mortality of maternal dietary supplements in rural gambia: 5 year randomised controlled trial A randomized controlled trial of prenatal nutritional supplementation in New York City. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults Weight status and dietary intake determine serum leptin concentrations in pregnant and lactating women and their infants. Short-Term Nutrition Education Reduces Low Birthweight and Improves Pregnancy Outcomes among Urban Poor Women in Bangladesh Maternal nutrition supplementation during pregnancy interferes with physical resemblance of siblings at birth according to infant sex. Nutritional supplementation, psychosocial stimulation, and mental development of stunted children: the Jamaican Study Energy supplementation in the last trimester of pregnancy in East Java: I. Effect on birthweight The effects of maternal cigarette smoking on placental morphology, histomorphometry, and biochemistry. Pregnancy and Glycemic Index Outcomes study: effects of low glycemic index compared with conventional dietary advice on selected pregnancy outcomes. Prenatal and Postnatal Milk Supplementation and Adult Insulin-like Growth Factor I: Long-term Follow-up of a Randomized Controlled Trial Impact of dietary counselling on nutrient intake during pregnancy: a prospective cohort study. Child growth (0-5 years), and the effect of entitlement to a milk supplement. Nutritional supplementation and the outcome of pregnancy. II. Visual habituation at 15 days. THE EFFECT OF A LOW CALORIE DIET OR A THIAZIDE DIURETIC ON THE INCIDENCE OF PRE‐ECLAMPSIA AND ON BIRTH WEIGHT Nutritional supplementation, maternal education, and cognitive development of infants at risk of malnutrition. The Bacon Chow study: effect of nutritional supplementation on maternal weight and skinfold thicknesses during pregnancy and lactation. Randomized, controlled trial to examine the impact of providing yogurt to women enrolled in WIC. Nutritional supplementation during pregnancy and offspring cardiovascular disease risk in The Gambia. Differing effects of low and high bulk maternal dietary supplements during pregnancy. The bacon Chow study: effects of maternal nutritional supplementation on birth measurements of children, accounting for the size of a previous (unsupplemented) child. Maternal and newborn nutrition studies at Philadelphia Lying-In Hospital: newborn studies. I. Size and growth of babies of mothers receiving nutrient supplements. Food Supplementation of Pregnant Women at Risk of Malnutrition and their Newborns' Responsiveness to Stimulation Effect of daily milk supplementation on serum and umbilical cord blood folic acid concentrations in pregnant Han and Mongolian women and birth characteristics in China. Influence of dietary supplementation during pregnancy on lactation performance. Fat-modified diets during pregnancy and lactation and serum lipids after birth Nutritional supplementation in girls influences the growth of their children: prospective study in Guatemala.
Background : The long-term impact of early malnutrition on human capital outcomes remains unclear , and existing evidence has come largely from observational studies . Objective : We compared the impact of a nutritional supplement given during pregnancy or lactation in rural Gambia on educational performance and cognitive ability in offspring at their maturity . Design : This study was a follow-up of a r and omized trial of prenatal high protein and energy supplementation conducted between 1989 and 1994 . Subjects were 16–22 y of age at follow-up , and information was collected on schooling achievement and cognitive ability by using the Raven 's progressive matrices test , Mill Hill vocabulary test , and forward and backward digit-span tests . Results : A total of 1459 individuals were traced and interviewed and represented 71 % of the original cohort and 81 % of the surviving cohort . There was no difference in cognitive ability or educational attainment between treatment groups by using any of the methods of assessment . Conclusion : We have shown little evidence to support a long-term effect of prenatal protein-energy supplementation compared with supplementation during lactation on cognitive development  in rural Gambians . This trial was registered at http://www.controlled-trials.com as IS RCT N72582014 CONTEXT The evidence that breastfeeding improves cognitive development is based almost entirely on observational studies and is thus prone to confounding by subtle behavioral differences in the breastfeeding mother 's behavior or her interaction with the infant . OBJECTIVE To assess whether prolonged and exclusive breastfeeding improves children 's cognitive ability at age 6.5 years . DESIGN Cluster-r and omized trial , with enrollment from June 17 , 1996 , to December 31 , 1997 , and follow-up from December 21 , 2002 , to April 27 , 2005 . SETTING Thirty-one Belarussian maternity hospitals and their affiliated polyclinics . PARTICIPANTS A total of 17,046 healthy breastfeeding infants were enrolled , of whom 13,889 ( 81.5 % ) were followed up at age 6.5 years . INTERVENTION Breastfeeding promotion intervention modeled on the Baby-Friendly Hospital Initiative by the World Health Organization and UNICEF . MAIN OUTCOME MEASURES Subtest and IQ scores on the Wechsler Abbreviated Scales of Intelligence , and teacher evaluations of academic performance in reading , writing , mathematics , and other subjects . RESULTS The experimental intervention led to a large increase in exclusive breastfeeding at age 3 months ( 43.3 % for the experimental group vs 6.4 % for the control group ; P < .001 ) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months . The experimental group had higher means on all of the Wechsler Abbreviated Scales of Intelligence measures , with cluster-adjusted mean differences ( 95 % confidence intervals ) of + 7.5 ( + 0.8 to + 14.3 ) for verbal IQ , + 2.9 ( -3.3 to + 9.1 ) for performance IQ , and + 5.9 ( -1.0 to + 12.8 ) for full-scale IQ . Teachers ' academic ratings were significantly higher in the experimental group for both reading and writing . CONCLUSION These results , based on the largest r and omized trial ever conducted in the area of human lactation , provide strong evidence that prolonged and exclusive breastfeeding improves children 's cognitive development . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N37687716 Background Research directed to optimizing maternal nutrition commencing prior to conception remains very limited , despite suggestive evidence of its importance in addition to ensuring an optimal nutrition environment in the periconceptional period and throughout the first trimester of pregnancy . Methods / Study design This is an individually r and omized controlled trial of the impact on birth length ( primary outcome ) of the time at which a maternal nutrition intervention is commenced : Arm 1 : ≥ 3 mo preconception vs. Arm 2 : 12 - 14 wk gestation vs. Arm 3 : none.192 ( derived from 480 ) r and omized mothers and living offspring in each arm in each of four research sites ( Guatemala , India , Pakistan , Democratic Republic of the Congo ) . The intervention is a daily 20 g lipid-based ( 118 kcal ) multi-micronutient ( MMN ) supplement .  Women r and omized to receive this intervention with body mass index ( BMI ) < 20 or whose gestational weight gain is low will receive an additional 300 kcal/d as a balanced energy-protein supplement . Research ers will visit homes biweekly to deliver intervention and monitor compliance , pregnancy status and morbidity ; ensure prenatal and delivery care ; and promote breast feeding . The primary outcome is birth length . Secondary outcomes include : fetal length at 12 and 34 wk ; incidence of low birth weight ( LBW ) ; neonatal/infant anthropometry 0 - 6 mo of age ; infectious disease morbidity ; maternal , fetal , newborn , and infant epigenetics ; maternal and infant nutritional status ; maternal and infant microbiome ; gut inflammatory biomarkers and bioactive and nutritive compounds in breast milk . The primary analysis will compare birth Length-for-Age Z-score ( LAZ ) among trial arms ( independently for each site , estimated effect size : 0.35 ) . Additional statistical analyses will examine the secondary outcomes and a pooled analysis of data from all sites . Discussion Positive results of this trial will support a paradigm shift in attention to nutrition of all females of child-bearing age . Trial registration Clinical Trials.gov NCT01883193 Background Previous studies suggest that over-nutrition in early infancy may programme long-term susceptibility to insulin resistance . Objective To assess the association of breast milk and quantity of infant formula and cows ' milk intake during infancy with insulin resistance measures in early adulthood . Design Long-term follow-up of the Barry Caerphilly Growth cohort , into which mothers and their offspring had originally been r and omly assigned , between 1972–1974 , to receive milk supplementation or not .  Participants were the offspring , aged 23–27 years at follow-up ( n = 679 ) .  Breastfeeding and formula/cows ' milk intake was recorded prospect ively by nurses . The main outcomes were insulin sensitivity ( ISI0 ) and insulin secretion ( CIR30 ) . Results 573 ( 84 % ) individuals had valid glucose and insulin results and complete covariate information . There was little evidence of associations of breastfeeding versus any formula/cows ' milk feeding or of increasing quartiles of formula/cows ' milk consumption during infancy ( <3 months ) with any outcome measure in young adulthood . In fully adjusted models , the differences in outcomes between breastfeeding versus formula/cows ' milk feeding at 3 months were : fasting glucose ( −0.07 mmol/l ; 95 % CI : −0.19 , 0.05 ) ; fasting insulin ( 8.0 % ; −8.7 , 27.6 ) ; ISI0 ( −6.1 % ; −11.3 , 12.1 ) and CIR30 ( 3.8 % ; −19.0 , 32.8 ) . There was also little evidence that increasing intakes of formula/cows ' milk at 3 months were associated with fasting glucose ( increase per quartile of formula/cows ' milk intake = 0.00 mmol/l ; −0.03 , 0.03 ) ; fasting insulin ( 0.8 % ; −3.2 , 5.1 ) ; ISI 0 ( −0.9 % ; −5.1 , 3.5 ) and CIR30 ( −2.6 % ; −8.4 , 3.6 ) . Conclusions We found no evidence that increasing consumption of formula/cows ' milk in early infancy was associated with insulin resistance in young adulthood Background Nutritionists advise pregnant women to eat fish to obtain adequate docosahexaenoic acid ( DHA ) , an essential nutrient important for optimal brain development . However , concern exists that this advice will lead to excess intake of methylmercury , a developmental neurotoxicant . Objective Conduct a pilot intervention to increase consumption of high-DHA , low-mercury fish in pregnancy . Methods In April-October 2010 we recruited 61 women in the greater Boston , MA area at 12–22 weeks gestation who consumed < = 2 fish servings/month , and obtained outcome data from 55 . We r and omized participants to 3 arms : Advice to consume low-mercury/high-DHA fish ( n=18 ) ; Advice + grocery store gift cards ( GC ) to purchase fish ( n=17 ) ; or Control messages ( n=20 ) . At baseline and 12-week follow-up we estimated intake of fish , DHA and mercury using a 1-month fish intake food frequency question naire , and measured plasma DHA and blood and hair total mercury . Results Baseline characteristics and mean ( range ) intakes of fish [ 21 ( 0–125 ) g/day ] and DHA from fish [ 91 ( 0–554 ) mg/d ] were similar in all 3 arms . From baseline to follow-up , intake of fish [ Advice : 12 g/day ( 95 % CI : -5 , 29 ) , Advice+GC : 22 g/day ( 5 , 39 ) ] and DHA [ Advice : 70 mg/d ( 3 , 137 ) , Advice+GC : 161 mg/d ( 93 , 229 ) ] increased in both intervention groups , compared with controls . At follow-up , no control women consumed > = 200mg/d of DHA from fish , compared with 33 % in the Advice arm ( p=0.005 ) and 53 % in the Advice+GC arm ( p=0.0002 ) . We did not detect any differences in mercury intake or in biomarker levels of mercury and DHA between groups . Conclusions An educational intervention  increased consumption of fish and DHA but not mercury . Future studies are needed to determine intervention effects on pregnancy and childhood health outcomes .Trial registration Registered on clinical trials.gov as Background The in utero environment is known to affect fetal development however many of the mechanisms by which this occurs remain unknown . The aim of this study was to examine the association between maternal dietary macronutrient intake and lifestyle throughout pregnancy and neonatal weight and adiposity . Methods This was an analysis of 542 mother and infant pairs from the ROLO study ( R and omised cOntrol trial of LOw glycaemic index diet versus no dietary intervention to prevent recurrence of fetal macrosomia ) . Food diaries as well as food frequency and lifestyle and physical activity question naires were completed during pregnancy . Maternal anthropometry was measured throughout pregnancy and neonatal anthropometry was measured at birth . Results Multiple linear regression analysis revealed the main maternal factor associated with increased birth weight was greater gestational weight gain R2adj23.3 % ( F = 11.547 , p < 0.001 ) . The main maternal factor associated with increased birth length was non-smoking status R2adj27.8 % ( F = 6.193 , p < 0.001 ) . Neonatal central adiposity ( determined using waist : length ratio ) was negatively associated with maternal age , and positively associated with the following parameters : smoking status , maternal pre-pregnancy arm circumference , percentage energy from saturated fat in late pregnancy , postpr and ial glucose at 28 weeks gestation and membership of the control group with a positive trend towards association with trimester 2 glycaemic load R2adj 38.1 % ( F = 8.000 , p < 0.001 ) . Conclusions Several maternal diet and lifestyle factors were associated with neonatal anthropometry .  Low glycaemic index dietary intervention in pregnancy was found to have a beneficial effect on neonatal central adiposity . Additionally , central adiposity was positively associated with maternal dietary fat intake and postpr and ial glucose highlighting the important role of healthy diet in pregnancy in promoting normal neonatal adiposity . Trial registration Current Controlled Trials IS RCT N54392969 Balanced glucose metabolism ensures optimal fetal growth with long-term health implication s conferred on both mother and child . We examined whether supplementation of probiotics with dietary counselling affects glucose metabolism in normoglycaemic pregnant women . At the first trimester of pregnancy 256 women were r and omised to receive nutrition counselling to modify dietary intake according to current recommendations or as controls ; the dietary intervention group was further r and omised to receive probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 ; diet/probiotics ) or placebo ( diet/placebo ) in a double-blind manner , whilst the control group received placebo ( control/placebo ) . Blood glucose concentrations were lowest in the diet/probiotics group during pregnancy ( baseline-adjusted means 4.45 , 4.60 and 4.56 mmol/l in diet/probiotics , diet/placebo and control/placebo , respectively ; P = 0.025 ) and over the 12 months ' postpartum period ( baseline-adjusted means 4.87 , 5.01 and 5.02 mmol/l ; P = 0.025 ) . Better glucose tolerance in the diet/probiotics group was confirmed by a reduced risk of elevated glucose concentration compared with the control/placebo group ( OR 0.31 ( 95 % CI 0.12 , 0.78 ) ; P = 0.013 ) as well as by the lowest insulin concentration ( adjusted means 7.55 , 9.32 and 9.27 mU/l ; P = 0.032 ) and homeostasis model assessment ( adjusted means 1.49 , 1.90 and 1.88 ; P = 0.028 ) and the highest quantitative insulin sensitivity check index ( adjusted means 0.37 , 0.35 and 0.35 ; P = 0.028 ) during the last trimester of pregnancy . The effects observed extended over the 12-month postpartum period . The present study demonstrated that improved blood glucose control can be achieved by dietary counselling with probiotics even in a normoglycaemic population and thus may provide potential novel means for the prophylactic and therapeutic management of glucose disorders Objective To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group . Design R and omised controlled trial . Setting Maternity hospital in Dublin , Irel and . Participants 800 women without diabetes , all in their second pregnancy between January 2007 to January 2011 , having previously delivered an infant weighing greater than 4 kg . Intervention Women were r and omised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy . Main outcomes The primary outcome measure was difference in birth weight . The secondary outcome measure was difference in gestational weight gain . Results No significant difference was seen between the two groups in absolute birth weight , birthweight centile , or ponderal index . Significantly less gestational weight gain occurred in women in the intervention arm ( 12.2 v 13.7 kg ; mean difference −1.3 , 95 % confidence interval −2.4 to −0.2 ; P=0.01 ) . The rate of glucose intolerance was also lower in the intervention arm : 21 % ( 67/320 ) compared with 28 % ( 100/352 ) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L ( P=0.02 ) . Conclusion A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age  infants in a group at risk of fetal macrosomia . It did , however , have a significant positive effect on gestational weight gain and maternal glucose intolerance . Trial registration Current Controlled Trials IS RCT N54392969 In developing countries , prenatal lipid-based nutrient supplements ( LNSs ) were shown to increase birth size ; however , the mechanism of this effect remains unknown . Cord blood hormone concentrations are strongly associated with birth size . Therefore , we hypothesize that LNSs increase birth size through a change in the endocrine regulation of fetal development . We compared the effect of daily prenatal LNSs with multiple micronutrient tablets on cord blood hormone concentrations using a r and omized , controlled design including 197 pregnant women from rural Burkina Faso . Insulin-like growth factors ( IGF ) I and II , their binding proteins IGFBP-1 and IGFBP-3 , leptin , cortisol , and insulin were quantified in cord sera using immunoassays . LNS was associated with higher cord blood leptin mainly in primigravidae ( + 57 % ; P = 0.02 ) and women from the highest tertile of BMI at study inclusion ( + 41 % ; P = 0.02 ) . We did not find any significant LNS effects on other measured cord hormones . The observed increase in cord leptin was associated with a significantly higher birth weight . Cord sera from small-for-gestational age newborns had lower median IGF-I ( -9 μg/L ; P = 0.003 ) , IGF-II ( -79 μg/L ; P = 0.003 ) , IGFBP-3 ( -0.7 μg/L ; P = 0.007 ) , and leptin ( -1.0 μg/L ; P = 0.016 ) concentrations but higher median cortisol ( + 18 μg/L ; P = 0.037 ) concentrations compared with normally grown newborns . Prenatal LNS result ed in increased cord leptin concentrations in primigravidae and mothers with higher BMI at study inclusion . The elevated leptin concentrations could point toward a higher neonatal fat mass Background : Low birth weight ( LBW ) is an important public health problem in undernourished population s. Objective : We tested whether improving women 's dietary micronutrient quality before conception and throughout pregnancy increases birth weight in a high-risk Indian population . Design : The study was a nonblinded , individually r and omized controlled trial . The intervention was a daily snack made from green leafy vegetables , fruit , and milk ( treatment group ) or low-micronutrient vegetables ( potato and onion ) ( control group ) from ≥90 d before pregnancy until delivery in addition to the usual diet . Treatment snacks contained 0.69 MJ of energy ( controls : 0.37 MJ ) and 10–23 % of WHO Reference Nutrient Intakes of β-carotene , riboflavin , folate , vitamin B-12 , calcium , and iron ( controls : 0–7 % ) . The primary outcome was birth weight . Results : Of 6513 women r and omly assigned , 2291 women became pregnant , 1962 women delivered live singleton newborns , and 1360 newborns were measured . In an intention-to-treat analysis , there was no overall increase in birth weight in the treatment group ( + 26 g ; 95 % CI : −15 , 68 g ; P = 0.22 ) . There was an interaction ( P < 0.001 ) between the allocation group and maternal prepregnant body mass index ( BMI ; in kg/m2 ) [ birth-weight effect : −23 , + 34 , and + 96 g in lowest ( < 18.6 ) , middle ( 18.6–21.8 ) , and highest ( > 21.8 ) thirds of BMI , respectively ] . In 1094 newborns whose mothers started supplementation ≥90 d before pregnancy ( per- protocol analysis ) , birth weight was higher in the treatment group ( + 48 g ; 95 % CI : 1 , 96 g ; P = 0.046 ) . Again , the effect increased with maternal BMI ( −8 , + 79 , and + 113 g ; P-interaction = 0.001 ) . There were similar results for LBW ( intention-to-treat OR : 0.83 ; 95 % CI : 0.66 , 1.05 ; P = 0.10 ; per- protocol OR = 0.76 ; 95 % CI : 0.59 , 0.98 ; P = 0.03 ) but no effect on gestational age in either analysis . Conclusions : A daily snack providing additional green leafy vegetables , fruit , and milk before conception and throughout pregnancy had no overall effect on birth weight . Per- protocol and subgroup analyses indicated a possible increase in birth weight if the mother was supplemented ≥3 mo before conception and was not underweight . This trial was registered at www.controlled-trials.com/is rct n/ as IS RCT N62811278 The effect of prenatal energy supplementation on  maternal anthropometry was assessed in a controlled , r and omized trial in Madura , East Java . At 26 - 28 wk of gestation women were either given 465 kcal/d ( HE group ) or 52 kcal/d ( LE group ) . Two hundred seventy-six women were enrolled in the HE group and 266 women , in the LE group .  Supplement intake was variable . Testing of effect by treatment and compliance was thus done by subcategories ( HE 1 - 3 and LE 1 - 3 , corresponding to less than 45 , 45 - 89 , and greater than or equal to 90 packets of supplement consumed ) . Analysis of variance did not show significant differences among the six subcategories in third-trimester weight gain , sum of skinfold thicknesses , 4-wk postpartum weight , or body mass index . In this population energy supplementation for the short duration of the last 90 - 110 d of pregnancy was not sufficient to improve maternal nutrition as judged by anthropometry We related the macroscopic and microscopic morphology and the histomorphometry of the placenta to prenatal nutritional supplementation . In the Prenatal Project , a controlled clinical trial , three dietary treatments ( supplement , a high-protein beverage ; complement , a balanced protein-calorie beverage , or routine vitamin and mineral tablets ) were r and omly allocated to poor Black pregnant women , and the outcome was assessed . Herein we report the effects on placental morphology and histomorphometry . There were significantly fewer preterm deliveries in the complement group , and this was reflected by an increase in the size of decidual cells , an index associated with placental aging . Several other characteristics of the placentas of the complement group may have been more directly associated with improved perinatal outcome : decreased intervillous fibrin , lower incidence of gross surface infa rct , and smaller ( and presumably less edematous ) cells of the villous stroma , may have mediated increased placental perfusion . There was no evidence of any placental change associated with the increase in very preterm delivery and the highly significant depressed birth weight among preterm deliveries in the supplement group . The significantly lower incidence of meconium staining of Wharton 's jelly among controls seems likely to have been a chance finding . While there were several other indices that reflected placental aging , the significantly increased chorioamnionitis , acute funisitis , and acute decidual inflammation among placentas of those who delivered prematurely [ the former two associated with very early delivery ( less than 35 wk gestation ) ] were likely to have been involved as causes of premature delivery The effects on  pregnancy outcome  and  maternal iron status of powdered milk ( PUR ) and a milk-based fortified product ( V-N ) were compared in a group of underweight gravidas . These take-home products were distributed during regular prenatal visits . Women in the V-N group had greater weight gain ( 12.29 vs 11.31 kg , p less than 0.05 ) and mean birth weights ( 3178 vs 3105 g , p less than 0.05 ) than those in the PUR group . Values for various indicators of maternal Fe status were also higher in the V-N group . Compared with self-selected noncompliers , similar in all control variables to compliers , children of women who consumed powdered milk or the milk-based fortified product had mean birth weights that were higher by 258 and 335 g , respectively . Data indicate a beneficial effect of the fortified product on both maternal nutritional status and fetal growth To improve maternal nutritional status and to ameliorate protein-energy malnutrition in pregnant women and infants , supplementary foods for rural pregnant women were formulated and evaluated . Six formulas with protein and energy contents of 16 - 22 g and 350 - 500 kcal/100 g food , respectively , were developed from locally available raw material s. A field evaluation of formulas I and V was conducted at the regional MCH Center at Rajchaburi , about 120 km from Bangkok .  Formulas providing 13 g protein and 350 kcal per day were given to two groups of mothers in the first or second pregnancy , starting at 28 + /- 2 wk of gestation . A third group , unsupplemented , served as controls .  Maternal weight gain and left mid-arm circumference were measured every 2 wk . Birth weight , length , head and chest circumferences of newborns , and placental weight were significantly higher in both supplemented groups . These findings suggest that among undernourished mothers , supplementation of as little as 13 g protein and 350 kcal daily during the last trimester can significantly improve maternal weight gain and birth weight of newborns BACKGROUND We previously showed that mortality from infectious diseases among young adults in rural Gambia is strongly correlated with the season of their birth . This suggests that early life insults that involve fetal malnutrition , exposure to natural toxins , or highly seasonal infections affecting the infant or pregnant mother cause permanent damage to the immune system . Excess mortality begins after puberty and has a maximal odds ratio of > 10 for deaths between ages 25 and 50 y. OBJECTIVE We investigated the immune function of children according to birth weight , season of birth , and exposure to maternal dietary supplementation during pregnancy . DESIGN Immune function was measured in 472 prepubertal children aged 6.5 - 9.5 y from 28 villages in rural Gambia . The mothers of these children had been r and omly assigned to a high-energy prenatal supplementation program , which significantly increased birth weight . This permitted supplementation status , birth weight , and season of birth to be investigated as exposure variables . The outcome variables tested were naive responses to rabies and pneumococcus vaccines , delayed-type hypersensitivity skin reactions , and mucosal defense ( secretory immunoglobulin A and dual-sugar permeability ) . RESULTS Immune responses were strongly related to current age and sex , suggesting a high level of sensitivity , but were not consistently related to birth weight , season of birth , or maternal supplementation ( control compared with intervention ) . CONCLUSION Events in early life did not predict a measurable defect in immune response within this cohort of rural Gambian children . It is possible that the early programming of immune function may be mediated through a defect in immunologic memory or early senescence rather than through impairment of early responses BACKGROUND The secular increase in height is assumed to result from long-term improvements in nutritional intakes and reductions in infectious disease burdens . Nutritional supplementation in early life reduces stunting in chronically undernourished population s. It is unknown whether these improvements can be transmitted to subsequent generations . OBJECTIVE Our objective was to estimate the intergenerational effect on offspring length of improved nutrition in the mother 's childhood . DESIGN We studied 263 children born in 1996 - 1999 to 231 women who had received nutritional supplementation , ie , atole ( high-protein , moderate-energy drink ) or fresco ( nonprotein , low-energy drink ) , prenatally and up to age 7 y as part of a community trial in Guatemala between 1969 and 1977 . Child length was measured at different times to age 36 mo . RESULTS Children born to women who received the enhanced supplement were taller ( age-adjusted difference : 0.80 cm ; 95 % CI : 0.16 , 1.44 cm ) than were children whose mothers received the low-energy supplement . This increment was independent of the children 's birth weight or socioeconomic status but was substantially attenuated and no longer significant after adjustment for maternal height ( adjusted difference : 0.43 cm ; 95 % CI : -0.10 , 0.96 cm ; P > 0.10 ) . The effect of maternal nutritional supplementation  was more pronounced in boys than in girls ( P for interaction < 0.10 ) and in children born to women who received supplements at ages 3 - 7 y than in children born to women who received supplements at ages 0 - 3 y ( P for interaction < 0.01 ) . CONCLUSION Nutritional supplementation in childhood has positive effects on both the supplemented persons and on the subsequent generation An intervention program was undertaken to assess dietary habits and the impact of nutrition education among pregnant women in the rural county of Florina , northern Greece . Analysis of dietary habits , nutrient intake , hemoglobin , and serum vitamin concentrations in an intervention and control group indicated that the population was adequately nourished although nutrient intake was below recommended levels for pregnant women . Nutrition counseling was associated with improvements in dietary intake and significantly greater maternal weight gain ( p less than 0.05 ) . Mean birth weight was slightly higher in the intervention group but so was the incidence of low birth weight ( 4.5 % vs 3.9 % ) . The prematurity rate was marginally lower in the intervention group ( p less than 0.04 ) , as was the number of perinatal deaths ( 9 vs 11 ) . The results indicate that nutrition counseling during pregnancy can improve dietary intake and maternal weight gain but the mediating influence on low frequency pregnancy outcomes is indeterminate in a population that is not nutritionally at risk Protein and nucleic acid content , and RNase levels were measured in placentas collected at birth in a r and omized controlled trial of prenatal nutritional supplementation in New York City . These biochemical indices were explored to underst and better the effects of nutritional supplementation . ( With high-protein supplements , gross measures had shown no improvement in outcome at birth and adverse effects on fetal growth , prematurity , and newborn survival ; with balanced protein-calorie supplements , there was a nonsignificant rise in birth weight and longer gestation . ) The biochemical indices were in general somewhat weakly related to fetal growth measures . Significant effects of nutritional treatment on the indices were minimal , and added no information that could account for gross effects observed in the fetus Breast-milk output was measured in women who during the last trimester of pregnancy consumed a high- or low-energy supplement ( 53 and 55 women , respectively ) . Infant and mother pairs were enrolled at 2 or 6 wk postpartum . Test weighings were done four times at 8-wk intervals . Mean breast-milk output ranged from 682 to 744 g/d in the age period of 2 wk to 7 mo . There was no difference in milk output between the two experimental groups . In all cohorts , breast-feeding frequency influenced milk output positively . Only at age 18 - 22 wk did the mothers ' prepregnancy or 4-wk postpartum body mass index play an additional role . The results confirm that breast-milk output of mildly undernourished women is comparable with that of well-nourished women .  Short-term energy supplementation during pregnancy did not increase breast-milk output , probably because the sample studied was not at nutritional risk The effect of food supplementation on physical growth during the last trimester of pregnancy and the first 3 yr of life was studied in a sample of families at risk of malnutrition living in the urban slums of Bogota , Colombia . Families in which the mother was pregnant and at least one-half of the children under 5 yr of age were below 85 % of weight for age were selected for the study . All were provided with free obstetrical and pediatric care . The families were then r and omly assigned to control and supplemented groups . The supplemented families received a daily allotment of 600 cal or 30 g of protein per capita for home consumption from the onset of the 3rd trimester of pregnancy until the subject children reached the age of 3 yr . Calorie consumption from the supplement by the study children ( offspring of the target pregnancy ) was 458 ± 249 calories at age 18 months and 363 ± 283 cal at age 36 months . Protein consumption at those ages was 34 . 1 ± 20.6 and 23.6 ± 19.7 g,'day . However , substitution of the supplement for foods from the regular diet result ed in net supplementation of approximately 200 cal and 22 g of protein per day . There were significant differences in weight between supplemented and control groups beginning at age 3 months and in length beginning at age 6 months . Supplementation reduced the total prevalence of malnutrition ( Gomez classification ) only slightly ; at 36 months of age , 72 % of the supplemented group and 77.8 % of the control group were malnourished . On the other h and , the prevalence of moderate and severe malnutrition ( Gomez II and III ) , was significantly reduced by supplementation . At 36 months , 20.6 % of the control group and 8.8 % of the supplemented group fell into those categories . Despite improved physical growth in the supplemented group , their height and weight remained substantially below those of the high socioeconomic Colombian st and ards . The failure of supplementation to close the gap between low and high socioeconomic groups was attributed , in part , to the high incidence of diarrheal disease among subjects of the study . It is postulated that simple provision of food supplements , without effective prevention of diarrheal disease , is likely to have limited effects on physical growth among disadvantaged children . Am . J. Clin . Nutr . 34 : 1885 - 1892 , 1981 Of 824 women screened , 410 were enrolled at midpregnancy in a prospect i ve , r and omized , controlled nutrition intervention study . Of these , 226 were predicted as likely to have small or large babies , 184 to have average-sized babies . Two hundred thirty eight mothers received USDA Women , Infants and Children ( WIC )  Food Supplementation vouchers from midpregnancy , 172 did not . Leukocyte protein synthesis ( as a cell model ) was significantly higher ( p = 0.009 ) by 36 weeks gestation in supplemented mothers . Mean birth weight of their babies was greater , 3254 vs 3163 g , ( + 91 g ) p = 0.039 , adjusted for sex , gestational age , prenatal visits , pregnancy interval , smoking , and previous low birth weight infants . Controlling for entry weight obviated the significance of the difference , except for WIC supplemented smokers ( greater than 10 cigarettes/day ) whose babies were significantly heavier by + 168 g ( p = 0.017 ) than those of unsupplemented smokers . WIC partially protects fetal growth in smokers In a double blind controlled intervention , two groups of nutritionally at-risk rural Taiwanese women were given a nutrient-rich dietary supplement ( group A , n = 114 ) or a placebo ( group B , n = 111 ) beginning after the birth of one child and continuing through the lactation period for a subsequent child . Outcome variables assessed include infant birth measurements postnatal physical growth , motor , mental , and dental development , morbidity , and maternal weight and skinfold changes during pregnancy and lactation . While few A-B differences in mean values of outcome variables were found , there were significant responses in subgroups of the sample . Comparisons of infants born after a nutrient-supplemented pregnancy ( A2 ) versus an unsupplemented pregnancy ( A1 ) showed that A2 male infants weighed more than A1 males at birth , and A1-A2 sibling correlations in birth measurements , especially Rohrer 's index ( wt/l3 ) were significantly reduced . Important mediators of supplement effects included sex of the offspring , season of birth , maternal body size , and birth of a previous infant characterized by dysmorphic prenatal growth . The limited effects of supplementation on the population as a whole may reflect the operation of long term adaptations which allow women to maintain reproductive success despite their apparent marginal nutritional status Cardiovascular disease and diabetes may be programmed early in life by abnormal development associated with undernutrition . We investigated whether maternal nutritional status ( MNS ; height , pregnancy weight gain , nonpregnant BMI , and prenatal supplementation )  or childhood nutritional status ( CNS ; birth weight , length , ponderal index , height-for-age Z-score at 24 mo , and supplementation from 0 to 24 mo ) were related to fasting plasma glucose levels in rural-born Guatemalan adults . We studied 209 men and 220 women ( mean age 24.4 y ) who were involved in a r and omized trial of nutritional supplementation of their mothers during pregnancy and during their early childhoods , conducted from 1969 to 1977 . In 2 villages , residents were offered Atole ( 3.8 MJ and 64 g protein/L ) ; 2 other villages were offered Fresco ( 1.4 MJ/L , no protein ) . No associations were observed between anthropometric measures of MNS or CNS and fasting plasma glucose levels . In subgroup analyses , inverse associations ( all P < 0.15 ) with birth size were found among women born to fatter mothers , women with low supplement intake , men born to short mothers , and men more severely stunted at 24 mo . Prenatal supplementation was inversely associated with fasting plasma glucose among women [ -0.40 + /- 0.17 mmol/(L. MJ . d ) , P = 0.02 ] . Among men , postnatal intake of supplementation of 0.10 to 0.20 MJ/d was associated with up to a 0.56 mmol/L reduction in fasting plasma glucose ( P = 0.03 ) , but intake in excess of 0.20 MJ/d provided no added benefit . Among women , the benefit of postnatal supplementation was restricted to those born thin ( test for interaction P = 0.10 ) . Improving the nutritional status of undernourished women and children may have positive long-term consequences Protein-energy malnutrition in synergism with infection is a major problem for most developing countries , and inadequate food consumption is a critical factor in its development . Food supplementation programs can improve nutrient consumption but may also have unintended consequences . Changes in consumption of foods as well as nutrients need to be identified and evaluated . The effects of a food supplementation program on family diet patterns and protein-energy intake were investigated using data from nutritionally at risk families in Bogota , Colombia . Because food supplements are income transfers they need to substitute for purchases of similar food items . However , the results of our investigation reveal that food supplementation based on familiar foods that are part of the usual family diet are consumed in substantial quantities and result in net nutrient consumption increases . The food supplementation program increases consumption of preferred food items and introduces greater diversity into the family diet . These effects are enhanced when combined with a home education program Colombian women at risk of malnutrition were enrolled in a health care program and r and omly assigned to supplementation and control groups at the beginning of the third trimester of pregnancy . The net dietary intake increments result ing from supplementation amounted to 155 cal and 20 g of protein per day . Supplementation had a significant effect on the mean birth weight of male infants , but not that of female infants ; the mechanisms responsible for the sex differences remain to be eluci date d. The r and omized trial design of the experiment and the documented similarity between the experimental and control groups at the onset permit the conclusion that the observed differences were caused by the food supplementation program . The effect of  supplementation  on maternal weight gain and the association of the latter with birth weight strongly suggest that improved maternal nutrition mediated the effect on birth weight Low-income pregnant women of Mexican descent were studied to determine whether their food habits could be improved by nutrition education . Biochemical indices of nutritional status were also investigated . Twenty-four-hour dietary recalls were obtained at an initial interview and again at a final interview after a nutrition education program , which was offered to a r and omly selected treatment group . At the initial interview , the mean nutrient intakes that were most often below two-thirds of the Recommended Dietary Allowance ( RDA ) were iron , vitamin A , thiamin , and calcium . The mean energy value of the diets was also frequently below the RDA . At the final intakes , although the mean energy values and the calcium and carbohydrate of both the control and treatment groups increased significantly , the following improvements in dietary intakes were seen only within the treatment group : 1 ) there were significant increases in the mean intake of protein , ascorbic acid , niacin , riboflavin , and thiamin , 2 ) there were significant decreases in the percentage of intakes below two-thirds of the RDA for ascorbic acid and riboflavin , and 3 ) there was a significant decrease in the incidence of multiple low nutrient intakes . These dietary improvements , which occurred only in the treatment group , suggest the effectiveness of the nutrition education program . The most common biochemical deficiencies were of folic acid , thiamin , and riboflavin . Except for an improvement in mean serum folate levels , the biochemical indices for the treatment group did not appear to be influenced by the nutrition education . It is possible that the vitamin and mineral supplements which were taken by 80 % of the women could have obscured improvements in biochemical indices which may have been due to the education program This study is a r and omized controlled double-blind trial on the effects of nutrition supplement of pregnant and lactating women on their offspring . The study was conducted by the late Dr. Bacon Chow in 14 villages in Sui-Lin township , a farming area about 180 miles from Taipei , Taiwan . Two hundred ninety-four women were r and omly assigned to one of two treatment groups . The daily supplement for one group provided 800 kcal and 40 g of protein/day ; for the other group it only provided 80 kcal/day . Supplementation began after 3 wk of the delivery of a first study infant , continued throughout lactation , and through the pregnancy and lactation of a second study infant . Between group comparisons on the birth weight , number of low birth weight infants , or incidence of fetal deaths showed no statistically significant findings . However , the birth weight of the second study infant was statistically different and higher than that of the first study infant in the high supplement group . Moreover , in the low supplement group there was a correlation of 0.22 ( p = 0.06 ) between the change scores for birth weight from the first to the second study infant and the quantity of supplements consumed during the last trimester of pregnancy . There was also in this same group a significant slope in a linear regression of birth weight on total daily caloric intake during the 3rd trimester of pregnancy for the male second study infants . These findings are partly in agreement with findings from three other large supplementation studies in Colombia , Guatemala , and New York . In this study the findings indicate that caloric supplementation does result in a small yet statistically meaningful increment in birth weight within a population which is not nutritionally at risk In many regions of the world , women breastfeed one child while pregnant with the next . Among rural Guatemalan women participating in a nutrition-supplementation trial , lactation overlapped with pregnancy in 253 of 504 ( 50.2 % ) of the pregnancies . For cases where overlap occurred , 41.4 % continued to breast-feed into the second trimester and 3.2 % , in the third trimester . The maternal and fetal responses to the energetic stresses of overlap and of the duration of the recuperative ( nonpregnant , nonlactating ) interval were assessed . Overlap result ed in increased supplement intake . Short recuperative periods ( less than 6 mo ) result ed in increased supplement intake and reduced maternal fat stores . The energetic stresses of overlap and short recuperative periods did not significantly affect fetal growth . The mother appears to buffer the energetic stress , protecting fetal growth . This research demonstrates that evidence of depletion of maternal nutrient stores caused by a dem and ing reproductive history is found when reproductive stress is characterized adequately Background / Objectives : The mother is an important mediator to the infant of polyunsaturated fatty acids ( PUFA ) , the essential constituents of membranes particularly in the brain and retina . We here aim ed in a prospect i ve study initiated in early pregnancy to establish whether serum fatty acid ( FA ) compositions and concentrations in the mother can be modified by dietary means emphasizing counseling on a recommended diet . Subjects/ Methods : Ninety women in the first trimester of pregnancy were r and omized into intervention ( n=45 ) or  control ( n=45 ) groups . The intervention comprised individual dietary counseling advocating choice of foods that will increase the intake of unsaturated and reduce that of saturated FA . To support this , appropriate products , including spreads , were provided for consumption at home . Dietary intakes were measured from food records and serum phospholipids , cholesteryl esters and triacylglycerols FA were analyzed by gas chromatography . Results : Dietary counseling result ed in lower intake of saturated and higher intake of unsaturated FA compared with the controls . These changes were reflected in higher proportions of serum phospholipid PUFA ( mean difference between groups 0.61 % ( 95 % confidence interval , CI 0.05–1.17 ) , P=0.03 ) , docosahexaenoic acid ( 0.5 % ( 0.15–0.85 ) , P=0.01 ) , sum of n-3 FA ( 0.61 % ( 0.07–1.15 ) , P=0.03 ) and lower ratio of n-6/n-3 FA ( −0.42 % ( −0.81–0.03 ) , P=0.03 ) in the intervention group at the third trimester of pregnancy but not at 1 month postpartum . Similar changes were seen in the FA of cholesteryl esters and triacylglycerols . Conclusion : Maternal serum n-3 FA status during pregnancy can be improved by dietary means emphasizing the importance of dietary advice The effect of  maternal supplementation during both gestation and lactation on infant growth from birth to 12 mth was investigated in the double-blind , r and omly allocated control trial conducted in Taiwan by the late Bacon F. Chow . The supplement was a milk-based formula providing 800 kcal and 40 g protein daily . The placebo provided less than 40 kcal per diem but resembled the supplement in appearance . Supplementation was limited to mothers and began after birth of one infant and continued without interruption until weaning of a second infant . Supplement effects were tested by comparing both supplement and placebo groups and first- and second-infant groups with respect to weight , length and head circumference . Both comparisons of growth curves and analyses of variance were carried out . Both strategies agreed in failing to detect differences in growth between supplement and placebo groups . However , differences were found between first and second infants in the supplement group Unselective dietary protein energy supplementation of Asian mothers at Sorrento Maternity Hospital did not enhance intrauterine growth . The effect of selective supplementation was therefore studied . Forty-five mothers who at 28 weeks were known to be nutritionally at risk ( triceps increment less than or equal to 20 microns/week between 18 and 28 weeks ) received one of three supplements during the third trimester : ( a ) vitamins only -- a multivitamin sachet daily containing vitamins A , B , C , and D ; ( b ) energy--42 - 125 MJ ( 10 000 - 30 000 kcal ) , all from carbohydrate , plus vitamins ; ( c ) protein energy -- energy and vitamins as before , but with 5 - 10 % of energy from milk protein .  Eighty-three mothers regarded as adequately nourished at 28 weeks also received one of the three supplements . In the nutritionally at-risk mothers the protein energy supplement was associated with a heavier crude birth weight and heavier weight for gestational age .  Supplementation did not lead to improved intrauterine growth in those mothers who were adequately nourished . The differential effect of supplementation depending on the mothers ' nutritional state during the second trimester may explain apparently conflicting results of other studies where some have shown a substantial effect of supplementation and others only a small effect . This effect of intervention is further evidence that " poor nutrition " contributes to poor intrauterine growth in selected mothers , even in developed countries BACKGROUND Prenatal multiple micronutrient ( MMN ) or balanced energy and protein supplementation has a limited effect on birth size of the offspring . OBJECTIVE The objective was to determine whether a prenatal MMN-fortified food supplement ( FFS ) improves anthropometric measures at birth compared with supplementation with an MMN pill alone . DESIGN We conducted a nonblinded , individually r and omized controlled trial in 1296 pregnant women in 2 villages in rural Burkina Faso . Supplements were provided on a daily basis , and compliance was closely verified by using a community-based network of home visitors . RESULTS Anthropometric measures at birth were available for analysis for 87 % of the 1175 live singleton deliveries enrolled . After adjustment for gestational age at birth , the FFS group had a significantly higher birth length ( + 4.6 mm ; P = 0.001 ) . FFS supplementation result ed in a modestly higher birth weight ( + 31 g ; P = 0.197 ) . Subgroup analyses showed clinical ly important treatment effects on birth length ( + 12.0 mm ; P = 0.005 ) and on birth weight ( + 111 g ; P = 0.133 ) for underweight [ body mass index ( in kg/m(2 ) ) < 18.5 ] pregnant women . Women with early pregnancy anemia who received FFS gave birth to longer newborns ( + 7.3 mm ; P = 0.002 ) than did those who received MMN supplementation . CONCLUSIONS The provision of FFS to pregnant women result ed in higher birth length than did MMN supplementation . For women with a suboptimal prepregnancy nutritional status , MMN supplementation should be complemented with a balanced energy and protein supplement to produce a clinical effect on birth size . The trial was registered at clinical trials.gov as NCT00909974 Fetal nutrition is thought to be an important determinant of later disease risk , although evidence from r and omized-controlled trials in humans is lacking . We followed children born during a protein-energy supplementation trial to investigate to what extent this maternal supplement , which improved birth weight , influenced offspring body composition in adolescence . Subjects were 1270 Gambian children ( 659 boys , 611 girls ) aged 11 - 17 y whose mothers had participated in the original cluster-r and omized trial and had received the supplement during pregnancy ( intervention ) or postpartum ( control ) .  Basic anthropometry was measured using st and ard techniques and fatness was assessed by bioelectrical impedance analysis and population -specific prediction equations . For boys ,  mean body fat was 12.6 % for both intervention and control groups . Mean trunk fat was 11.9 % in the intervention group and 12.0 % in the control . Intervention girls had a mean body fat of 19.5 % and trunk fat of 15.2 % ; for control girls , it was 19.3 and 14.8 % , respectively . BMI , body fat , trunk fat , fat mass index , and fat-free mass index did not differ for either sex when analyzed with generalized estimating equations adjusted for age , maternal height , maternal parity , location , season of birth , and menarche in females . Neither infant-attained size nor the onset of menarche were affected by maternal supplementation . These findings suggest that protein-energy supplements to pregnant women , compared with lactating women , do not affect offspring body composition during adolescence Background / Objective : Well-being has been linked to the quality of diet and lifestyle in adults ; however , there is a paucity of data in pregnancy . The aim of this study was to examine the relationship between well-being and socioeconomic status , diet and lifestyle during pregnancy and to consider the effect of intervention with low glycaemic index ( GI ) diet on well-being . Subjects/ Methods : This was a cohort analysis of 619 participants of the ROLO study ( R and omised cOntrol trial of LOw GI diet versus no dietary intervention to prevent recurrence of fetal macrosomia ) . The following data were collected : educational attainment , dietary intakes ( food frequency question naire ) , physical activity ( self-reported ) and well-being ( WHO-5-Item Wellbeing Index — expressed as a percentage ) . Results : Well-being was positively associated with education and physical activity . Third-level education was associated with a 3.07-point higher well-being percentage score , and each day that an individual achieved > 30 min walking per week was associated with a 1.10-point increase in percentage well-being score , Radj2 2.4 % ( F=7.260 , P=0.001 ) . The intervention low GI group had a significantly lower percentage well-being score than the usual diet group ( 56.3 % vs 59.9 % , P=0.015 ) . No correlation was noted between well-being and GI status calculated from food diaries ( P=0.469 ) . Well-being was not associated with micronutrient intake . Conclusions : Well-being in pregnancy was independently and positively associated with education and physical activity and negatively associated with low GI dietary intervention . These findings have significance not only for women at risk of low mood but also for healthcare professionals when counselling women about the importance of healthy lifestyle in pregnancy ABSTRACT Ready-to-eat ( RTE ) snacks are routinely distributed to pregnant women in India . These provide protein and calories but are low in micronutrients . We investigated whether RTE snacks fortified with leaf concentrate ( LC ) could improve pregnancy outcomes , including maternal haemoglobin ( Hb ) concentrations and infants ’ birthweight . This r and omized controlled two-arm trial was conducted over 18 months : control ( sRTE ) group received st and ard 120 g RTE snack ( 102 g wheat flour , 18 g soya flour ) ; intervention ( lcRTE ) group received the same snack fortified with 7 g LC . The study was conducted in Jaipur , Rajasthan , India . One hundred and five pregnant women aged 18 - 35 years were studied . Among the 105 women r and omized to the two arms of the trial , 2 ( 1.9 % ) were severely anaemic ( Hb ≤6.0 g/dL ) ; 55 ( 53.4 % ) were moderately anaemic ( Hb 6.0 - 8.0 g/dL ) ; 34 ( 33.0 % ) were mildly anaemic ( Hb 8.6 - 10.9 g/dL ) ; and 12 ( 11.7 % ) were not anaemic ( Hb ≥11.0 g/dL ) . In the final month of pregnancy , 83.0 % ( 39/47 ) of women in the sRTE group had Hb ≤8.5 g/dL compared to 37.8 % ( 17/45 ) in the lcRTE group ( p<0.001 ) . After adjustment for age and baseline Hb concentration , the difference in Hb concentrations due to LC fortification was 0.94 g/dL ( 95 % CI 6.8 - 12.0 ; p<0.001 ) . Mean live birthweight in the lcRTE group was 2,695 g ( SD 325 g ) compared to 2,545 g ( 297 g ) in the sRTE group ( p=0.02 ) . The lcRTE snacks increased infants ’ birthweight by 133.7 g ( 95 % CI 7.3 - 260.2 ; p=0.04 ) compared to sRTE snacks . Leaf concentrate fortification of antenatal protein-calorie snacks in a low-income setting in India protected against declining maternal haemoglobin concentrations and increased infants ’ birthweight when compared with unfortified snacks . These findings require replication in a larger trial BACKGROUND Low birth weight and subsequent rapid child growth are associated with later blood pressure levels . The role of maternal and child nutrition in this association remains unclear . METHODS We studied 450 men and women ( ages 21 - 29 years ) born during a r and omized trial of protein-energy supplementation ( Atole ) vs low energy/no protein supplementation ( Fresco ) in pregnancy and early childhood in four rural Guatemalan villages from 1969 to 1977 . RESULTS Protein-energy supplementation was not associated with differences in blood pressure in adulthood ( diastolic blood pressure ( DBP ) : beta = 0.69 mm Hg , 95 % confidence internal ( CI ) ( 20.82 - 2.19 ) ; P = 0.37 ; systolic blood pressure ( SBP ) : beta = 0.17 mm Hg , 95 % CI ( 21.68 - 2.02 ) ; P = 0.86 ) . Within the Atole group , maternal height was associated with later SBP ( 0.22 mm Hg/cm , 95 % CI ( 20.002 - 0.45 ) ; P = 0.05 ) . No other associations between maternal nutritional status , birth size , child growth , or supplement intake were observed for adult blood pressure . CONCLUSIONS Our data do not support the role of maternal nutrition during pregnancy , birth size , or early child growth in programming adult blood pressure . Likewise , we found no effect of protein-energy supplementation in pregnancy or in early childhood on blood pressure in young adults OBJECTIVE A low – glycemic index diet is effective as a treatment for individuals with diabetes and has been shown to improve pregnancy outcomes when used from the first trimester . A low – glycemic index diet is commonly advised as treatment for women with gestational diabetes mellitus ( GDM ) . However , the efficacy of this advice and associated pregnancy outcomes have not been systematic ally examined . The purpose of this study was to determine whether prescribing a low – glycemic index diet for women with GDM could reduce the number of women requiring insulin without compromise of pregnancy outcomes . RESEARCH DESIGN AND METHODS All women with GDM seen over a 12-month period were considered for inclusion in the study . Women ( n = 63 ) were r and omly assigned to receive either a low – glycemic index diet or a conventional high-fiber ( and higher glycemic index ) diet . RESULTS Of the 31 women r and omly assigned to a low – glycemic index diet , 9 ( 29 % ) required insulin . Of the women r and omly assigned to a higher – glycemic index diet , a significantly higher proportion , 19 of 32 ( 59 % ) , met the criteria to commence insulin treatment ( P = 0.023 ) . However , 9 of these 19 women were able to avoid insulin use by changing to a low – glycemic index diet . Key obstetric and fetal outcomes were not significantly different . CONCLUSIONS Using a low – glycemic index diet for women with GDM effectively halved the number needing to use insulin , with no compromise of obstetric or fetal outcomes Background Fish and meat intake may affect  gestational weight gain , body composition and serum fatty acids . We aim ed to determine whether a longitudinal dietary intervention during pregnancy could increase fish intake , affect serum phospholipid fatty acids , gestational weight gain and body composition changes during pregnancy in women of normal weight participating in the Pregnancy Obesity Nutrition and Child Health study . A second aim was to study possible effects in early pregnancy of fish intake and meat intake , respectively , on serum phospholipid fatty acids , gestational weight gain , and body composition changes during pregnancy . Methods In this prospect i ve , r and omized controlled study , women were allocated to a control group or to a dietary counseling group that focused on increasing fish intake .  Fat mass and fat-free mass were measured by air-displacement plethysmography . Reported intake of fish and meat was collected from a baseline population and from a subgroup of women who participated in each trimester of their pregnancies .  Serum levels of phospholipid arachidonic acid ( s-ARA ) , eicosapentaenoic acid ( s-EPA ) , and docosahexaenoic acid ( s-DHA ) were measured during each trimester . Results Weekly fish intake increased only in the intervention group ( n = 18 ) from the first to the second trimester ( median difference 113 g , p = 0.03 ) and from the first to the third trimester ( median difference 75 g , p = 0.01 ) . In the first trimester , fish intake correlated with s-EPA ( r = 0.36 , p = 0.002 , n = 69 ) and s-DHA ( r = 0.34 , p = 0.005 , n = 69 ) , and meat intake correlated with s-ARA ( r = 0.28 , p = 0.02 , n = 69 ) . Fat-free mass gain correlated with reported meat intake in the first trimester ( r = 0.39 , p = 0.01 , n = 45 ) . Conclusions Dietary counseling throughout pregnancy could help women increase their fish intake . Intake of meat in early pregnancy may increase the gain in fat-free mass during pregnancy OBJECTIVES To evaluate the impact of maternal nutrition during pregnancy on infant blood pressure . STUDY DESIGN Pregnant women ( n = 256 ) were r and omized into 3 groups : modified dietary intake according to current recommendations and probiotics ( diet/probiotics ) , placebo ( diet/placebo ) , and a control/placebo group . In the infants born to these women , blood pressure was recorded at age 6 months using an automated oscillometric DINAMAP R. RESULTS Despite significant differences in maternal dietary intakes between the study groups , the intervention focusing on maternal fat intake showed no direct impact on infants ' blood pressure . Instead , a complex U-shaped interrelationship was uncovered ; the highest and lowest quartiles of intakes of specific nutrients , carbohydrate ( P = .006 for systolic pressure and P = .015 for diastolic pressure ) , and monounsaturated fatty acids ( P = .029 for diastolic pressure ) compared with the middle quartiles result ed in higher blood pressure at age 6 months . The pattern between maternal carbohydrate intake during pregnancy and infants ' blood pressure remained significant even after adjustment for breastfeeding and body length . A reverse U-shaped trend again was observed between maternal intake of fruits and infants ' systolic blood pressure ( P = .077 ) . CONCLUSION With a view toward programming blood pressure to adulthood , our results suggest an opportunity for dietary counseling to promote child health Background Recent observational research indicates that immune development may be programmed by nutritional exposures early in life . Such findings require replication from trials specifically design ed to assess the impact of nutritional intervention during pregnancy on infant immune development . The current trial seeks to establish : ( a ) which combination of protein-energy ( PE ) and multiple-micronutrient ( MMN ) supplements would be most effective ; and ( b ) the most critical periods for intervention in pregnancy and infancy , for optimal immune development in infancy . Methods / Design The ENID Trial is a 2 x 2 x 2 factorial r and omized , partially blind trial to assess whether nutritional supplementation to pregnant women ( from < 20 weeks gestation to term ) and their infants ( from 6 to 12 months of age ) can enhance infant immune development . Eligible pregnant women from the West Kiang region of The Gambia ( pregnancy date d by ultrasound examination ) are r and omized on entry to 4 intervention groups  ( Iron-folate ( FeFol = st and ard care ) , multiple micronutrients ( MMN ) , protein-energy ( PE ) , PE + MMN ) . Women are visited at home weekly for supplement administration and morbidity assessment and seen at MRC Keneba at 20 and 30 weeks gestation for a detailed antenatal examination , including ultrasound . At delivery , cord blood and placental sample s are collected , with detailed infant anthropometry collected within 72 hours . Infants are visited weekly thereafter for a morbidity question naire . From 6 to 12 months of age , infants are further r and omized to a lipid-based nutritional supplement , with or without additional MMN . The primary outcome measures of this study are thymic development during infancy , and antibody response to vaccination . Measures of cellular markers of immunity will be made in a selected sub-cohort . Subsidiary studies to the main trial will additionally assess the impact of supplementation on infant growth and development to 24 months of age . Discussion The proposed trial is design ed to test whether nutritional repletion can enhance early immune development and , if so , to help determine the most efficacious form of nutritional support . Where there is evidence of benefit from a specific intervention/combination of interventions , future research should focus on refining the supplements to achieve the optimal , most cost-effective balance of interventions for improved health outcomes .Trial registration IS RCT To study the role of nutrition in the association of birth size and childhood growth with development of cardiovascular disease , the authors in 2002 - 2004 surveyed 665 men and 790 women aged 25 - 42 years who had been exposed as children to a community-r and omized nutrition supplementation intervention in four villages in eastern Guatemala . Exposure was associated with a lower fasting glucose level ( 7.0 mg/dl , 95 % confidence interval ( CI ) : 0.5 , 13.5 ) for exposure at ages 36 - 72 months ; lower systolic blood pressure ( 3.0 mmHg , 95 % CI : 0.4 , 5.6 ) for exposure at ages 24 - 60 months ; and a lower triglyceride level ( sex-adjusted ; 22.2 mg/dl , 95 % CI : 0.4 , 44.1 ) and higher high density lipoprotein cholesterol level ( males only ; 4.7 mg/dl , 95 % CI : 1.5 , 7.9 ) for exposure prior to age 36 months . Improved nutrition at any age prior to 7 years was not associated with diastolic blood pressure , total or low density lipoprotein cholesterol level , or prevalence of the metabolic syndrome .  Interventions design ed to address nutrient deficiencies and ameliorate stunting that are targeted at pregnant women and young children are unlikely to increase cardiovascular disease risk later in life and may instead lower the risk OBJECTIVE To examine the association between gestational weight gain and maternal body mass index ( BMI ) among Vietnamese women and the risk of delivering an infant too small or too large for gestational age . METHODS A prospect i ve health-facility-based study of 2989 pregnant Vietnamese women was conducted in the city of Nha Trang in 2007 - 2008 .  Cubic logistic regression was used to investigate the association of interest . Infants were classified into weight-for-gestational-age categories according to weight centiles for the Asian population . Gestational age was based on the date of last menstrual period and adjusted by the results of first-trimester ultrasound . FINDINGS BMI was low ( < 18.5 ) , normal ( 18.5 - 22.9 ) and high ( ≥ 23.0 ) in 26.1 % , 65.4 % and 8.5 % of the women , respectively . In each of these BMI categories , the percentage of women who delivered infants too small for gestational age was 18.1 , 10.0 and 9.4 , respectively , and the mean gestational weight gain was 12.5 kg ( st and ard deviation , SD : ± 3.6 ) , 12.2 kg ( SD : ± 3.8 ) and 11.5 kg ( SD : ± 4.7 ) , respectively . Among women with low BMI , the risk of delivering an infant too small for gestational age ranged from approximately 40 % if the gestational weight gain was < 5 kg to 20 % if it was 5 - 10 kg . CONCLUSION Having a low BMI , commonly found in Viet Nam , puts women at risk of delivering an infant too small for gestational age , especially when total maternal gestational weight gain is < 10 kg Knowledge about the impact of maternal food and micronutrient supplementation on infant micronutrient status is limited . We examined the effect of maternal food and micronutrient supplementation on infant micronutrient status in the Maternal and Infant Nutrition Interventions in Matlab Trial . Pregnant women ( n = 4436 ) were r and omized to Early or Usual promotion of enrollment in a food supplementation program . In addition , they were r and omly allocated to 1 of the following 3 types of daily micronutrient supplements provided from wk 14 of gestation to 3 mo postpartum : 1 ) folic acid and 30 mg iron ( Fe30Fol ) ; 2 ) folic acid and 60 mg iron ; or 3 ) a multiple micronutrient including folic acid and 30 mg iron ( MMS ) . At 6 mo , infant blood sample s ( n = 1066 ) were collected and analyzed for hemoglobin and plasma ferritin , zinc , retinol , vitamin B-12 , and folate . The vitamin B-12 concentration differed between the micronutrient supplementation groups ( P = 0.049 ) . The prevalence of vitamin B-12 deficiency was lower in the MMS group ( 26.1 % ) than in the Fe30Fol group ( 36.5 % ) ( P = 0.003 ) . The prevalence of zinc deficiency was lower in the Usual food supplementation group ( 54.1 % ) than in the Early group ( 60.2 % ) ( P = 0.046 ) . There were no other differential effects according to food or micronutrient supplementation groups . We conclude that maternal multiple micronutrient supplementation may have a beneficial effect on vitamin B-12 status in infancy Background Maternal diet is known to impact pregnancy outcome . Following a low glycemic index ( GI ) diet during pregnancy has been shown to improve maternal glycemia and reduce infant birthweight and may be associated with a higher fibre intake . We assessed the impact of a low GI dietary intervention on maternal GI , nutritional intake and gestational weight gain ( GWG ) during pregnancy . Compliance and acceptability of the low GI diet was also examined . Method Eight hundred women were r and omised in early pregnancy to receive low GI and healthy eating dietary advice or to receive st and ard maternity care .  The intervention group received dietary advice at a group education session before 22 weeks gestation . All women completed a 3 day food diary during each trimester of pregnancy . Two hundred and thirty five women from the intervention arm and 285 women from the control arm returned complete 3x3d FDs and were included in the present analysis . Results Maternal GI was significantly reduced in the intervention group at trimester 2 and 3 . The numbers of women within the lowest quartile of GI increased from 37 % in trimester 1 to 52 % in trimester 3 ( P < 0.001 ) among the intervention group . The intervention group had significantly lower energy intake ( P < 0.05 ) , higher protein ( % TE ) ( P < 0.01 ) and higher dietary fibre intake ( P < 0.01 ) post intervention . Consumption of food groups with known high GI values were significantly reduced among the intervention group . Women in the intervention low GI group were less likely to exceed the Institute of Medicine ’s GWG goals . Conclusion A dietary intervention in early pregnancy had a positive influence on maternal GI , food and nutrient intakes and GWG . Following a low GI diet may be particularly beneficial for women at risk of exceeding the GWG goals for pregnancy . Trial registration Current Controlled Trials Registration Number : IS RCT N54392969 The perinatal nutritional environment impacts upon the health and well-being of mother and child also in the long term . The aim of the present study was to determine the safety and efficacy of perinatal probiotic-supplemented dietary counselling by evaluating pregnancy outcome and fetal and infant growth during the 24 months ' follow-up . Altogether , 256 women were r and omised at their first trimester of pregnancy into a control and a dietary intervention group . The intervention group received intensive dietary counselling provided by a nutritionist and were further r and omised , double-blind to receive probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 ; diet/probiotics ) or placebo ( diet/placebo ) . Firstly , probiotic intervention reduced the frequency of gestational diabetes mellitus ( GDM ) ; 13 % ( diet/probiotics ) v. 36 % ( diet/placebo ) and 34 % ( control ) ; P = 0.003 . Secondly , the safety of this approach was attested by normal duration of pregnancies with no adverse events in mothers or children . No significant differences in prenatal or postnatal growth rates among the study groups were detected . Thirdly , distinctive effects of the two interventions were detected ; probiotic intervention reduced the risk of GDM and dietary intervention diminished the risk of larger birth size in affected cases ; P = 0.035 for birth weight and P = 0.028 for birth length . The results of the present study show that probiotic-supplemented perinatal dietary counselling could be a safe and cost-effective tool in addressing the metabolic epidemic . In view of the fact that birth size is a risk marker for later obesity , the present results are of significance for public health in demonstrating that this risk is modifiable OBJECTIVE Increasing the consumption of Fe-rich foods and thus improving Fe bioavailability without significantly increasing diet cost is the most sustainable intervention for improving Fe intake . We assessed the effect of supplementary food consisting of fermented soyabean ( tempeh ) and vitamin C-rich fruit consumed during pregnancy on  maternal iron deficiency ( ID ) . DESIGN Pregnant women were r and omly allocated by village into optimized diet and control groups . Supplementary food was given 6 d/week at home . The average weekly food provided comprised 600 g of tempeh , 30 g of meat , 350 g of guava , 300 g of papaya and 100 g of orange .  Hb , ferritin and transferrin receptor ( TfR ) concentrations were measured at 12 - 20 and at 32 - 36 weeks of gestation . SETTING Thirty-nine villages in Indonesia . SUBJECTS Pregnant women ( 12 - 20 weeks of gestation , n 252 ) . RESULTS At baseline , mean Hb , ferritin and TfR concentrations and body Fe concentration were within the normal range and did not differ between groups . At near term , mean Hb , ferritin and body Fe decreased , whereas mean TfR increased significantly in both groups . The mean changes in Fe status were similar in both groups . In Fe-deficient women , consumption of an optimized diet was associated with smaller decreases in Hb ( 1·02 ( 95 % CI 0·98 , 1·07 ) g/l ; P = 0·058 ) , ferritin ( 1·42 ( 95 % CI 1·16 , 1·75 ) μg/l ; P = 0·046 ) and body Fe ( 2·57 ( 95 % CI 1·71 , 3·43 ) mg/kg ; P = 0·073 ) concentrations , compared with a state of no intervention . Fe-deficient women at baseline benefited more from supplementary food compared with Fe-replete women . CONCLUSIONS Daily supplementary food containing tempeh and vitamin C-rich fruits during pregnancy might have positive effects on maternal ID Background Birthweight , and by inference maternal nutrition during pregnancy , is thought to be an important determinant of offspring blood pressure but the evidence base for this in humans is lacking data from r and omized controlled trials . Methods The offspring from a maternal prenatal protein-energy supplementation trial  were enrolled into a follow-up study of chronic disease risk factors including blood pressure . Subjects were 11–17 years of age and blood pressure was measured in triplicate using an automated monitor ( Omron 705IT ) . One-thous and two-hundred sixty seven individuals ( 71 % of potential participants ) were included in the analysis . Results There was no difference in blood pressure between those whose mothers had consumed protein-energy biscuits during pregnancy and those whose mothers had consumed the same supplement post-partum .  For systolic blood pressure the intention-to-treat regression coefficient was 0.46 ( 95 % CI : –1.12 , 2.04 ) . Mean systolic blood pressure for control children was 110.2 ( SD ± 9.3 ) mmHg and for intervention children was 110.8 ( SD ± 8.8 ) mmHg . Mean diastolic blood pressure for control children was 64.7 ( SD ± 7.7 ) mmHg and for intervention children was 64.6 ( SD ± 7.6 ) mmHg . Conclusions We have found no association between maternal prenatal protein-energy supplementation and offspring blood pressure in adolescence amongst rural Gambians . We found some evidence to suggest that offspring body composition may interact with the effect of maternal supplementation on blood pressure BACKGROUND Relative leg length is frequently used as a biomarker of childhood nutrition in epidemiological studies , but evidence is lacking . We examined the association between supplemental nutrition in pregnancy and childhood and relative proportions of components of height in adolescence . METHODS In a community trial of nutritional supplementation , villages from adjacent administrative areas were selected to serve as intervention ( n = 15 ) and control ( n = 14 ) arms . In the intervention villages , balanced protein-calorie supplementation ( 2.51 MJ , 20 g protein ) was offered daily to pregnant women and their offspring until the age of 6 years . Children born in the trial were re-examined 15 years later to assess components of height . RESULTS A total of 1165 adolescents ( intervention : 654 , 49 % of trial participants ; control : 511 , 41 % of trial participants ) aged 13 - 18 years were examined . Supplemented children were 10 mm taller [ 95 % confidence interval ( CI ) : 1.4 to 18.7 mm ] , but almost all of the increase was in trunk length ( 9 mm , 95 % CI : 2.6 to 15.4 mm ) . The age- and gender-adjusted β-coefficients for the association of nutritional supplementation  with relative trunk , leg and lower leg lengths ( expressed as st and ard deviation scores ) were 0.26 ( 95 % CI : 0.11 to 0.42 ) , 0.08 ( 95 % CI : -0.03 to 0.19 ) and 0.03 ( 95 % CI : -0.08 to 0.15 ) respectively , thereby unsupportive of cephalocaudal gradient in growth . CONCLUSIONS In this nutritional supplementation trial in an undernourished population , we were unable to confirm relative leg length as a biomarker of childhood nutrition . Alternative explanations may underlie the reported associations between childhood conditions and relative leg length BACKGROUND Maternal obesity and excessive gestational weight gain ( GWG ) are major short- and long-term risk factors for maternal and fetal complications . OBJECTIVE The objective was to study whether a lifestyle intervention based on a brochure or on active education can improve dietary habits , increase physical activity ( PA ) , and reduce GWG in obese pregnant women . DESIGN In this r and omized controlled trial , 195 white , obese pregnant women [ age : 29 + or - 4 y ; body mass index ( in kg/m(2 ) ) ; 33.6 + or - 4.2 ] were r and omly assigned into 3 groups : a group that received nutritional advice from a brochure , a group that received the brochure and lifestyle education by a nutritionist , and a control group . Nutritional habits  were evaluated every trimester through 7-d food records . PA was evaluated with the Baecke question naire . RESULTS Energy intake did not change during pregnancy and was comparable in all groups . Fat intake , specifically saturated fat intake , decreased and protein intake increased from the first to the third trimester in the passive and active groups compared with an opposite change in the control group . Calcium intake and vegetable consumption increased during pregnancy in all groups . PA decreased in all groups , especially in the third trimester . No significant differences in GWG and obstetrical or neonatal outcome could be observed between the groups . CONCLUSIONS Both lifestyle interventions improved the nutritional habits of obese women during pregnancy . Neither PA nor GWG was affected The current study attempts to identify the effects of an individual prescription for protein and kilocalorie requirements during pregnancy on subsequent maternal and infant outcomes . This study was a replication of Agnes Higgins ' Intervention Method for Nutritional Rehabilitation During Pregnancy developed at the Montreal Diet Dispensary , Montreal , Canada . The present study was a r and omized clinical trial using an experimental control group design . There were 47 subjects in phases 1 and 2 of a multiphase study .  Total food intake data was available for 43 subjects with singleton live births . The Higgins method was found to have a significant impact on increasing the amount of protein but not calories consumed by the experimental group . A significant increase in maternal weight and infant birth weight was found in those underweight and normal weight women , who gained at least 10 lb ( 4.5 kg ) in the first 20 weeks of their pregnancy and who consumed an adequate amount of their prescriptions of both protein and kilocalories . All the women with premature labor and pregnancy-induced hypertension were in the group with an inadequate early pregnancy weight gain and inadequate nutrition intake . Data collection to increase sample size is ongoing The present study is a secondary analysis of the ROLO study , a r and omised control trial of a low-glycaemic index ( GI ) diet in pregnancy to prevent the recurrence of fetal macrosomia . The objectives of the present study were to identify which women are most likely to respond to a low-GI dietary intervention in pregnancy with respect to three outcome measures : birth weight ; maternal glucose intolerance ; gestational weight gain ( GWG ) . In early pregnancy , 372 women had their mid-upper arm circumference recorded and BMI calculated . Concentrations of glucose , insulin and leptin were measured in early pregnancy and at 28 weeks . At delivery , infant birth weight was recorded and fetal glucose , C-peptide and leptin concentrations were measured in the cord blood . Women who benefited in terms of infant birth weight were shorter , with a lower education level . Those who maintained weight gain within the GWG guidelines were less overweight in both their first and second pregnancies , with no difference being observed in maternal height . Women who at 28 weeks of gestation developed glucose intolerance , despite the low-GI diet , had a higher BMI and higher glucose concentrations in early pregnancy with more insulin resistance . They also had significantly higher-interval pregnancy weight gain . For each analysis , women who responded to the intervention had lower leptin concentrations in early pregnancy than those who did not . These findings suggest that the maternal metabolic environment in early pregnancy is important in determining later risks of excessive weight gain and metabolic disturbance , whereas birth weight is mediated more by genetic factors . It highlights key areas , which warrant further interrogation before future pregnancy intervention studies , in particular , maternal education level and inter-pregnancy weight gain Abstract Objective : To test the efficacy in terms of birth weight and infant survival of a diet supplement programme in pregnant African women through a primary healthcare system . Design : 5 year controlled trial of all pregnant women in 28 villages r and omised to daily  supplementation with high energy groundnut biscuits ( 4.3MJ/day ) for about 20 weeks before delivery ( intervention ) or after delivery ( control ) . Setting : Rural Gambia . Subjects : Chronically undernourished women ( twin bearers excluded ) , yielding 2047 singleton live births and 35 stillbirths . Main outcome measures : Birth weight ; prevalence of low birth weight ( < 2500 g ) ; head circumference ; birth length ; gestational age ; prevalence of stillbirths ; neonatal and postneonatal mortality . Results : Supplementation increased weight gain in pregnancy and significantly increased birth weight , particularly during the nutritionally debilitating hungry season ( June to October ) . Weight gain increased by 201 g ( P<0.001 ) in the hungry season , by 94 g ( P<0.01 ) in the harvest season ( November to May ) , and by 136 g ( P<0.001 ) over the whole year . The odds ratio for low birthweight babies in supplemented women was 0.61 ( 95 % confidence interval 0.47 to 0.79 , P<0.001 ) . Head circumference was significantly increased ( P<0.01 ) , but by only 3.1 mm . Birth length and duration of gestation were not affected . Supplementation significantly reduced perinatal mortality : the odds ratio was 0.47 ( 0.23 to 0.99 , P<0.05 ) for stillbirths and 0.54 ( 0.35 to 0.85 , P<0.01 ) for all deaths in first week of life . Mortality after 7 days was unaffected . Conclusion : Prenatal dietary supplementation reduced retardation in intrauterine growth when effectively targeted at genuinely at-risk mothers . This was associated with a substantial reduction in the prevalence of stillbirths and in early neonatal mortality . The intervention can be successfully delivered through a primary healthcare system . Key messages In developing countries chronic maternal undernutrition is a prime contributor to the birth of over 25 million low birthweight babies annually and to high rates of neonatal mortality . An absence of well design ed field trials has created uncertainty about the potential efficacy of maternal feeding programmes This large scale r and omised controlled trial shows that dietary supplementation in pregnancy can be highly effective in reducing the proportion of low birthweight babies and perinatal mortality Incorporating supplementary feeding into a rural primary healthcare system is feasible Late pregnancy is the period most amenable to This r and omized controlled trial of nutritional supplementation in pregnancy , in a poor black urban population in the United States , aim ed to increase the birth weight and influence the postnatal development of the offspring of mothers at high risk of having low birth weight infants . The execution of the research design and adherence to the treatment regimen among the experimental population appeared adequate for a reasonable test of the treatments . At birth , the only significant favorable effect of supplementation observed was the prevention of depressed birth weight among the offspring of mothers who smoked heavily . With balanced protein-calorie supplementation , length of gestation was increased , the proportion of low-birth-weight infants reduced , and mean birth weight raised by 41 gm ( not statistically significant ) . With high protein supplementation , there was an excess of very early premature births and associated neonatal deaths , and there was significant growth retardation up to 37 weeks of gestation . At 1 year of age , significant effects of high protein supplement were found on three psychological measures : visual habituation , visual dishabituation , and mean length of free play episodes . These measures were unrelated to measures of growth at birth and at 1 year of age . There were no detectable residual adverse effects of high protein supplementation at 1 year of age BACKGROUND Substantial , but indirect , evidence suggests that improving nutrition in early childhood in developing countries is a long-term economic investment . We investigated the direct effect of a nutrition intervention in early childhood on adult economic productivity . METHODS We obtained economic data from 1424 Guatemalan individuals ( aged 25 - 42 years ) between 2002 and 2004 . They accounted for 60 % of the 2392 children ( aged 0 - 7 years ) who had been enrolled in a nutrition intervention study during 1969 - 77 . In this initial study , two villages were r and omly assigned a nutritious supplement ( atole ) for all children and two villages a less nutritious one ( fresco ) . We estimated annual income , hours worked , and average hourly wages from all economic activities . We used linear regression models , adjusting for potentially confounding factors , to assess the relation between economic variables and exposure to atole or fresco at specific ages between birth and 7 years . FINDINGS Exposure to atole before , but not after , age 3 years was associated with higher hourly wages , but only for men . For exposure to atole from 0 to 2 years , the increase was US$ 0.67 per hour ( 95 % CI 0.16 - 1.17 ) , which meant a 46 % increase in average wages . There was a non-significant tendency for hours worked to be reduced and for annual incomes to be greater for those exposed to atole from 0 to 2 years . INTERPRETATION Improving nutrition in early childhood led to substantial increases in wage rates for men , which suggests that investments in early childhood nutrition can be long-term drivers of economic growth Leptin regulates energy homeostasis and immune and metabolic functions . Highly elevated leptin concentrations during pregnancy may be associated with aberrations in maternal metabolism and long-term health consequences both in women and children . The objective of the present study was to evaluate whether dietary counselling , probiotic supplementation , maternal characteristics or dietary intake during pregnancy has an impact on serum leptin concentrations in women , cord blood or in children . A total of 256 pregnant women were r and omised to a control group ( n 85 ) or to receive dietary counselling with probiotics ( n 85 ) or placebo ( n 86 ) . Dietary counselling aim ed at affecting the type of fat used and to increase the amount of fibre in the women 's diet . Women 's dietary intake and serum leptin concentrations were analysed at the first and third trimesters of pregnancy and at 1 month postpartum . Furthermore , leptin concentrations were measured from the cord blood and from children 's serum at 1 and 6 months of age . Weight status and dietary composition were the key determinants of leptin concentrations . Specifically , high dietary fibre and low SFA intakes were related to low serum leptin concentrations in women . Female sex and birth weight were associated with higher infant leptin , whereas cord blood leptin was additionally affected by maternal leptin concentration and protein intake . Probiotics or dietary counselling did not affect leptin concentrations . Weight control to recommended levels and modification of diet towards higher fibre and lower SFA intakes during pregnancy may through leptin concentrations provide health benefits to both women and children Background Maternal malnutrition and poor gestational weight gain are the most important causes of low birthweight and infant mortality in Bangladesh . Objective To assess the effect of short-term nutrition education on weight gain in the third trimester of pregnancy , birth outcomes , and breastfeeding . Methods Three hundred pregnant women participated in this r and omized , controlled trial during a 3-month intervention period . The study was conducted in two antenatal clinics in urban Dhaka . One group of women was given monthly education sessions during the third trimester of pregnancy to promote consumption of khichuri , while the control group received only routine services from the health facilities .  Birthweight was recorded within 24 hours after delivery . Breastfeeding practice s were observed for 1 month after delivery . Results In the intervention group , maternal weight gain in the third trimester was 60 % higher ( 8.60 vs. 5.38 kg , p = .011 ) , mean birthweight was 20 % higher ( 2.98 vs. 2.49 kg , p < .001 ) , the rate of low birth-weight was 94 % lower ( 2.7 % vs. 44.7 % , p < .001 ) , and the rate of initiation of breastfeeding within 1 hour after birth was 52 % higher ( 86.0 % vs. 56.7 % , p < .001 ) , in comparison with the control group . Birthweight was associated with frequency of intake of khichuri ( p < 0.001 ) . Conclusions Nutrition education with a focus on promoting consumption of khichuri during the third trimester of pregnancy significantly reduced the rate of low birthweight and increased maternal weight gain A r and omized controlled double-blind study of nutrition supplementation of pregnant and lactating women was conducted in Suilin township , Taiwan . Pregnant mothers were r and omly assigned to one of two treatment groups consisting of either a high ( 800 kcal and 40 g protein ) calorie daily supplement or a placebo . For each mother treatment began following the delivery of her first study infant , continued throughout the lactation period ; and through the pregnancy and lactation of her second study infant . Comparisons of sibling-sibling anthropometric correlations at birth between groups show that among the placebo group the sibling correlations are statistically significant and of the same magnitude seen in previous studies ( approximately 0.5 ) , while among high calorie siblings correlations are unusually low and often not significant . This is particularly true for male fetuses , suggesting that the latter are more sensitive to nutritional environmental variations in utero , than are female fetuses . Reduction in familial correlations , presumed measures of genetic influence , in nutritionally stressed population s , will occur when the environment of relatives differ , but are not due to malnutrition per se There is little unequivocal evidence that nutritional supplementation of undernourished children has a beneficial effect on their mental development . The effects of nutritional supplementation , with or without psychosocial stimulation , of growth-retarded ( stunted ) children aged 9 - 24 months were assessed in a study in Kingston , Jamaica . 129 children from poor neighbourhoods were r and omly assigned to four groups -- control , supplemented only , stimulated only , and supplemented plus stimulated . A group of matched non-stunted children ( n = 32 ) was also included . The supplement comprised 1 kg milk-based formula per week for 2 years , and the stimulation weekly play sessions at home with a community health aide . The children 's development ( DQ ) was assessed on the Griffiths mental development scales . Initially the stunted groups ' DQs were lower than those of the non-stunted group , and those of the control group declined during the study , increasing their deficit . Stimulation and supplementation had significant independent beneficial effects on the children 's development . Estimates of the supplementation effect ranged from 2.2 ( 95 % confidence limits-1.4 , 5.7 ) for the h and and eye subscale to 12.4 ( 5.4 , 19.5 ) for the locomotor subscale and those for the stimulation effect from 6.4 ( 2.8 , 10.0 ) for h and and eye to 10.3 ( 3.3 , 17.3 ) for locomotor . The treatment effects were additive , and combined interventions were significantly more effective than either alone . These findings suggest that poor mental development in stunted children is at least partly attributable to undernutrition Summary . The effect of two levels of energy supplementation in the last trimester of pregnancy on birthweight  was tested in a controlled r and omized trial in three villages in Madura , East Java .  The high and low energy supplements provided 1·95 MJ ( 465 kcal ) and 218 kj ( 52 kcal ) per day respectively . In the baseline period the home diet provided on average 6·28 MJ ( 1500 kcal ) ( SD 2·1 MJ ( 499 kcal ) ) and 41g(SD 13 g ) of protein . The mean birthweight  was 2835 g and the rate of low birth‐weight 12·2 % . In the experimental period the home diet was better . The average intake ranged from 6·45 to 7·19 MJ ( 1541–1717 kcal ) and 41·4–44·2 g per day , depending on the degree of compliance . Mean birth‐weight increased by 100 g and the rate of low birthweight dropped to 9·5 % . There was no difference between the high and low energy supplemented group as a whole , probably due to the masking effect of the better home diet in the experimental period . It is likely that a positive effect of energy supplementation on birthweight was restricted to the group of pregnant women with the lowest home dietary intake and /or a low prepregnant weight . In this community targeting of supplementation to lean seasons and /or to women with a low prepregnant weight may be cost‐effective We related cigarette smoking during pregnancy to the macroscopic and microscopic morphology , histomorphometry , and biochemistry of the placenta among participants in The Prenatal Project , a r and omized , controlled trial of nutritional supplementation during pregnancy . The aim was to ascertain if the harmful effects of cigarette smoking on the fetus were reflected , and possibly mediated , by changes in the placenta , and whether such changes might be modified by the nutritional supplements , parallel to the nutritional reversal of birthweight depression among heavy smokers . Maternal smoking was associated with increased alkaline ribonuclease ( RNase ) levels , possibly result ing in disturbed protein synthesis . More smokers had placentas with villous hyperplasia on histologic examination . This was accompanied by biochemical evidence of significantly increased cellularity ( increased DNA/gm of placental mass and decreased protein/DNA ratios ) and ( nonsignificant ) trends to reduced syncytial villous cell size on histomorphometry . There were joint effects of cigarette smoking and use of either form of nutritional supplementation on the fibrin and stoma components of the villi , but such changes are not necessarily pathologic . The significant reduction in pathology of the stem villi among smokers was confined to those who were nutritionally supplemented , particularly heavy smokers . This change may thus have reflected the protective effects of supplementation on the birthweight of the offspring of these heavy smokers BACKGROUND Eating carbohydrate foods with a high glycemic index ( GI ) has been postulated to result in fetoplacental overgrowth and higher infant body fat . A diet with a low glycemic index ( LGI ) has been shown to reduce birth percentiles and the ponderal index ( PI ) . OBJECTIVES We investigated whether offering LGI dietary advice at the first antenatal visit would result in a lower fetal birth weight , birth percentile , and PI than providing healthy eating ( HE ) advice . This advice had to be presented within the re sources of routine antenatal care . DESIGN The Pregnancy and Glycemic Index Outcomes study was a 2-arm , parallel- design , r and omized , controlled trial that compared the effects of LGI dietary advice with HE advice on pregnancy outcomes . Eligible volunteers who attended for routine antenatal care at < 20 wk of gestation were r and omly assigned to either group . RESULTS A total of 691 women were enrolled , and 576 women had final data considered . In the LGI group , the GI was reduced from a mean ( ± SEM ) of 56 ± 0.3 at enrollment to 52 ± 0.3 ( P < 0.001 ) at the final assessment . There were no significant differences in primary outcomes of fetal birth weight , birth percentile , or PI . In a multivariate regression analysis , the glycemic load was the only significant dietary predictor ( P = 0.046 ) of primary outcomes but explained < 1 % of all variation . CONCLUSION A low-intensity dietary intervention with an LGI diet compared with an HE diet in pregnancy did not result in any significant differences in birth weight , fetal percentile , or PI Objective : Insulin-like growth factors ( IGF ) are increasingly recognized as important determinants of adult health , in particular risk of certain cancers . However , little is known about the determinants of adult IGFs and to what degree they may be programmed by early life influences . Design : R and omized controlled trial of prenatal and postnatal milk supplementation among 951 subjects born in 1972 to 1974 in South Wales . Main outcome measure : Measures of IGF-I , IGF binding protein 3 , and the molar ratio . Results : Data on adult IGFs were available from 663 subjects at a mean age of 25 years . Subjects in the intervention arm had lower IGF-I ( −8.5 ng/mL ; 95 % confidence interval , −15.1 to −1.8 , P = 0.01 ) and ratio ( −1.20 ; 95 % confidence interval , −2.33 to −0.04 , P = 0.04 ) . These differences could not be explained by follow-up bias or confounding factors . Conclusions : These results provide experimental data on the role of early life programming either in the intrauterine or postnatal period that may have long-term influences on the IGF axis , with potential implication s for disease risk The aim of this study was to assess the impact of dietary counselling combined with the provision of food products on food and nutrient intake in pregnant women . We carried out a prospect i ve cohort study of healthy and atopic pregnant women ( n 209 ) , who were r and omized into dietary intervention and control groups . The intervention group received dietary counselling and food products to modify the fat composition of their diet to meet current recommendations . Three-day food records were collected during each trimester of pregnancy . Women in the intervention group consumed more vegetables , fruits , soft margarines and vegetable oils and less butter than those in the control group during the course of pregnancy ( P<0.05 ) . The main distinction between the groups in nutrient intake over the pregnancy was attributable to a higher energy intake ( % energy ) of PUFA by 0.5%energy ( 95 % CI 0.1 , 0.8 ) and to a lower intake of SFA by 0.8 % energy ( 95 % CI -1.4 , -0.4 ) in the intervention group . Dietary intake of vitamin E was 1.4 mg ( 95 % CI 0.6 , 2.2 ) , folate 20.9 microg ( 95 % CI 0.8 , 41.0 ) and ascorbic acid 19.8 mg ( 95 % CI 3.5 , 36.0 ) higher in the intervention group compared to the controls , while no differences in other nutrients were detected . Dietary counselling combined with the provision of food products during pregnancy is of importance in modifying food and nutrient intake , with potential health benefits Twelve hundred and fifty-one pregnant women were contacted and their infants followed to age 5 years . Nine hundred and fifty-one ( 76 % ) children completed the trial . Measurements were made of birthweight , length , head circumference , and triceps skinfold at 10 days , and of weight , height , head circumference , and triceps at 5 years . Throughout the entire period of the study half the families , selected at r and om , were supplied with milk tokens entitling the mother , while pregnant , and all children under age 5 years , to 1 pint of milk a day at half its current price . The tokens led to a small increase in milk purchases by the families and to a small increase in milk drunk by the children . However no effect was detected in any growth measurement either in the total group , or in a more " vulnerable " group of children from the largest families Colombian women at risk of mild-to-moderate malnutrition were enrolled in a health care program and r and omly assigned into nutritional supplementation and control groups at the beginning of the third trimester of preganancy . One hundred unsupplemented and 144 supplemented infants were tested at 15 days of age : a 2X2 checkerboard was presented eight times followed by a single presentation of a 6X6 checkerboard . Unsupplemented infants showed less initial attention followed by slower habituation and higher levels of movement than the supplemented infants . The observed effect of maternal nutritional supplementation during the last trimester of pregnancy on new-born attention was interpreted to be maturational in nature A 1200 calorie diet or cyclopenthiazide with potassium was given to two groups of 51 high weight gain primigravidae and baby weight and the incidence of pre‐eclampsia  were compared with those in a matched control group . There was no difference in the development of pre‐eclampsia , but the weight of babies in the control group was higher than in the treated groups . The body fat was reduced in the diet group and the total body water in the diuretic group Infants born to families at risk of malnutrition were studied prospect ively from the beginning of the 3rd trimester of the mother 's pregnancy until the child reached 3 yr of age to ascertain the effects of nutritional supplementation and /or a maternal education program on their cognitive development . Four hundred thirty-three families were assigned r and omly to six groups : group A served as a control ; group B received the supplement from the age of 6 months to 3 yr ; group C received the supplement during the 3rd trimester of pregnancy and the first 6 months of the child 's life ; and group D received the supplement throughout the entire study period . In addition , group A1 was enrolled in a maternal education program but received no nutritional supplement and group B1 received both treatments . The Griffiths test of infant development was administered at 4 , 6 , 12 , 18 , 24 , and 36 months of age , and the Corman-Escalona Einstein scale was administered at each age up to 18 months . Children who received food supplementation performed better than those who did not , especially on subtests that were primarily motoric . The effect of food supplementation on behavior appeared to be contemporaneous . In addition , the treatment effects were more pronounced for girls than for boys in this sample . Although these interventions reduced the gap in cognitive performance between lower and upper socioeconomic classes , a disparity nevertheless remained by the end of the study Effects of a feeding programme on maternal weight , triceps and subscapular skinfolds during pregnancy and lactation were assessed in a marginally undernourished population of rural Taiwan . Mothers participated during two pregnancy and lactation periods . At 3 weeks after the delivery of the first infant , one group of 114 mothers began consuming a nutrient-dense supplement ( A ) , while another group of 111 received a placebo ( B ) . There was no significant A-B difference in pregnancy weight gain ( A 7.52 kg , B 7.75 kg ) or in mean maternal weight , triceps or subscapular skinfolds at any time during pregnancy or lactation . Despite a general trend toward moderate weight loss during lactation , one-third of mothers in both groups gained weight . Highly significant increases in weight and skinfold thicknesses from one lactation period to the next characterized both groups . The absence of demonstrable supplement-effects on maternal anthropometry concomitant with increments in infant birth weight supports the notion that infants can benefit from maternal supplementation without changes in maternal nutritional status OBJECTIVE Examine the impact of providing yogurt to women enrolled in the Special Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) . DESIGN R and omized , controlled intervention trial . SETTING Two California WIC local agency sites . PARTICIPANTS 511 pregnant , breast-feeding , or postpartum women . INTERVENTION Substitution of part of the WIC milk allowance with yogurt accompanied with educational material s. MAIN OUTCOME MEASURES Participants ' consumption and attitudes regarding yogurt provision . ANALYSIS Chi-square , Fisher exact , and Student t test to compare pre- versus post-intervention responses . Nonparametric Wilcoxon , chi-square , and t test to compare changes in response in intervention versus controls . Analysis of covariance models to test the influence of language preference on outcomes . RESULTS Over 86 % of women wanted to substitute some of their milk vouchers with yogurt . Among these , 62 % reported preferring yogurt to milk . The majority ( 89 % ) redeemed the yogurt coupons . Compared to controls , intervention women reported a trend ( P = .09 ) toward an increase in yogurt intake of 1.0 fl oz/day while not decreasing other dairy consumption . Those in the intervention group with the lowest tertile of yogurt intake at baseline increased yogurt consumption by 2.8 fl oz/day ( P = .003 ) relative to controls with lowest intake . CONCLUSIONS Yogurt is likely to be a popular substitute for milk and could contribute to increased dairy intake among women if it were an option in WIC BACKGROUND Maternal nutritional intake during pregnancy may have important consequences for long-term health in offspring . OBJECTIVE The objective was to follow up the offspring in 2 r and omized trials of nutrient supplementation during pregnancy to investigate the effect on cardiovascular disease ( CVD ) risk  in offspring . DESIGN We recruited offspring born during 2 trials in The Gambia , West Africa . One trial provided protein-energy-dense food supplements ( 1015 kcal and 22 g protein/d ) to pregnant ( intervention , from 20 wk gestation until delivery ) or lactating ( control , for 20 wk from birth ) women and was r and omized at the village level . The second was a double-blind , individually r and omized , placebo-controlled trial of calcium supplementation ( 1.5 g/d ) , which was also provided from 20 wk gestation until delivery . RESULTS Sixty-two percent ( n = 1267 ) of children ( aged 11 - 17 y ) born during the protein-energy trial were recruited and included in the analysis , and 64 % ( n = 350 ) of children ( aged 5 - 10 y ) born during the calcium trial were recruited and included in the analysis . Fasted plasma glucose was marginally lower in children born to mothers receiving protein-energy supplements during pregnancy than in those children of the lactating group ( adjusted mean difference : -0.05 mmol/L ; 95 % CI : -0.10 , -0.001 mmol/L ) . There were no other differences in CVD risk factors , including blood pressure , body composition , and cholesterol , between children born to intervention and control women from the protein-energy trial . Maternal calcium supplementation during pregnancy was unrelated to offspring blood pressure . CONCLUSION These data suggest that providing supplements to pregnant women in the second half of pregnancy may have little effect on the CVD risk of their offspring , at least in this setting and at the ages studied here . This trial was registered at www.controlled-trials.com as IS RCT N96502494 The study attempted to determine if the bulk of dietary supplements given to pregnant women after midgestation affects fetal growth .  127 Zulu women were r and omly assigned to four groups , two of which received daily food supplements design ed to raise their energy , protein and vitamin intakes to levels recommended by the U.S. Food and Nutrition Board . One of these supplements had a high bulk , the other a low bulk . The third supplement contained only zinc and the fourth a placebo . Women in all four groups had a similar weight gain and length of gestation . Birth weights were from 6.5 to 9.5 % greater with the low bulk than with the other supplements Studies on nutritional supplementation  of pregnant mothers have observed small but sometimes significant effects on fetal growth . Previously we also reported significant changes in physical resemblance of siblings at birth due to this kind of supplementation , using data collected by the late Dr. Bacon Chow and associates . This suggested that components of variation in physical growth may change as a result of supplementation . To explore this further , we sought the effects of nutritional supplementation on somatic growth , holding constant the birth measurements of a previous ( unsupplemented ) sibling . Only head circumference at birth came close to showing a statistically significant ( P less than 0.06 ) supplement effect on its mean ( + 0.36 cm ) when the measurement of the first infant was held constant . Both increases and decreases in weight for length as assessed by Rohrer 's Index ( wt/l3 ) occurred with supplementation . Increases in the index occurred by a significant ( P less than 0.01 ) gain in birth weight ( 238 g ) between 1st and 2nd siblings in the supplement group but not in the placebo group . Decreases in this index result ed from a significant gain in birth length ( 1.3 cm ) in supplemented families with a previous ( untreated ) sibling having a below average length for average weight . These non-linear effects on somatic growth suggest that responses to maternal nutritional supplementation may be more effective in a subgroup of the population where the normal adaptive responses to low energy protein intakes may have failed or where nutritional conditions over pregnancy may have varied considerably THE Nutrition Study carried on at the Pennsylvania Hos­ pital from 1947 to 1952 was design ed to investigate the effect of the addition of protein and vitamin supple­ ments to the diets of pregnant women upon the outcome of their pregnancy and upon the physical status of their infants . The previous reports from the Study have dealt primarily with the first of these two questions , and it is with the second , the relationship between supplementation of the maternal diet and the physical status of the baby , that this report is concerned . Under the plan of the study , women coming to the Clinic of the Hospital during the first 16 weeks of pregnancy were re­ ferred to the Nutrition Clinic . There they were assigned to one of four groups , on a r and om basis controlled for race , age , and gravida . One group was design ated as the control and was given no nutritional supplement , a second group was given vitamins only , the third group a protein supplement only , and the fourth group was given both vitamins and the protein sup­ plement.4 Uniform diet instructions were given to the Pregnant women at risk of malnutrition were enrolled in a health care programme in Colombia , South America , and were r and omly assigned to a group receiving supplementary food or to a control group at the beginning of the third trimester of pregnancy . There were no differences between the groups in social or nutritional variables Many studies have demonstrated the efficacy of folic acid ( FA ) supplementation in prevention of neural tube defects ( NTDs ) , although the extent of NTDs varies among individuals of different races and ethnic origin . China is a multi-ethnic country with no st and ard practice for FA-fortified food . Milk is consumed by women , but little is known about the effects of milk on folate concentration in maternal blood and neonatal umbilical cord blood in Han and Mongolian women after stopping taking the supplement for a month and five month , respectively . The objective of this study was to determine whether only daily consumption of liquid milk can increase the blood folate concentration in pregnant women and whether there are differences in blood folate concentrations between Han and Mongolian women after cessation of FA supplementation . Of the 4052 women enrolled in the parallel group design study . Three thous and five hundred and twenty-six women had confirmed pregnancies and were r and omized to receive liquid milk or not until delivery . Women who consumed the liquid milk had significantly increased serum folate concentrations at 16 and 32 weeks of gestation as well as cord blood at birth compared to control groups in both ethnic groups . Infants born to women drinking milk also had better the term birth weight and height , which may be related to the increased concentration of folate . In conclusion , daily consumption of milk can increase the serum folate concentration in pregnant Han and Mongolian women in China ( differences in the efficacy of FA and milk supplementation ) and may enhance birth outcomes This study assesses the effect of supplementation of energy and protein to meet the nutrient requirements of pregnant women in India on the basis of lactation performance and the nutritional status of the infant . 20 pregnant women between the ages of 20 - 23 belonging to a low socioeconomic group who were in their last trimester of pregnancy were selected . Out of 20 10 women were supplemented while the other 10 served as controls . The results reveal that the mean milk yield of supplemented women did not increase significantly ( P<0.05 ) when compared to that of control women during the 1st month of lactation suggesting that lactation potential may be the same in all women in the 1st month irrespective of inadequacies in food intake during the last trimester of pregnancy . The milk yield was significantly higher ( 307 g ) in supplemented women than that of controls in the 3rd month of lactation . Although no difference in weight gain was observed due to supplementation in pregnancy additional food intake supported lactation for a longer period . The birth weight and length of infants born to women who received the supplement were higher by 264 g and 1.81 cm respectively suggesting the effect of supplementary food . Supplementation also brought about a significant increase ( P<0.05 ) in hemoglobin levels which may be attributed to the contribution of iron and protein contained in the supplement . A comparison of length weight and arm circumference of infants in the present study during the 1st 3 months of infancy with those of Harvard st and ards revealed that the increments in these measurements were equal to those of the st and ards though the actual values were 90 - 95 % of Harvard st and ards in the case of the supplemented group and 80 - 85 % in the control group . From the investigation it can be concluded that dietary supplementation during the last trimester of pregnancy has beneficial effects on maternal hemoglobin levels and on morbidity lactation performance birth weight and the physical development of the infant Objective : This study investigated the influence of modifying the maternal dietary fat on the serum lipids of infants at birth and at one year of age . Methods : This single-blind r and omized clinical trial was done on 180 4-month-pregnant women . All subjects proved to have a fat-unmodified diet through a 4-day food record dietary question naire . They were divided r and omly into two groups . The intervention group was kept on a fat-modified diet including saturated fatty acid ( SFA ) < 10 % , monounsaturated fatty acids : ( MUFA ) 10 - 5 % , polyunsaturated fatty acid ( PUFA ) upto 10 % and cholesterol < 300 mg/day with dietary advice for the pregnancy period . The control group was given only the latter advice . All subjects were followed up monthly . The serum lipids including total cholesterol ( T.cho ) , triglyceride ( TG ) , and HDL cholesterol ( HDL-C ) were analyzed through enzymatic methods . The level of LDL-cholesterol ( LDL-C ) was calculated by Friedewald formula . The comparison of mean cord and one-year-old infant serum lipids were done through unpaired T-test in two groups . Results : The mean level of T.cho in the intervention and control group was ( 70.3±15.9 , vs 81.4±17.2 , P<0.009 ) , TG ( 85.3 ± 16.7 vs 97.5 ± 18.2 , P<0.007 ) , LDL-C ( 27.8 ± 15.2 vs 34.8 ±17.1 , P<0.04 ) and non-HDL-C ( 44.5±7.2 vs 54.5 ± 8.1 , P<0.02 ) and in one year old infant the comparison of serum lipids were as follows . T.cho ( 145.7 ± 51.4 vs 161.4 + 56.2 , P<0.003 ) , TG ( 90.1 ± 31.8 vs 98.3 ± 33.1 , P<0.02 ) , LDL-C ( 85.6 ± 20.4 vs 92.3 ± 19.6 , P<0,05 ) and non-HDL-C ( 113.6 ± 30.2 vs 128.8 ± 34.8 , P<0.04 ) . However , there was no significant difference in HDL-C of both groups . Conclusion : There is a significant decrease of T.cho , TG , LDL-C and non-HDL-C levels with no significant increase of HDL-C in the intervention group with the fat-modified diet . Maternal fatmodified diet could be suitable way to prevent cardiovascular disease among infants from the beginning of the life BACKGROUND Better early childhood nutrition improves schooling , adult health , skills , and wages , but there is little evidence regarding its effect on the next generation . OBJECTIVE We assessed whether nutritional supplementation in children aged < 7 to 15 y affected their children 's nutritional status 29 - 38 y later . DESIGN We studied 791 children 0 - 12 y who were offspring of 401 Guatemalan women who had participated as children in a nutritional supplementation trial in which 2 villages were r and omly assigned to receive a  nutritious supplement ( atole )  and 2 were assigned to receive a less-nutritious supplement ( fresco ) . We compared anthropometric indicators between the offspring of mothers exposed to atole and the offspring of mothers exposed to fresco .  RESULTS Compared with the offspring of women exposed to fresco , the offspring of women exposed to atole had a 116-g ( 95 % CI : 17 , 215 g ) higher birth weight , were 1.3-cm ( 0.4 , 2.2 cm ) taller , had a 0.6-cm ( 0.4 , 0.9 cm ) greater head circumference , had a 0.26 ( 0.09 , 0.43 ) greater height-for-age z score , and had a 0.20 ( 0.02 , 0.39 ) greater weight-for-age z score . The association for height differed by offspring sex . Sons of women exposed to atole were 2.0-cm ( 95 % CI : 1.0 , 3.1 cm ) taller than the sons of women exposed to fresco . Supplementation was not associated with 6 other offspring anthropometric indicators that reflect measures of adiposity . Supplementation in boys did not affect their children 's anthropometric measures . CONCLUSION Nutritional supplementation in girls is associated with substantial increases in their offsprings ' ( more for sons ) birth weight , height , head circumference , height-for-age z score , and weight-for-age z score
BACKGROUND  Gestational weight gain  is positively associated with fetal growth , and observational studies of food supplementation in pregnancy have reported increases in gestational weight gain and fetal growth .
OBJECTIVES To assess the effects of education during pregnancy to increase energy and protein intake , or of actual energy and protein supplementation , on energy and protein intake , and the effect on maternal and infant health outcomes .