By: Sheela Sinharoy
Janet King of UC-Berkeley and Davis began with a review of the evidence related to maternal nutrition in the preconception period. She explained that a woman’s preconception nutritional status has an impact on fetal growth, affecting both linear growth and birthweight. One mechanism for this relationship is through the placenta, which responds to undernutrition with altered expression and activity of nutrient transporters, increased oxidative stress, epigenetic modification of placental genes, and abnormal villous branching. Maternal nutritional status, in turn, can be influenced by a number of factors, including the inter-pregnancy interval and maternal age.
Next, speakers presented two examples of interventions targeting maternal nutrition during the preconception period. Usha Ramakrishnan of Emory University and Phuong Nguyen of Thai Nguyen University (Vietnam) spoke about a study in Vietnam, while Caroline Fall of the University of Southampton (UK) described a project in India. In Vietnam, mothers were given micronutrient supplements in pill form. In India, the research team developed 70 recipes for micronutrient-rich snacks, which were then delivered to women six days a week. The study in Vietnam observed no impact on birth outcomes. Results from India indicated that birthweight was higher in treatment than control groups, but this difference was not significant. Still, these studies represented an important starting point in the relatively under-studied area of preconception nutrition interventions.
Finally, Luz María DeRegil of the Micronutrient Initiative spoke about the research and policy gaps related to preconception nutrition. She emphasized the need for more data on interventions, pointing out that while a great deal of evidence exists for some interventions, such as salt iodization, many others still need to be rigorously evaluated. In particular, a need exists for research on the most effective delivery platforms and on strategies for demand creation. This should include delivery platforms for adolescent friendly care, in order to encourage adolescent mothers to access health and nutrition services.
In terms of policy, she pointed out that the importance of preconception nutrition has been recognized by institutions such as the Food and Agriculture Organization and the World Health Organization, which together released the Rome Declaration on Nutrition in November 2014 committing to “develop policies, programmes and initiatives for ensuring healthy diets throughout the life course … including … before and during pregnancy.” However, this commitment can be extended further by individual governments, which can support women to improve their diets and nutritional status.
Although the speakers in today’s session focused primarily on maternal undernutrition in middle- and low-income countries, one commenter noted that the issue of overnutrition also deserves attention, especially when it occurs in combination with micronutrient deficiencies. In either case, the importance of women’s nutrition before and during pregnancy for improved birth outcomes seems clear.