Abstract
BackgroundObservational evidence suggests that improving fetal growth may improve adult health. Experimental evidence from nutritional supplementation trials undertaken amongst pregnant women in the less developed world does not show strong or consistent effects on adult disease risk and no trials from the more developed world have previously been reported. ObjectiveTo test the hypothesis that nutritional supplementation during pregnancy influences offspring disease risk in adulthood DesignClinical assessment of a range of established diseases risk markers in young adult offspring of 283 South Asian mothers who participated in two trials of nutritional supplementation during pregnancy (protein/energy/vitamins; energy/vitamins or vitamins only) at Sorrento Maternity Hospital in Birmingham UK either unselected or selected on the basis of nutritional status. Results236 (83%) offspring were traced and 118 (50%) of these were assessed in clinic. Protein/energy/vitamins supplementation amongst undernourished mothers was associated with increased infant birthweight. Nutritional supplementation showed no strong association with any one of a comprehensive range of markers of adult disease risk and no consistent pattern of association with risk across markers in offspring of either unselected or undernourished mothers. ConclusionsWe found no evidence that nutritional supplements given to pregnant women are an important influence on adult disease risk however our study lacked power to estimate small effects. Our findings do not provide support for a policy of nutritional supplementation for pregnant women as an effective means to improve adult health in more developed societies.
Highlights
The nutritional “fetal origins” hypothesis holds that physiological adaptation to nutritional status during gestation has life-long consequences for health[1,2]
Supplementation regimes were vitamins only; carbohydrate and vitamins and protein, carbohydrate and vitamins.130 mothers booking between November 1979 and June 1980 were all given vitamins (Orovite 7: vitamin A 0.75mg, thiamine 1.4mg, riboflavin 1,7mg, pyridoxine 2.0mg, nicotinamide 18mg, ascorbic acid 60mg, calciferol 2.5 μg daily delivered in sachets for dissolving in water) and monitored till 28 weeks gestation
45 mothers showing evidence of under-nutrition were again randomised to one of the three, supplementation regimes. In this trial those randomised to vitamins only continued to receive Orovite 7; those randomised to carbohydrate and vitamins received Orovite 7 plus 1810 KJ daily of carbohydrate in the form glucose syrup and those randomised to protein, carbohydrate and vitamins received Orovite 7 plus 1810 KJ daily 90% of energy as carbohydrate and 10% as protein
Summary
The nutritional “fetal origins” hypothesis holds that physiological adaptation to nutritional status during gestation has life-long consequences for health[1,2]. Human evidence for the importance of fetal nutrition as an influence on adult health is based mainly on observational studies showing that smaller birth size (which may reflect poorer nutrition in utero) is associated with greater adult risk of cardiovascular and metabolic disease[5,6,7]. Amongst mothers showing evidence of under-nutrition, supplements given in later pregnancy were effective in increasing offspring birth weight. Objective: To test the hypothesis that nutritional supplementation during pregnancy influences offspring disease risk in adulthood Design: Clinical assessment of a range of established diseases risk markers in young adult offspring of 283 South Asian mothers who participated in two trials of nutritional supplementation during pregnancy (protein/energy/vitamins; energy/vitamins or vitamins only) at Sorrento Maternity Hospital in Birmingham UK either unselected or selected on the basis of nutritional status. Our findings do not provide support for a policy of nutritional supplementation for pregnant women as an effective means to improve adult health in more developed societies
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