Can maternal dietary supplements help in preventing infant malnutrition?

Abstract

Many nutritional intervention programmes throughout the world have targeted food supplements towards women during the "at risk" periods of pregnancy and lactation. Some of these programmes, together with a number of small-scale scientific studies, have attempted to evaluate the efficacy of supplementation in terms of birth outcome or lactational performance. After reviewing the available evidence it is concluded: (a) that supplementation during late pregnancy can have a significant beneficial effect on birthweight in women who are genuinely "at risk" due to an inadequate home diet; (b) that statistical projections would predict that the increase in birthweight should be accompanied by a significant decrease in neonatal mortality; (c) that supplementation during lactation is most unlikely to increase breast-milk output or significantly improve its composition except perhaps in extremely malnourished women. Since pregnant women form a small and easily identifiable target group, and since the potential benefits of extra food may be substantial, it is recommended that future efforts are focussed in this direction. Large-scale effectiveness and cost-benefit trials are required with neonatal mortality as the primary outcome.

PIP: Research conducted in the Gambia suggests that food supplementation exerts a significant effect on infant health when administered to at-risk women during late pregnancy, while supplementation during lactation is not as effective. In the Gambian study, all pregnant women in 1 village were provided with groundnut biscuits and vitamin-fortified tea 6 days a week throughout the pregnancy. The effectiveness of this regimen was evaluated through comparison of 4 years of supplemented births and 4 years of preintervention births. This comparison indicated that, during the harvest season, the supplement had no effect on birth outcome. However, outside of the harvest season, the food supplement program was associated with a 200 gm increase in birth weight and the prevalence of low birth weight was reduced from 23.7% to 7.5%--gains that are, in turn, associated with a 37% decline in neonatal mortality. The same supplements were provided to lactating women in the Gambian village, and breast milk output from 1 year of supplementation was compared with that from the previous preintervention year. Here, there was only a minimal increase (7%) in fat content, no change in energy content, and a disturbing reduction in serum prolactin levels (associated with an earlier return to fertility). It was concluded that supplementation of the diet of pregnant women can have a beneficial impact on birth outcome in cases where there is a genuine nutritional deficit within an entire population, within selected subgroups, or at certain times of the year. Needed to persuade government health officials of the cost-effectiveness of such an intervention are large-scale studies that use neonatal mortality as the major outcome variable.