Focusing on Maternal Nutrition to Improve the Health and Well-Being of Pregnant Women in the United States

ABSTRACT

Poor maternal nutrition remains a critical public health problem globally, including the United States. The global prevalence of maternal underweight and short stature were 14.2% and 9.7%, respectively, in 2015, and nearly half were still anemic. Although we have made significant progress in reducing maternal underweight, there is considerable inequality by region, combined with little to no progress for the other indicators, such as anemia, and increases in overweight and obesity.1,3Studies have shown that routine prenatal iron-folate supplementation is effective in reducing anemia and improving birth outcomes, but several other micronutrient deficiencies (vitamins A, D, B1, B2, B6, B12, and zinc) are common, especially during pregnancy and lactation, when requirements are increased,1,4 and factors such as climate change, the COVID-19 pandemic, and conflicts are expected to worsen the availability of and access to quality food across the globe by 2030.5 Although the prevalence of anemia during pregnancy is much lower in the United States than in other parts of the world, 1 in 10 pregnant women who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children were anemic, and these rates were much higher in selected subgroups and also increased from 2008 to 2018 in some states.6 Poor diet quality and inadequate intakes of key nutrients such as n-3 fatty acids, iodine, and iron are also common in the United States.7,8 Data from the National Health and Nutrition Examination Surveys show that more than 95% of women of reproductive age, including pregnant women, do not meet the recommended intake of at least 250 milligram (mg) of the long chain n-3 fatty acids, docosahexaenoic acid, and eicosapentaenoic acid, and iodine status is also suboptimal during pregnancy.8,9Finally, a major concern is the increased consumption of ultra-processed foods and reduced physical activity that have contributed to dramatic increases in obesity and overweight across the life course in the past three decades.10 Maternal obesity is a major risk factor for adverse pregnancy outcomes, including gestational diabetes, hypertension, preeclampsia, cesarean delivery, preterm delivery, large size for gestational age, and infant death, and recent data from the National Vital Statistics System show that prepregnancy obesity (body mass index >30 kg/m2) increased from 26.1% in 2016 to 29% in 2019 in the United States across all age, education, and race/ethnicity groups.10,11 Furthermore, women who are overweight or obese may also experience increased difficulties in breastfeeding their infants.