Might efforts to increase birthweight in undernourished women do more harm than good?

Abstract

Birth weight does not measure health or morbidity. Infant deaths are not due to low birth weight alone but to disease processes which result in low birth weight. Newborns with low birth weight for gestational age constitute most low birth weight infants in developing countries while in developed countries premature newborns make up most low birth weight infants. The number of premature births in North American has not decreased at all while the average birth weight has increased. In developed countries, increased fetal growth has been accompanied by increased cesarean section rates. The possibility of longterm detrimental effects on growth and development of low birth weight for gestational age is much smaller on mortality and severe illness than it is for premature birth. Food supplementation and antimalarial chemoprophylaxis interventions increase fetal growth, but they do not reduce the premature delivery rate and morbidity and mortality. Interventions could have adverse effects in developing countries where access to obstetric services is limited. Specifically, interventions causing increased fetal growth can result in difficulties during labor and delivery for women in developing countries, many of whom already have cephalopelvic disproportion. Newborns in the normal range of developed countries could increase the risk of obstructed labor. This would result in increased maternal morbidity and mortality. Many women from various cultural groups restrict food consumption during pregnancy to avoid difficulties during labor. If they learn that antimalarial chemoprophylaxis caused increased fetal growth they might resist taking it. Yet hungry pregnant women should have sufficient food and be protected from malaria. But health workers should not use intervention for the express purpose of increasing birth weight.