PRENATAL NUTRITION

The title of my paper, “Prenatal Nutrition,” in the context of the subject of this session, “Problems and Solutions in Developing Countries,” suggests that my remit is to discuss the effects of deficiencies in the mother’s diet on the nutrition of her fetus. In some countries, mothers suffer from a chronic shortage of food during pregnancy as they do during the rest of their lives, but in others, even where protein-energy malnutrition is common in young children, the women are not necessarily malnourished. In southern Uganda, for example, women show no signs of dietary deficiency, although their young children may well be suffering from kwashiorkor. Undernutrition during pregnancy, whether chronic or acute, is no new problem. There were food shortages in Europe during and after W.W. I, and many papers were published describing the effects of these on the size of the babies at birth. Many of them were inconclusive and contradictory, probably because the conditions were not sufficiently carefully defined. Krogman refers to 29 authors who reported a decrease in birth weight and to another 26 who found no change. In the period between the two wars many surveys were made to find out the effects of inadequate diets eaten by poor women in various parts of the world on the birth weights of their babies. Some of this work was summarized by Barcroft2 and Garry & Wood.3 The conclusion was that children born to women at the lower end of the socioeconomic scale were generally a little lighter at birth than those of women living in more afluent circumstances, and that nutrition was probably one of the responsible factors. W.W. I1 again brought food shortages to Europe and other parts of the world. These were sometimes brief and acute and in other instances prolonged but less severe. Into the first class falls the period of hunger in Holland lasting from September 1944 to May 1945, when the transport system was paralyzed by a strike. The well-known papers by showed that there was a sharp decline in birth weight in Rotterdam and The Hague during this time, being at its lowest between December and May. The estimated energy available in the rations for pregnant women during this time was less than 1000 kcallday. The birth weights rose again as soon as Holland was liberated and food became available. Holmer reached the same conclusions in a different way. He analyzed records of birth weights at another Dutch hospital in The Hague. In the first half of 1945 the number of children under 3000 g at birth was 41 % of the total, in 1942 it had been 24%. Another wartime study was conducted by an to no^,^ who described the weights of babies born in Leningrad from August 1941 until January 1943. The period of acute food shortage lasted from September 1941 to February 1942. The average birth weight of babies born at the State Pediatric Institute fell by 500 to 600 g during the period of famine, but the decline in birth weight may not have been entirely due to lack of food for, as in other similar studies, the women had many other problems.