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. 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. Effects of a nutrition intervention program during pregnancy. Maternal data phases 1 and 2. Effects on birth weight and perinatal mortality of maternal dietary supplements in rural gambia: 5 year randomised controlled trial Energy supplementation during pregnancy and postnatal growth A randomized controlled trial of prenatal nutritional supplementation in New York City. Maternal nutrition supplementation during pregnancy interferes with physical resemblance of siblings at birth according to infant sex. 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. 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. 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 Influence of dietary supplementation during pregnancy on lactation performance. Fat-modified diets during pregnancy and lactation and serum lipids after birth
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 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 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 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 The effect of improving maternal nutrition during pregnancy on growth of the child has not been assessed , since previous studies supplemented the diets of children as well as mothers . In a controlled r and omised trial in Madura , East Java , pregnant women received a  high ( HE ) or low ( LE ) energy supplement that provided 1950 kJ ( 465 kcal ) or 218 kJ ( 52 kcal ) , respectively , in the last trimester of pregnancy . The effect of this intervention on the children 's growth was assessed longitudinally for the first 5 years of life . Only the children of mothers who had complied for at least 90 days were included . Infants entered the study at birth and their growth was measured at 4-week intervals until 12 months old ; thereafter they were measured every 3 months . Growth curves were calculated from a mathematical model , based on the best fit of actual measurements and the age-related growth velocity . Up to the age of 24 months , HE children were significantly heavier than LE children ( p less than 0.05 ) . HE children were also taller throughout the first 5 years ( p less than 0.005 from 15 to 48 months , p less than 0.05 at both 3 - 12 and 60 months ) . Weight-for-height by age was similar in both groups , but stunting ( height-for-age ) was less prevalent in HE children . In a community characterised by chronic energy deficiency among women of reproductive age , energy supplementation of women for the last 90 days of pregnancy was effective in the promotion of postnatal growth and reduction in malnutrition of preschool children 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 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 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 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 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 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 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 advice to increase or reduce energy or protein intake , or of actual energy or protein supplementation or restriction , during pregnancy on energy and protein intakes , gestational weight gain , and the outcome of pregnancy .