VANDERBILT COOPERATIVE STUDY OF MATERNAL AND INFANT NUTRITION

Abstract

Observations of nutritional level were made in 2338 lower income whi te women receiving care at the Vanderbilt University obstetric clinic. 73% received no dietary supplement while the remaining 27% received varied supplementation seldom extending through the whole period of gestation. There was a decrease of approximately 200 calories daily in the average intake between the second and third trimesters, partly in response to the physician's request and partly due to the mother's initiative. It is postulated that this reflects lessened activity on the part of the mother. The change in blood constitutents fell into 4 patterns: 1) for total serum protein, serum Vitamin A, and urinary excretion of thiamine and riboflavin there was a decline during Weeks 32-34 of gestation followed by a postpartum rise; 2) for serum carotene, tocopherol, and the urinary excretion of N'-methylnicotinamide there was a progressive increase during pregnancy followed by a postpartum decline ; 3) for serum Vitamin C there was a slight decrease during gestation followed by a sharp decline in lactating mothers; 4) for iron there was a progressive increase in the absorption and utilization as pregnancy advances. Although the group had generally good nutrition some were underweight or overweight, some ate poorly, some excessively, some had low nutrient levels, and some had obstetric and pediatric complications. The underweight women were concentrated in the lower parity groups and had a higher incidence of prematurity but fewer neonatal deaths and congenitally malformed infants. The overweight group had a threefold increase in preeclampsia, more stillborn children, lowered frequency of puerperal morbidity, and more toxemia. The low hemoglobin group had excessive blood loss during the later 1/2 of pregnancy, delivery, or puerperium. Other studies have shown that infants of such women have anemia at 1 year and supplemental infant feeding is indicated. It appears that the recommended standards for calories are too high for the expectant mother of today. A diet that will provide essential nutrients is readily obtainable from food sources and except for specific supplementation in specific cases, the common obstetric routine of broad-spectrum nutrition supplementation is questioned.