May 2002: (II)S26 –S34 Maternal Nutrition—Effect on Fetal Growth and Outcome of Pregnancy Prema Ramachandran, M.D. During the rst half of the 20th century, chronic energy undernutrition due to low dietary intake, repeated infections, and rapid succession of pregnancy were the factors most responsible for maternal undernutrition and consequent adverse outcomes of pregnancy. Efforts to improve di- etary intake, treatment of infections, and provi- sion of contraceptive care were the major fo- cuses of intervention from 1950 to 1990. These interventions resulted in reduction in severe grades of undernutrition. However, there was no reduction in mild and moderate degrees of un- dernutrition and anemia during pregnancy and there was no signicant improvement in the course and outcome of pregnancy, or in birth weight. During the 1990s, among the middle- and upper-income groups, there has been a progres- sive rise in obesity and consequent adverse ef- fects. The advent of HIV infection in India in the 1980s will inevitably lead to increases in severe undernutrition associated with HIV infection in pregnancy and an adverse impact of maternal HIV infection on the fetus. Practicing physicians and nutritionists in the new millennium will there- fore have to assess each person individually and provide appropriate advice regarding diet, exer- cise, fertility, and infection prevention and control in order to achieve optimum health and nutrition status during pregnancy and to prevent adverse pregnancy outcomes. © 2002 International Life Sciences Institute Introduction It has long been recognized that pregnant and lactating women form one of the most vulnerable segments of the population from a nutrition point of view. The ill effects of maternal undernutrition affect not only the mother but also her offspring. During the second half of the twen- tieth century, studies were undertaken to dene the nutrition requirements during pregnancy, the adverse consequences of undernutrition on the mother-child dyad and the intervention strategies for minimizing, if not eliminating, these adverse consequences. Adverse nutri- tion and health consequences of “too early, too close, too many, and too late” pregnancies on the mother-child dyad were recognized early in India and contraceptive care was identied as an effective indirect intervention to improve maternal and child nutrition. While undernutri- tion continues to be a major problem as in the earlier decades, the 1980s have witnessed the progressive rise in obesity and lifestyle-related chronic noncommunicable diseases in the middle- and upper-income groups. Thus India today has to combat the double burden of under- nutrition and obesity. Research studies during the 1960s and 1970s docu- mented the magnitude of adverse effects associated with iron, folate, iodine, and vitamin A deciency during pregnancy and lactation. National programs to combat these micronutrient deciencies were drawn up and are being implemented. In recent years, there have been reports of the reemergence of problems such as vitamin D deciency in pregnancy in the middle- and upper- income groups in some parts of the country. Yet another important indirect cause of undernutri- tion continues to be infections. Obstetricians and pedia- tricians continue to tackle the increased morbidity in anemic women and children. Associations between uri- nary tract infection, chlamydial infection, and low birth weight have been reported in some studies. With the advent of HIV epidemic in India in the 1980s, it is inevitable that over the next decade there will be an increase in the severe undernutrition associated with HIV in pregnancy and adverse impact of maternal HIV infec- tion on the fetus. Screening for these infections and their management will have to become a part of antenatal care. Thus practicing physicians and nutritionists will have to assess each person carefully and provide appro- priate advice regarding diet, exercise, fertility, and infec- tion prevention and control to improve health and nutri- tion status. Dr. Ramachandran is Adviser, (Health, Nutrition & Family Welfare) Planning Commission, Yojana Bha- van, Sansad Marg New Delhi-110001, India. Views expressed in the paper are views of the author and not of Planning Commission, Government of India. S26 Nutrition Reviews , Vol. 60, No. 5 Downloaded from https://academic.oup.com/nutritionreviews/article/60/suppl_7/S26/1884486 by guest on 17 December 2021