Many mothers and children all over the world are affected by malnutrition, some populations are experiencing the two extremes of either chronic undernourishment with high rates of micronutrient deficiency (such as anemia) and stunting or rapid increases in obesity (driven by high caloric but poor-quality diets) as well as hypertension and diabetes; in addition, some face a dual burden where both types of malnutrition coexist simultaneously. Increased understanding of epigenetics and critical windows of development has brought much attention to the first 1,000 days from conception through age two years, but maternal nutritional status before and between pregnancies as well as child nutrition and growth beyond age two are also important for long-term health and development. Last fall, in collaboration with PLOS Medicine, PLOS ONE invited researchers to submit original articles for a Collection with a wide focus on various aspects of nutrition and health of mothers and their children, including social and nutritional transitions, maternal and infant nutrition, public health clinical care interventions covering the period from before conception through childhood as well as articles from the perspective of the developmental origin of health and disease. This blog introduces the first five PLOS ONE articles that appear in the Collection.
Maternal prepregnancy body size and gestational weight gain are intrauterine risk factors for birth size, child obesity and increased risk of chronic disease, and has been a focus in many developed countries around the globe, but little has been known about these risk factors in the Eastern Mediterranean Region (EMR). The Maternal and Infant Nutritional Assessment (MINA) study reported by Abdulmalik and colleagues  describes maternal weight, sociodemographic and lifestyle characteristics and birth outcomes in a small and select birth cohort of 341 pregnant women from Lebanon and Qatar. The study reports that high maternal weight is common with an overall prevalence of maternal prepregnancy overweight and gestational weight gain of 42% and 44% respectively, and an unadjusted percentage of overweight mothers in Qatar almost twice as high as in Lebanon. The authors attribute this difference to Qatar’s more advanced state of nutrition transition. They also identify several determinants of maternal weight and gestational weight gain in this population that can be considered when informing culturally-specific interventions to promote healthy maternal prepregnancy weight and weight gain in the EMR.
Three papers describe maternal and child nutrition status from the large population-based MINA-Brazil Study conducted in Acre Brazil, a primarily urban area with a high burden of malaria and poor sanitation. Dal Bom et al.’s study  illustrates the dual burden of malnutrition that face this population: both stunting and overweight occur at age one in the same population, however, overweight is three times more common. The authors’ comprehensive analysis of risk factors for overweight indicates that high socioeconomic status, high maternal BMI, and large birth size is associated with high infant BMI while the occurrence of malaria during infancy is associated with poor growth. Mosquera and colleagues  then report on a particularly relevant aspect of infant nutrition, exclusive breastfeeding (EBF), showing that during the first 30 days of life EBF is below 50% in this population, with first time mothers, infants with wheeze and use of pacifier associated with cessation of exclusive nursing. These results demonstrate that there are still communities at risk where EBF is extremely low and highlight the urgent need to promote interventions to support breastfeeding and adequate maternal and child nutrition worldwide. Neves and colleagues  call for attention on the current WHO antenatal care guidelines that recommend supplementation with iron and folic acid only, by reporting an alarming prevalence of gestational night blindness (11.5%) and maternal anemia (39.4%) in this population. Interestingly, the authors determine that factors associated with night blindness were  5 residents in the household, smoking during pregnancy and attending less than 6 antenatal care visits. However, they also reveal that factors associated with maternal anemia were mothers less than 19 years of age, malaria and lack of micronutrient supplements during pregnancy. The results from this study suggest that critical maternal nutritional deficiencies still exist in susceptible regions and that a broader spectrum of micronutrient supplementation may be necessary.
Finally, the life-course perspective is well illustrated by the findings from Bahru and colleagues’ report  of the Young Lives Cohort in Ethiopia, whereby exposure to severe drought at age five years is associated with reduced height-for-age z-score during adolescence. The results of this study remind us that, while the first 1,000 days constitute a critical window for development, periods during childhood outside of that window can also have a profound and persistent impact on growth through childhood. This leads the authors to conclude that disaster relief programs need to recognize both the shorter- and longer-term consequences in their approach and remedy.
The papers in this Collection improve our understanding of current science in maternal and child’s health and the role of various risk nutritional factors and outcomes, drawing from a diverse range of disciplines and methodologies, including anthropometry, biochemical/biophysical methods, clinical methods, dietary methods, and environmental domains. These papers suggest that the health of a child starts with the health of the pregnant woman [1,4] as well as providing evidence on the significant impact of environmental factors, including prenatal and social environment, on the health of infant  and adolescents . The low rate of exclusive breastfeeding is also a concerning health issue  that links to the health of the child. Moreover, the dual burden of malnutrition (both under and over) reported in Brazil Amazonia  is now a reality in many countries across various income levels. These five publications together with future papers of the Collection will contribute to filling gaps in the scientific literature and improve our understanding regarding maternal and child’s nutrition-related health issues. We hope this Collection will provide evidence to expedite policy change and implementation, and the development of clinical and public health programs that are culturally appropriate and developmentally sensitive to reduce the impact of malnutrition – a global dual burden.
The full papers can be found by visiting the Special Issue Collection. Future articles reporting observational and experimental studies that continue these themes will soon be added to the Collection, so please stay tuned!
- Abdulmalik MA, Ayoub JJ, Mahmoud A, MINA collaborators, Nasreddine L, Naja F (2019) Pre-pregnancy BMI, gestational weight gain and birth outcomes in Lebanon and Qatar: Results of the MINA cohort. PLoS ONE 14(7): e0219248. https://doi.org/10.1371/journal.pone.0219248
- Dal Bom JP, Mazzucchetti L, Malta MB, Ladeia-Andrade S, de Castro MC, Cardoso MA, et al. (2019) Early determinants of linear growth and weight attained in the first year of life in a malaria endemic region. PLoS ONE 14(8): e0220513. https://doi.org/10.1371/journal.pone.0220513
- Mosquera PS, Lourenço BH, Gimeno SGA, Malta MB, Castro MC, Cardoso MA, et al. (2019) Factors affecting exclusive breastfeeding in the first month of life among Amazonian children. PLoS ONE 14(7): e0219801. https://doi.org/10.1371/journal.pone.0219801
- Neves PAR, Lourenço BH, Pincelli A, Malta MB, Souza RM, Ferreira MU, et al. (2019) High prevalence of gestational night blindness and maternal anemia in a population-based survey of Brazilian Amazonian postpartum women. PLoS ONE 14(7): e0219203. https://doi.org/10.1371/journal.pone.0219203
- Bahru BA, Bosch C, Birner R, Zeller M (2019) Drought and child undernutrition in Ethiopia: A longitudinal path analysis. PLoS ONE 14(6): e0217821. https://doi.org/10.1371/journal.pone.0217821
About the Authors:
Barbara Abrams is a Professor in the Graduate School at the University of California’s Berkeley School of Public Health. She is a perinatal and nutritional epidemiologist whose work emphasizes prevention of obesity and promotion of excellent maternal and child health at the individual and neighborhood level, across the life course and between generations.
Her research focuses on the inter-relationships between maternal weight, nutrition and social factors and their contributions to several outcomes: 1) maternal health before, during, after and between pregnancies and into mid-life, 2) perinatal outcomes and 3) the role of maternal health during pregnancy on children’s physical health and development. Her work aims to inform public health, clinical and policy interventions that encourage optimal maternal weight and health and prevent outcomes such as severe maternal morbidity, adverse fetal and child outcomes, with special attention to reducing health disparities.
Dr. Chen is a professor and the Chao endowed chair in global health nursing at University of California San Francisco. She is also the director of the Doctor of Nursing Practice program and a Fellow in the American Academy of Nursing. Her program of research focuses on two main areas: (1) development of innovative childhood obesity prevention interventions; and (2) reducing global health disparities for non-communicable disease in Asia.
Dr. Chen has received more than 25 research grants and published 60 peer-reviewed articles in international journals in the field of Nursing, Medicine, and Public Health. She is an internationally known nurse scientist focused on prevention of non-communicable diseases, especially obesity and diabetes prevention in Chinese Americans and Chinese in Asia.
Camilla is a medical doctor and epidemiologist trained in nutrition. Her primary interest is human growth and development and the early prevention of obesity and non-communicable chronic diseases. Camilla coordinates the Center for Research in Food Environments and Nutrition-Related Chronic Diseases (CIAPEC) at the University of Chile.
CIAPEC runs longitudinal studies during key periods of life with the aim of better understanding the emergence of nutrition-related chronic diseases such as obesity, metabolic diseases and breast cancer in the context of a post-transitional country. Camilla is also an advisor for several governmental agencies involved in infant policies such as the nutrition department of the Ministry of Health, Chile.
Shane Norris is a Professor in the Department of Paediatrics at the University of the Witwatersrand, Johannesburg, South Africa. Shane directs the South African Medical Research Council Unit’s Developmental Pathways for Health Research Unit, and the South African Department of Science and Technology-National Research Foundation’s Centre of Excellence in Human Development.
He has extensive research experience in longitudinal cohort studies and epidemiology and his research expertise and interest include (i) maternal and child health, (ii) child nutrition, growth, body composition, and development; and (ii) intergenerational transmission of obesity and metabolic disease risk.
Dr. Spencer Proctor is a Professor and the Director of the Division of Human Nutrition at the University of Alberta (UofA), Edmonton, Canada. Dr. Proctor trained in Australia in the field of cardiovascular sciences and later in pharmaceutics. Following his PhD, he was awarded an International Fellowship from the Australian Medical Research Council that brought him to the Dept Surgery at the UofA. Shortly following this he joined the Nutrition Faculty at the UofA.
Dr. Proctor is a member of the Molecular and Cell Biology of Lipid Group and is affiliated with both the Alberta Diabetes and Mazankowski Heart Institutes. Dr. Proctor’s ongoing interests include; the role of dietary and intestinal lipids in diabetes and CVD, fatty acid bioactivity and atherosclerosis etiology. He has been recognized at the national and international level for his contributions and his research program is funded by NSERC, Heart and Stroke Foundation of Canada, CIHR, Dairy and Livestock Sectors as well as the pharmaceutical industry.