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Complementary and Alternative Medicine
July 20, 2023
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Gestational Maternal Undernutrition: Implications on Fetal Development, Cardiovascular Diseases and Prevention by Complementary and Alternative Medicine

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SUMMARY

There are reported links between sub-optimal maternal nutrition and compromised fetal development and growth leading to
higher cardiovascular disease (CVD) incidence in adolescence and later stages of life. CVDs are a major cause of disease and
death in mankind and are an impediment to sustainable human development, globally. Recent reports suggest that about 17.9
million human deaths are caused by CVDs, annually (WHO, 2022). Among the various CVDs, the most prevalent one is coronary
artery disease (CAD). The CAD resulted in about 9 million deaths and affected 110 million people, in 2015 (WHO, 2022). The
health of a woman and her generations depends upon nutritional status, during pregnancy and lactation. The risks of progressing
insulin resistance, high blood pressure, and type-2 diabetes mellitus in later stages of life were likely greater in babies born with
low birth weights than those born with normal weights and not exposed to maternal malnutrition. Complementary alternative
medicine (CAM) often includes the use of dietary supplements, such as specific vitamins and minerals, to support the nutritional
needs of both the mother and the developing fetus. Herbal sources of iron, such as nettle (Urtica dioica) and yellow dock (Rumex
crispus), have been historically used to address anemia and improve iron status. A positive impact of Moringa oleifera
supplementation has been demonstrated on maternal nutritional status and birth outcomes. Galactagogue herbs like fenugreek
(Trigonella foenum-graecum) and fennel (Foeniculum vulgare) have been traditionally used to enhance milk production and
support breastfeeding mothers.

INTRODUCTION

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The World Health Organization

This chapter has been written to give a good insight into the global incidence of maternal and child undernutrition, maternal under-nutritional effects on fetal development and CVD incidence, the link between CVDs and IMT, association of Intrauterine Growth Restriction (IUGR) and CVDs, during pregnancy and optimal nutritional provisions during pregnancy to avoid adverse effects of maternal undernutrition for improvement of overall health and wellbeing.

IMPACT OF GESTATIONAL MATERNAL UNDERNUTRITION ON FETAL DEVELOPMENT

“It is on the condition of the health of the mother that the condition of the health of the child depends”, Hippocrates stated. This is one of the very early reported references to the concept that placental life has an effect on adult life. But the full concept came into being as we know it in the 1930s, during this era substandard living conditions in infancy were linked to premature death, later. Further studies were carried out which linked these substandard living conditions in early life to several cardiac disorders later in life when the living conditions were better this gave a hint that development in early life and the environment was rather important for the well-being of the individual, in 1977 (Hanson, 2015).
Approximately one-half of the world’s total population is affected by maternal and child undernutrition (Ahmed et al., 2012). Maternal and child undernutrition causes 3·5 million deaths annually, 11% of worldwide disability-adjusted lifeyears (DALYs), and more than one-third of the disease burden in children (less than 5 years of age). Optimum and balanced maternal nutrition is indispensable for proper fetal development and growth (Barker & Clark 1997). Nutritional factors and proteins present in milk promote fetal growth in pregnant women (Borazjani et al., 2013). Ignorance, poverty, food insecurity, infectious diseases, lack of proper feeding practices for infants and young children, and poor sanitation and hygiene lead to the prevailing high levels of child and maternal undernutrition in developing nations. Maternal undernutrition is highly prevalent in the resource-poor countries of southeast Asia, sub-Saharan Africa, and south-central Asia. Its prevalence in South Asia ranges from 10 to 40% (Ahmed et al., 2012; Jouanne et al., 2021).
Pakistan being a developing country, about 12.5% population (28 million) faced undernourishment, in 2021 (FAO, 2021). In Pakistan, both lactating and pregnant women suffer from a higher prevalence of malnutrition (16.1%) than their non-pregnant peers (12.5%). It is understood that undernutrition reduces a nation’s economic progress by at least 8% resulting in poorer cognition, direct productivity losses, and reduced schooling. The enormity of children and maternal undernutrition in Pakistan is so much so that about one crore children in Pakistan face stunting, largely due to maternal undernutrition (UNICEF, 2022). To cope with this grave situation, in 2014, the World Bank committed 47.95 million US dollars to improve the nutritional status of lactating and pregnant women. A similar situation is prevalent for women and children in many developing countries (World Bank, 2014).

Maternal undernutrition has been proven to have a profound effect on fetal growth, with body weight and many key organs. It has been reported previously that during the first two weeks of pregnancy, the provision of a 5% protein diet only (undernutrition) led to a reduction in brain weight, size, and cortical thickness of the brain (Gressens et al., 1997). A severe gestational maternal protein restriction in rats caused a reduced number of glomeruli and hypertension in both male and female newborns, this hypertension is salt-sensitive and worsens with age, but is approximately equivalent in males and females (Woods et al., 2004)

Chronic energy deficit or maternal undernutrition means
having a body mass index (BMI) below 18.5. If the females are
under-nourished females at the time of conception, then during
pregnancy (when there are additional demands due to the
growing fetus), they are unlikely to improve their nutritional
status. They are more likely to fail to gain sufficient weight
during pregnancy and are at a higher risk of mortality than wellnourished and healthy women (Smith et al., 2003).

IUGR predisposes developing fetuses to reduced organ and
body weights. Most information about the long-term and short term effects of IUGR has come from animal models. In recent
years, many animal models of placental insufficiency and/or
poor maternal nutrition have been developed to investigate the
causes and effects of IUGR. Both maternal dietary
manipulations and surgical interventions have been employed
for these studies. A number of animal species have been studied
for IUGR effects, including rodents, rabbits sheep, and primates
(Louey et al., 2000; Mitchell et al., 2004; Jonker et al., 2018).

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