Maternal growth during pregnancy and the competition for nutrients

Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, Camden 08103.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 09/1994; 60(2):183-8.
Source: PubMed


The influence of maternal growth in knee height during pregnancy on birth weight, gestation, and maternal body composition was examined in 318 teenagers (144 growing, 174 nongrowing) and 276 mature women from the Camden Study. Body-composition differences associated with maternal growth did not arise until after 28 wk gestation, when growing gravidas continued to accrue fat, had larger gestational gains, and retained more of their gestational weight gain postpartum. Nevertheless, still-growing young mothers had infants with lower birth weight, particularly when the mother continued to accrue higher amounts of fat on the arm or back (subscapular site) late in gestation. Thus, despite an apparently sufficient weight gain and the accumulation of abundant stores during pregnancy, young still-growing women appeared not to mobilize fat reserves late in pregnancy to enhance fetal growth, apparently reserving them instead for their own continued development.

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    • "There is a disparity in the literature on the effects of young age on prolonged labor. In most developed countries, young maternal age per se has not been shown to be associated with complications such as prolonged labor or need for caesarean section (Treffers, 2002, Scholl, 1994). There is evidence from other studies that young age and physiological immaturity are associated with prolonged and obstructed labor (Kurz, 1997, Suvacarev, 2003). "
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    • "Nutrition in pregnancy demands extra care due to the growing foetus, placing a high demand on the mother's energy, protein and micronutrients (Butte and King, 2005). Good nutrition is the best way to prevent anaemia during pregnancy but young still-growing women are highly disadvantaged due to competition for nutrients between the mother and the foetus (Scholl et al., 1994). "

    Full-text · Article · Dec 2014 · Acta Tropica
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    • "A plausible biological explanation may be incomplete maternal physical growth and relative malnutrition, which is related to the mother’s gynecological age rather than chronological age [3]. In a U.S. study, growing adolescents accrued more fat and more weight during their pregnancy, but their infants weighed less at birth and their mothers retained more weight postpartum [41]. In resource-constrained settings, adolescent mothers may have an even larger nutritional burden; a study in rural Nepal observed lighter newborns and a larger loss of mid-upper arm circumference in pregnancy among adolescent mothers than their older counterparts [42]. "
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    ABSTRACT: Previous studies have reported on adverse neonatal outcomes associated with parity and maternal age. Many of these studies have relied on cross-sectional data, from which drawing causal inference is complex. We explore the associations between parity/maternal age and adverse neonatal outcomes using data from cohort studies conducted in low- and middle-income countries (LMIC). Data from 14 cohort studies were included. Parity (nulliparous, parity 1-2, parity ≥3) and maternal age (<18 years, 18-<35 years, ≥35 years) categories were matched with each other to create exposure categories, with those who are parity 1-2 and age 18-<35 years as the reference. Outcomes included small-for-gestational-age (SGA), preterm, neonatal and infant mortality. Adjusted odds ratios (aOR) were calculated per study and meta-analyzed. Nulliparous, age <18 year women, compared with women who were parity 1-2 and age 18-<35 years had the highest odds of SGA (pooled adjusted OR: 1.80), preterm (pooled aOR: 1.52), neonatal mortality (pooled aOR: 2.07), and infant mortality (pooled aOR: 1.49). Increased odds were also noted for SGA and neonatal mortality for nulliparous/age 18-<35 years, preterm, neonatal, and infant mortality for parity ≥3/age 18-<35 years, and preterm and neonatal mortality for parity ≥3/≥35 years. Nulliparous women <18 years of age have the highest odds of adverse neonatal outcomes. Family planning has traditionally been the least successful in addressing young age as a risk factor; a renewed focus must be placed on finding effective interventions that delay age at first birth. Higher odds of adverse outcomes are also seen among parity ≥3 / age ≥35 mothers, suggesting that reproductive health interventions need to address the entirety of a woman's reproductive period. Funding was provided by the Bill & Melinda Gates Foundation (810-2054) by a grant to the US Fund for UNICEF to support the activities of the Child Health Epidemiology Reference Group.
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