Relationship between maternal nutritional status and infant's weight and body proportions at birth M Thame, RJ Wilks, N McFarlane-Anderson, FI Bennett and TE Forrester Tropical Metabolism Research Unit, University of the West Indies, Mona, Kingston 7, Jamaica Objectives: To examine maternal nutritional status and its relationship to infant weight and body proportions. Design: Retrospective study of births from January±December 1990. Setting: University Hospital of the West Indies, Jamaica. Subjects: Records for 2394 live, singleton births, between 200±305 d gestation. Main outcome measures: Birth weight, crown heel length, head circumference, ponderal index, head circumference:length ratio, placental weight, placental:birth weight ratio. Results: Mothers who were lighter had babies who had lower birth weight, were shorter, had smaller heads and had a higher HC:L ratio. Shorter and thinner women had babies who had lower birth weights, were shorter, had smaller heads and lighter placentas. Thinner women also had babies with a lower placental:birth weight ratio, and their BMI's were not linearly related to ponderal index and HC:L ratio. Women whose ®rst trimester Hb levels were < 9.5 g/dl had babies with the lowest birth weight, crown heel length, placental weight and ponderal index. These measurements increased as the Hb levels rose to 12.5 g/dl but then fell at Hb levels > 12.5 g/dl. In the second and third trimester Hb levels were negatively associated with birth weight, crown heel length, head circumference, placenta weight and ponderal index. Conclusions: The data support the hypothesis that poor maternal nutrition is associated with foetal growth restraint. Poor maternal nutrition as indicated by low weight, height, and BMI are associated with smaller, shorter babies with smaller heads. Haemoglobin levels > 12.5 g/dl in pregnancy are associated with lighter, shorter, thinner babies, with smaller heads. Descriptors: foetal growth restraint; maternal nutrition; birth weight Introduction Perinatal morbidity and mortality are related to growth restraint in utero which presents as low weight at birth. The evidence that the low birth weight infant (BWT < 2500 g) is at risk at birth, perinatally and in early life, is well documented (Kramer, 1987; Naeye, 1979). So is the role of maternal nutritional status in in¯uencing infant size (Kramer, 1987; Naye, 1979). Post maternal nutrition is associated with constrained foetal growth and therefore lower birth weight. Restriction of energy and/or protein intake by mother during pregnancy is associated with small size at birth in rats, mice, sheep and pigs (Widdowson, 1971; Chow, 1964; Zeman, 1969; McCance, 1974; Levy and Jackson, 1993; Widdowson and McCance, 1963). In humans, children of mothers who are poorly nourished before and during pregnancy are smaller at birth (Barker, 1994). Mothers who were small at birth in turn give birth to small babies (Barker, 1994; Stein and Susser, 1975). Recently, retrospective studies by Barker and colleagues have shown that the risk of chronic cardiovascular disease in adulthood is inversely related to birth weight, even within the normal range (Barker, 1994). Speci®c relation- ships were shown between different patterns of foetal growth restraint and type of chronic cardiovascular disease in adulthood. Thus, adults who were small babies with reduced birth weight had increased blood pressure, thin babies (low ponderal indices) developed high blood pres- sure and non insulin dependent diabetes, while dispropor- tionate babies (short in relation to head circumference) were shown to be at risk as adults for raised blood pressure, LDL cholesterol, and ®brinogen (Barker, 1992; Barker, 1993). The relationships between impaired foetal growth and risk factors for chronic cardiovascular diseases have also been demonstrated in childhood (Law et al, 1991). In recent studies of Jamaican children aged 7±14 y, birth weight was inversely related to blood pressure, and crown heel length at birth was inversely related to glycosolated haemoglobin levels and serum total cholesterol concentrations. Blood pressure in children was also inversely related to maternal haemoglobin concentration (Forrester et al, 1996). How- ever, thin maternal triceps skinfolds during pregnancy was a more powerful predictor of blood pressure in childhood than maternal haemoglobin concentration (Godfrey et al, 1994). In situations of marginal nourishment there is some evidence that mothers adjust their metabolic demands, hence potentially sparing nutrients for the development of the foetus (Poppit et al, 1994). However, where there is chronic undernutrition, the limits of adaptation might be exceeded and foetal growth become impaired. Inadequate Correspondence: Dr T Forrester. Received 28 May 1996; revised 17 September 1996; accepted 27 September 1996 European Journal of Clinical Nutrition (1997) 51, 134±138 ß 1997 Stockton Press. All rights reserved 0954±3007/97 $12.00