Published online by Cambridge University Press: 08 August 2009
Introduction
There has been a great deal of literature devoted to better understanding the determinants of offspring size at birth. Over several decades the importance of maternal size has been acknowledged as a key factor in the fetal development of her offspring and from this association it has followed that maternal nutrition must also be of importance to the growth of her unborn infants. This chapter reviews the extent of the evidence for an association between maternal nutrition and reduced offspring size at birth, as characterised by low birthweight (birthweight of less than 2500 g irrespective of length of gestation). After acknowledging the complexity of the notion of low birthweight (LBW), maternal nutrition is defined in the context of its potential influence on fetal growth and the available evidence is summarised for associations between LBW and maternal anthropometry, nutritional status and diet in pregnancy. The evidence is drawn from both observational studies and from intervention studies (randomised controlled trials, RCTs), the latter of which may avoid the biases that often arise in uncontrolled trials. Where sufficient data are available the effects of nutritional interventions are quantified in terms of their demonstrated effects on fetal size and maturity at birth. The second part of the chapter discusses important limitations in our current understanding of the nature of the association and the potential implications this has for interventions to improve fetal growth.
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