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This review focuses on how maternal prenatal nutritional states may affect the health of grandchildren and later generations. We first summarize the limited current data in human populations relating to the potential transmission of phenotypes across multiple generations that result from the nutritional experience of a pregnant woman. We then discuss findings from other species, especially mammals, that provide important clues as to whether, and if so how, such transmission could occur in humans. Finally, we consider how studies of human populations could be best designed to detect transmission across multiple generations. We argue that just as epidemiologists embraced a life-course perspective to human health and disease in the twentieth century, we must now seek to better understand how health and disease could be shaped across multiple generations.

Objectives: The objectives of this study were to assess whether high exposure to the Canada Prenatal Nutrition Program (CPNP) improved 1) the personal health practices, such as smoking and breastfeeding, of participants and 2) birth outcomes, such as low birth weight and preterm birth. Intervention: The CPNP is a population-level health intervention that aims to contribute to improved health outcomes for pregnant women and their newborn children facing conditions of risk. The program, which is jointly managed by the federal and provincial governments, serves more than 45,000 Canadian women annually. Participants: Participants were women who entered the program prenatally in 2002–2006 and were socially, demographically and geographically diverse. Almost 12% were adolescents, and almost 10% were over 34 years of age; 5% were recent immigrants (in Canada <10 years), and close to one quarter were Aboriginal. Setting: This comprised a broad range of community-based projects in 2,000 communities. Outcomes: Descriptive statistics showed that the CPNP is reaching the women for which it is intended. Participants with high CPNP exposure were more likely to reduce the number of cigarettes they smoked, to cease drinking, to breastfeed their infants and to breastfeed for longer, and to increase their use of vitamin/mineral supplements from never to daily. Furthermore, they were less likely to give birth to an infant that was preterm, had low birth weight, was small for gestational age or had poor neonatal health. Unexpectedly, participants were more likely to give birth to a large-for-gestational-age infant. Our stratified "equity" analyses showed some variation by social group, indicating that the benefits were not consistently shared by all. Conclusion: High CPNP exposure improved the health behaviours and birth outcomes of women and their newborn children facing conditions of risk. Furthermore, our equity analysis found that the associations between higher CPNP exposure and healthy behaviour changes, and even more so, ...

Written for the clinician and other healthcare professionals who treat and counsel pregnant women and women of child-bearing age, Handbook of Nutrition and Pregnancy is an excellent and easy-to-use resource in the practical form of a handbook. In Handbook of Nutrition and Pregnancy, the authors provide historical perspective and background to support recommendations which are provided in each chapter, importantly for the practitioners, recommendations and guidelines have been summarized and provided in tables that are easy to locate and interpret. This book discusses relevant topics in the scientific community such as determining to what extent prenatal and perinatal environmental factors are linked to childhood and adult obesity and chronic diseases. This book also examines issues that are common to both the developed and the developing worlds and includes chapters that are specific to nutritional and reproductive factors seen mainly in developing countries. These chapters discuss contemporary issues that impact both the woman and the developing infant. Also covered in several chapters is a review of nutritional as well as physiological factors that either increase or decrease the potential for high risk pregnancies such as gestational diabetes mellitus, Type I and Type II diabetes mellitus, preeclampsia, anemia, and so forth. Handbook of Nutrition and Pregnancy is a comprehensive volume that includes up-to-date information in chapters written by the leaders in the fields of diet, nutrients, ingredients, environmental factors and physiological consequences addressing the needs of women of childbearing potential and pregnant women.

I Developmental Biology -- 1 Adaptive Mechanisms of Growth Control -- 2 Human Biochemical Development -- 3 Developmental Pharmacology -- 4 Glimpses of Comparative Growth and Development -- II Biometrical Methods in Human Growth -- 5 Statistics of Growth Standards -- 6 Sampling for Growth Studies -- 7 The Mathematical Handling of Long-Term Longitudinal Data -- III Genetics -- 8 Introduction to Genetic Analysis -- 9 The Genetics of Human Fetal Growth -- 10 The Genetics of Birth Weight -- 11 The Genetics of Adult Stature -- 12 The Genetics of Maturational Processes -- IV Prenatal Growth -- 13 Anatomy of the Placenta -- 14 Physiology of the Placenta -- 15 Fetal Measurements -- 16 Implications for Growth in Human Twins -- 17 Association of Fetal Growth with Maternal Nutrition -- 18 Carbohydrate, Fat, and Amino Acid Metabolism in the Pregnant Woman and Fetus -- 19 Pre- and Perinatal Endocrinology -- 20 Development of Immune Responsiveness -- 21 Fetal Growth; Obstetric Implications.

Abstract
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides food vouchers, nutritional counseling, and health care referrals to low-income pregnant and breastfeeding women and their young children. This paper uses duration models to study the factors that influence the timing of prenatal WIC participation among pregnant women. The estimates show that Hispanic women, women with low levels of education, women who have no private insurance, and women who are overweight participate in WIC earlier than others. WIC program rules such as allowing applicants to self-declare income and linking WIC eligibility to Medicaid eligibility are related to earlier participation for women experiencing their first pregnancies. Extending the analysis to women pregnant for the second time shows a strong relationship between WIC participation during the first pregnancy and the timing, and likelihood, of participation during the second pregnancy.

The current state of knowledge about the neurodevelopmental sequelae of prenatal cocaine exposure is reviewed. Maternal cocaine use is associated with a number of other factors such as poor nutrition, inadequate prenatal care, and exposure to other substances, including alcohol and tobacco, that also affect neurodevelopmental outcome. The effects of postnatal maternal cocaine use on the mother's capacity to care for the infant as well as the association of cocaine use with more general environmental factors—for example, poverty, violence, neglect, and abuse—are discussed as important factors to consider when attempting to define whether or not prenatal cocaine exposure has specific and unique effects on the developing fetal brain. Six methodological problems commonly found in the literature on prenatal cocaine exposure are cited as issues to consider when attempting to evaluate the validity of currently available findings.

OBJECTIVES: In developing countries, the benefits of using prenatal supplements on birth outcomes have been well established. The rate of prenatal supplement (iron-folic acid) use compliance is low (52.8%) in northern region of Ghana even though the supplements are provided free to all pregnant women by the government. Little is known about the reasons for the non-compliance. We aimed to investigate through focus groups the barriers and motivators for taking the supplement among subjects who attend health facilities located in northern region of Ghana. METHODS: We conducted six focus groups with lactating women with toddlers (0–23 months) as they were expected to reflect a complete experience of pregnancy cycle. RESULTS: We identified five common themes: a) knowledge on supplement benefits, b) family support, c) social network support, d) reinforcement by health care providers, and e) different views on benefits of prenatal supplements. Key motivators were knowledge on supplement benefits, family support, social network support, and reinforcement by health care providers. Common barriers were adverse effects, inadequate knowledge on supplements, and disrespectful communication from health care providers. CONCLUSIONS: Motivators/barriers for prenatal supplements usage/non-usage is a complex web. Adherence may be enhanced by reducing barriers related to communication of health care providers and adverse effects, improving social network support, improving family support, and improving health care provider interactions. FUNDING SOURCES: None.

Intro -- MALNUTRITIONRISK FACTORS, HEALTH EFFECTSAND PREVENTION -- NUTRITION AND DIET RESEARCHPROGRESS -- MALNUTRITIONRISK FACTORS, HEALTH EFFECTSAND PREVENTION -- LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA -- CONTENTS -- PREFACE -- CHAPTER 1. METABOLIC DISORDERS: IS THEREA RELATION WITH NUTRITIONAL CHANGESDURING THE PRENATAL STAGE? -- ABSTRACT -- INTRODUCTION -- MATERNAL NUTRITIONAND FETAL DEVELOPMENT -- FETAL PROGRAMMING,METABOLISMAND FEEDING DISORDERS -- PRENATAL NUTRITION AND THEIR RELATIONWITH FEEDING BEHAVIOR DISORDERS -- A. Causal Factors of EDs -- B. Genetic Factors -- C. Social and Environmental Factors -- NEUROENDOCRINOLOGY AND FOOD INTAKE -- CONCLUSION -- ACKNOWLEDGMENTS -- REFERENCES -- CHAPTER 2. SPECIFICS OF MALNUTRITIONIN THE ELDERLY -- ABSTRACT -- INTRODUCTION -- PRINCIPAL CHARACTERISTICS OF MALNUTRITIONIN THE ELDERLY -- PREVALENCE OF MALNUTRITION IN THE ELDERLY -- PHYSIOLOGICAL CHANGES IN THE ELDERLY -- RISK FACTORS OF MALNUTRITION IN THE ELDERLY -- TYPES OF MALNUTRITION -- CLINICAL PICTURE OF MALNUTRITIONIN THE ELDERLY -- DIAGNOSIS OF MALNUTRITION IN THE ELDERLY -- 1. Nutrition History -- Mini Nutritional Assessment (MNA) -- 2. Anthropometrical Examinations -- Body Mass -- Body-Mass Index (BMI) -- Mid-Arm Circumference -- Triceps Skin Fold -- Determination of the Circumference of the Musculature of the Arm -- 3. Laboratory Examinations -- Biochemical Examinations -- Total Protein (TP) -- Albumin -- Prealbumin -- Transferin -- Cholinesterase -- Serum Lipids -- Total Cholesterol -- C-Reactive Protein (CRP) -- Hematological and Immunological Examinations -- Absolute Number of Lymphocytes -- 4. Functional Examination - Dynamometry -- Prevention of Malnutrition in the Elderly -- THERAPY OF MALNUTRITION AND DEFICIENCY STATESIN THE ELDERLY -- 1. Dietary Measures and Adjustment of Dietary Habits -- 2. Enteral Nutrition.

Cover -- Front Matter -- Contents -- Preface -- Foreword -- References -- Contributors -- Chairpersons & -- Speakers -- Moderators -- Participants -- Adolescent Health Globally: Issues and Challenges -- Abstract -- Adolescent Health and Development: A Global Perspective -- Adolescent Health Risks and Problems -- Health and Social Development in Adolescence -- Challenges and Opportunities -- Disclosure Statement -- References -- Preconception Care and NutritionInterventions in Low- and Middle-Income Countries -- Abstract -- Preconception Care - The Definition -- Nutritional Interventions: From Prenatal to Preconception -- Systematic Review on Preconception Risks and Interventions -- Optimizing Maternal Weight -- Preconception Nutrition Counselling -- Micronutrient Supplements -- Discussion and Conclusion -- Disclosure Statement -- References -- Adolescent Health and Nutrition in the US and Canada: An Overview of Issues and Determinants -- Abstract -- Social Determinants of First Nations Adolescents -- Education -- Transition from Pediatric to Adult Care -- Impact of the Environment -- Adolescent Alcohol and Substance Use -- Adolescent Parenting -- Adolescents in Foster Care in the US and Canada -- Adolescent Nutrition -- Ethnicity and Racism -- Immigrant Youth -- Conclusion -- Disclosure Statement -- References -- Nutrition Challenges and Issues of Relevance to Adolescents in Lowand Middle-Income Countries -- Abstract -- Introduction -- Puberty as a Discrete Window for Growth and Opportunity for Counteracting Stunting -- Nutrient Requirements during the Pubertal Growth Spurt -- Adolescence as a Key Physiological Development Period Affecting Future Reproductive Outcomes -- Adolescent Pregnancies and Associated Nutritional Issues -- Future Risks to the Offspring: Epigenetic Programming -- Conclusions -- Acknowledgements -- Disclosure Statement.

For nearly 30 years, the rates of both wasting and stunting in the Philippines have been nearly flat. For 2019, the rate of stunting among children under five years of age (28.8 percent) was only slightly lower than in 2008 (32 percent)—the prevalence of underweight in 2019 was 19 percent and that of wasting was 6 percent. Based on the World Health Organization's classification of undernutrition rates, the stunting prevalence of children in the Philippines is of "very high" public health significance. The Philippines' 29 percent stunting rate places it fifth among countries in the East Asia and Pacific region, and among the top 10 countries globally. The Philippines' high levels of childhood undernutrition can lead to a staggering loss of the country's human and economic potential. The burden on the Philippines' economy brought by childhood undernutrition was estimated at US$4.4 billion, or 1.5 percent of the country's GDP, in 2015. Undernutrition robs Filipino children of their chance at a bright future. When viewed through the lens of the World Bank's Human Capital Index (HCI), the country's 2020 HCI score of 0.52 predicts that the future productivity of children born today will be 48 percent below what they might achieve if they were to enjoy complete education and full health. Undernutrition in the Philippines: Scale, Scope, and Opportunities for Nutrition Policy and Programming presents a comprehensive, analytical work on this topic. It provides evidence of why it is critical that the government of the Philippines prioritize tackling this persistent challenge. The report assesses the determinants and causes of childhood undernutrition and reviews current policies and programs directed at addressing this problem. Based on these analyses, the report provides recommendations of how national policies and programs can be strengthened to reduce the high rates of undernutrition in the country. It sets out to inform the debate on the causes and potential solutions of undernutrition while identifying high-priority policies and policy commitments for action.

18 pages, 2 figures, 3 tables.-- PMID: 15913055 [PubMed]. ; [ESP] Cada vez existe mayor evidencia de la influencia de la dieta y de la exposición a dosis bajas de tóxicos durante la etapa prenatal y primera infancia sobre la salud y el bienestar en etapas posteriores de la vida. Siguiendo las recomendaciones de la OMS y de la Unión Europea en el año 2003 se constituyó la Red de Investigación Cooperativa Infancia y Medio Ambiente para estudiar los efectos del medio ambiente y la dieta en el desarrollo fetal e infantil en diversas zonas geográficas en España. La Red integra diversos grupos multidisciplinares de investigación y está constituida por seis cohortes, tres preexistentes y tres de novo, que seguirán de forma prospectiva a 3.600 mujeres embarazadas, desde el inicio del embarazo hasta los 4-6 años del niño. Los objetivos generales de la red son: (1) Describir la exposición individual a tóxicos ambientales durante la gestación y la primera infancia. (2) Evaluar los efectos de la exposición a tóxicos y de la dieta en el desarrollo fetal e infantil. (3) Evaluar la interacción entre factores tóxicos, nutricionales y genéticos en el desarrollo fetal e infantil. El seguimiento se realiza en cada trimestre de la gestación, al nacimiento, al año y hasta los cuatro o seis años del niño. La información se recoge mediante cuestionarios, datos clínicos, exploración física, ecografías, biomarcadores y mediciones ambientales. En este trabajo se presentan las características generales de la red y se describe la situación actual de cada una de las cohortes. ; [ENG] Increasingly greater evidence exists as to the influence which diet and exposure to low doses of toxic substances during the prenatal stage and early childhood has on health and well-being throughout later stages of life. Following the WHO and European Union recommendations in 2003, the Cooperative Environment and Childhood Research Network was set up to study the effects of the environment and diet on fetal and early childhood development in different geographical areas of Spain. This Network integrates different multidisciplinary research groups and is comprised of six cohorts - three pre-existing and three de novo - which will follow up prospectively 3,600 pregnant women, from the start of pregnancy up to age 4-6 years of the child. This network's general objectives are: (1) To describe individual exposure to toxic substances in the environment during gestation and early childhood. (2) To evaluate the effects of exposure to toxic substances and diet on fetal and early childhood development. (3) To evaluate the interaction among toxic, nutritional and genetic factors in fetal and early childhood development. The follow-up is done every three months during gestation, at birth, at age one and up to age four or six. The information is gathered by means of questionnaires, clinical data, physical examinations, echographs, biomarkers and environmental measurements. The general characteristics of the network and a description of the current situation of each one of the cohorts are provided in this study. ; La Red no se hubiera podido poner en marcha sin el apoyo económico del Instituto de Salud Carlos III (G03/176). El Estudio INMA ha recibido también ayudas de «Fundació La Caixa» para la cohorte de Ribera d'Ebre (97/009-00 and 00/077-00); de la Comisión de la Unión Europea (QLK4-1999-01422) para la cohorte de Granada; del «Fondo de Investigación Sanitaria» (FIS 031615), del Ministerio de Ciencia y Tecnología (SAF 2002-03508), de la Generalitat Valenciana, Conselleria d'Empresa, Universitat i Ciencia (g03/136) para la cohorte de Valencia; del «Fondo de Investigación Sanitaria» (97/0588 y 00/0021-02) y de la Comisión de la Unión Europea (QLK4-2000-00263) para la cohorte de Menorca. ; Peer reviewed

The nutritional status of both women and men before conception has profound implications for the growth, development, and long-term health of their offspring. Evidence of the effectiveness of preconception interventions for improving outcomes for mothers and babies is scarce. However, given the large potential health return, and relatively low costs and risk of harm, research into potential interventions is warranted. We identified three promising strategies for intervention that are likely to be scalable and have positive effects on a range of health outcomes: supplementation and fortification; cash transfers and incentives; and behaviour change interventions. On the basis of these strategies, we suggest a model specifying pathways to effect. Pathways are incorporated into a life-course framework using individual motivation and receptiveness at different preconception action phases, to guide design and targeting of preconception interventions. Interventions for individuals not planning immediate pregnancy take advantage of settings and implementation platforms outside the maternal and child health arena, since this group is unlikely to be engaged with maternal health services. Interventions to improve women's nutritional status and health behaviours at all preconception action phases should consider social and environmental determinants, to avoid exacerbating health and gender inequalities, and be underpinned by a social movement that touches the whole population. We propose a dual strategy that targets specific groups actively planning a pregnancy, while improving the health of the population more broadly. Modern marketing techniques could be used to promote a social movement based on an emotional and symbolic connection between improved preconception maternal health and nutrition, and offspring health. We suggest that speedy and scalable benefits to public health might be achieved through strategic engagement with the private sector. Political theory supports the development of an advocacy coalition of groups interested in preconception health, to harness the political will and leadership necessary to turn high-level policy into effective coordinated action.

STUDY QUESTION: What is the relationship between maternal paracetamol intake during the masculinisation programming window (MPW, 8-14 weeks of gestation) and male infant anogenital distance (AGD), a biomarker for androgen action during the MPW? SUMMARY ANSWER: Intrauterine paracetamol exposure during 8-14 weeks of gestation is associated with shorter AGD from birth to 24 months of age. WHAT IS ALREADY KNOWN: The increasing prevalence of male reproductive disorders may reflect environmental influences on foetal testicular development during the MPW. Animal and human xenograft studies have demonstrated that paracetamol reduces foetal testicular testosterone production, consistent with reported epidemiological associations between prenatal paracetamol exposure and cryptorchidism. STUDY DESIGN, SIZE, DURATION: Prospective cohort study (Cambridge Baby Growth Study), with recruitment of pregnant women at ~12 post-menstrual weeks of gestation from a single UK maternity unit between 2001 and 2009, and 24 months of infant follow-up. Of 2229 recruited women, 1640 continued with the infancy study after delivery, of whom 676 delivered male infants and completed a medicine consumption questionnaire. PARTICIPANTS/MATERIALS, SETTING, METHOD: Mothers self-reported medicine consumption during pregnancy by a questionnaire administered during the perinatal period. Infant AGD (measured from 2006 onwards), penile length and testicular descent were assessed at 0, 3, 12, 18 and 24 months of age, and age-specific Z scores were calculated. Associations between paracetamol intake during three gestational periods (14 weeks) and these outcomes were tested by linear mixed models. Two hundred and twenty-five (33%) of six hundred and eighty-one male infants were exposed to paracetamol during pregnancy, of whom sixty-eight were reported to be exposed during 8-14 weeks. AGD measurements were available for 434 male infants. MAIN RESULTS AND THE ROLE OF CHANCE: Paracetamol exposure during 8-14 weeks of gestation, but not any other period, was associated with shorter AGD (by 0.27 SD, 95% CI 0.06-0.48, P = 0.014) from birth to 24 months of age. This reduction was independent of body size. Paracetamol exposure was not related to penile length or testicular descent. LIMITATIONS, REASONS FOR CAUTION: Confounding by other drugs or endocrine-disrupting chemicals cannot be discounted. The cohort was not fully representative of pregnant women in the UK, particularly in terms of maternal ethnicity and smoking prevalence. There is likely to have been misclassification of paracetamol exposure due to recall error. WIDER IMPLICATIONS OF THE FINDINGS: Our observational findings support experimental evidence that intrauterine paracetamol exposure during the MPW may adversely affect male reproductive development. STUDY FUNDING/COMPETING INTERESTS: This work was supported by a European Union Framework V programme, the World Cancer Research Fund International, the Medical Research Council (UK), the Newlife Foundation for Disabled Children, the Evelyn Trust, the Mothercare Group Foundation, Mead Johnson Nutrition, and the National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre. The authors declare no conflict of interest. ; European Union (Framework V programme), World Cancer Research Fund International, Medical Research Council (UK), Newlife Foundation for Disabled Children, Evelyn Trust, Mothercare Group Foundation, Mead Johnson Nutrition, National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre ; This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Oxford University Press.

We evaluate an intervention targeting early life nutrition and well-being for households in extreme poverty in Northern Nigeria. The intervention leads to large and sustained improvements in children's anthropometric and health outcomes, including an 8 percent reduction in stunting 4 years, post-intervention. These impacts are partly driven by information-related channels. However, the certain and substantial flow of cash transfers is also key. They induce positive labor supply responses among women, and enables them to undertake productive investments in livestock. These provide protein rich diets for children, and generate higher household earnings streams long after the cash transfers expire. (JEL I12, I32, I38, J13, J16, J22, O12)

Food insecurity is detrimental to child development, yet little is known about the combined influence of food insecurity and nutritional interventions on child development in low-income countries. We proposed that women assigned to an early invitation time to start a prenatal food supplementation program could reduce the negative influence of food insecurity on maternal-infant interaction. A cohort of 180 mother-infant dyads were studied (born between May and October 2003) from among 3267 in the randomized controlled trial Maternal Infant Nutritional Interventions Matlab, which was conducted in Matlab, Bangladesh. At 8 wk gestation, women were randomly assigned an invitation time to start receiving food supplements (2.5 MJ/d; 6 d/wk) either early (~9 wk gestation; early-invitation group) or at the usual start time (~20 wk gestation; usual-invitation group) for the government program. Maternal-infant interaction was observed in homes with the use of the Nursing Child Assessment Satellite Training Feeding Scale, and food-insecurity status was obtained from questionnaires completed when infants were 3.4–4.0 mo old. By using a general linear model for maternal-infant interaction, we found a significant interaction (P = 0.012) between invitation time to start a prenatal food supplementation program and food insecurity. Those in the usual-invitation group with higher food insecurity scores (i.e., more food insecure) had a lower quality of maternal-infant interaction, but this relationship was ameliorated among those in the early-invitation group. Food insecurity limits the ability of mothers and infants to interact well, but an early invitation time to start a prenatal food supplementation program can support mother-infant interaction among those who are food insecure.