Energy supplementation during pregnancy and postnatal growth

doi:10.1016/0140-6736(92)92168-F

The Lancet

Volume 340, Issue 8820, 12 September 1992, Pages 623-626

https://doi.org/10.1016/0140-6736(92)92168-F Get rights and content

Abstract

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 randomised 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<0·05). HE children were also taller throughout the first 5 years (p<0·005 from 15 to 48 months, p<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.

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We however measure significant negative association between Muslim male children’s height at age 4 years and exposure to Ramadan during mid- and early-gestation episodes. In fact, an inﬂicted change in phenotype, if any, need not to be immediately visible at birth (Kusin et al., 1992; Roseboom et al., 2000; Eriksson, 2006). Even when the effect at birth is identiﬁable in birthweight, the conveyed information is not necessarily the same as what can be disclosed by height since birthweight is mostly affected by nutritional environment during the late gestation months, whereas height is more sensitive to nutrition during early and mid-gestation months, when most vital organs form.
We examine the effect of prenatal exposure to Ramadan on children’s height by sex, age, region, and the degree of religiosity. Since Ramadan rotates on solar calendars, we pool demographic and health survey data from numerous developing countries to increase the number of birth years and fairly control for potential seasonal effects. Our results suggest that Ramadan-induced nutritional stress during early- and mid-gestation may negatively affect the height of 3 and 4 years old Muslim male children. The effect tends to be stronger in West Africa and Central Asia. It also tends to be stronger in more religious countries. We do not detect consistent negative effects on height in female children.
Associations between birth size and later height from infancy through adulthood: An individual based pooled analysis of 28 twin cohorts participating in the CODATwins project
2018, Early Human Development
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It has been suggested that intrauterine programming in response to fetal malnutrition induces permanent changes in structure and function of the body, which may cause shorter height in later life [17]. This is in accordance with a randomized trial in East Java showing that energy supplementation during pregnancy increased postnatal growth and reduced malnutrition in preschool children [32]. As in our multinational database, the previous studies on birth weight and length also found greater associations in DZ twin pairs ranging 3.6–4.4 cm height/kg birth weight [23–26] and 0.84–0.96 cm height/cm birth length [24,26], suggesting that genetic factors are involved in the relationship between birth size and later height.
There is evidence that birth size is positively associated with height in later life, but it remains unclear whether this is explained by genetic factors or the intrauterine environment.
To analyze the associations of birth weight, length and ponderal index with height from infancy through adulthood within mono- and dizygotic twin pairs, which provides insights into the role of genetic and environmental individual-specific factors.
This study is based on the data from 28 twin cohorts in 17 countries. The pooled data included 41,852 complete twin pairs (55% monozygotic and 45% same-sex dizygotic) with information on birth weight and a total of 112,409 paired height measurements at ages ranging from 1 to 69 years. Birth length was available for 19,881 complete twin pairs, with a total of 72,692 paired height measurements. The association between birth size and later height was analyzed at both the individual and within-pair level by linear regression analyses.
Within twin pairs, regression coefficients showed that a 1-kg increase in birth weight and a 1-cm increase in birth length were associated with 1.14–4.25 cm and 0.18–0.90 cm taller height, respectively. The magnitude of the associations was generally greater within dizygotic than within monozygotic twin pairs, and this difference between zygosities was more pronounced for birth length.
Both genetic and individual-specific environmental factors play a role in the association between birth size and later height from infancy to adulthood, with a larger role for genetics in the association with birth length than with birth weight.
Maternal undernutrition during early pregnancy inhibits postnatal growth of the tibia in the female offspring of rats by alteration of chondrogenesis
2018, General and Comparative Endocrinology
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Previous studies mentioned that leg length in adulthood was correlated with birth weight, but suggested that leg growth after birth was independent of prenatal nutrition because there was no strong correlation between birth weight and leg length when they were adjusted for birth length (Ferrie et al., 2006; Gunnell et al., 1999; Wadsworth et al., 2002). However, Kusin et al. showed that infants were taller at the age of 5 years when their mothers were given high-energy supplements rather than low-energy supplements during the last trimester (Kusin et al., 1992). Therefore, prenatal nutrition may affect leg growth and height after birth through fetal programming during endochondral ossification of the femur and tibia.
Epidemiological research has suggested that birth weights are correlated with adult leg lengths. However, the relationship between prenatal undernutrition (UN) and postnatal leg growth remains controversial. We investigated the effects of UN during early pregnancy on postnatal hindlimb growth and determined whether early embryonic malnutrition affects the functions of postnatal chondrocytes in rats.
Undernourished Wistar dams were fed 40% of the daily intake of rats in the control groups from gestational days 5.5–11.5, and femurs, tibias, and trunks or spinal columns were morphologically measured at birth and at 16 weeks of age in control and undernourished offspring of both sexes. We evaluated cell proliferation and differentiation of cultured chondrocytes derived from neonatal tibias of female offspring and determined chondrocyte-related gene expression levels in neonatal epiphysis and embryonic limb buds.
Tibial lengths of undernourished female, but not male, offspring were longer at birth and shorter at 16 weeks of age (p < .05) compared with those of control rats. In chondrocyte culture studies, stimulating effects of IGF-1 on cell proliferation (p < .01) were significantly decreased and levels of type II collagen were lower in female undernourished offspring (p < .05). These phenomena were accompanied by decreased expression levels of Col2a1 and Igf1r and increased expression levels of Fgfr3 (p < .05), which might be attributable to the decreased expression of specificity protein 1 (p < .05), a key transactivator of Col2a1 and Igf1r.
In conclusion, UN stress during early pregnancy reduces postnatal tibial growth in female offspring by altering the function of chondrocytes, likely reflecting altered expression of gene transactivators.
Early life mortality and height in Indian states
2015, Economics and Human Biology
Citation Excerpt :
Behrman and Rosenzweig (2004) show that differences in birth weight between identical twins predicts differences in height. Finally, Kusin et al. (1992) present experimental evidence from Indonesia that supplementation during pregnancy improves postnatal growth – that is, growth from age zero to age five. These findings are particularly important for India, where discrimination against women of child-bearing age, even in food consumption, is well documented (Jeffrey et al., 1988; Das Gupta, 1995; Palriwala, 1993).
Height is a marker for health, cognitive ability and economic productivity. Recent research on the determinants of height suggests that postneonatal mortality predicts height because it is a measure of the early life disease environment to which a cohort is exposed. This article advances the literature on the determinants of height by examining the role of early life mortality, including neonatal mortality, in India, a large developing country with a very short population. It uses state level variation in neonatal mortality, postneonatal mortality, and pre-adult mortality to predict the heights of adults born between 1970 and 1983, and neonatal and postneonatal mortality to predict the heights of children born between 1995 and 2005. In contrast to what is found in the literature on developed countries, I find that state level variation in neonatal mortality is a strong predictor of adult and child heights. This may be due to state level variation in, and overall poor levels of, pre-natal nutrition in India.
Effects of dietary interventions on neonatal and infant outcomes: A systematic review and meta-analysis
2014, American Journal of Clinical Nutrition
Nutrition plays a fundamental role in fetal growth and birth outcomes.
We synthesized effects of dietary interventions before or during pregnancy on neonatal and infant outcomes.
Randomized controlled trials that assessed the whole diet or dietary components and neonatal or infant outcomes were included. Two authors independently identified articles to be included and assessed the methodologic quality. A meta-analysis was conducted separately for each outcome by using a random-effects model. Results were reported by dietary intervention as follows: 1) counseling, 2) food and fortified food products, or 3) a combination (counseling plus food) intervention, and 4) collectively for all dietary interventions. Results were subanalyzed by the nutrient of interest, country income, and BMI.
Of 2326 abstracts screened, a total of 29 randomized controlled trials (31 publications) were included in this review. Food and fortified food products were effective in increasing birth weight [standardized mean difference (SMD): 0.27; 95% CI: 0.14, 0.40; P < 0.01] and reducing the incidence of low birth weight (SMD: −0.22; 95% CI: −0.37, −0.06; P < 0.01). All dietary interventions and those focused on macronutrient intake also increased birth weight (P < 0.01) and length (P < 0.05) and reduced the incidence of low birth weight (P < 0.01). Dietary interventions in low-income countries and underweight or nutritionally at-risk populations increased birth weight (P < 0.05) and reduced the incidence of low birth weight (P = 0.01). No effects were seen for the following other outcomes: placental weight, head circumference, macrosomia, Apgar score, small for gestational age, large for gestational age, and perinatal mortality.
Additional high-quality randomized controlled trials that test different dietary interventions are required to identify maternal diet intakes that optimize neonatal and infant outcomes.

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ORIGINAL ARTICLESEnergy supplementation during pregnancy and postnatal growth

Abstract

Nutr Res

Early Hum Dev

Early Hum Dev

Am J Clin Nutr

Am J Clin Nutr

The state of the world's children

The epidemiology of stunting

Supplementary feeding programmes for young children in developing countries

Am J Clin Nutr

ORIGINAL ARTICLES
Energy supplementation during pregnancy and postnatal growth