Preconception care and nutrition interventions in low- and middle-income countries

Maternal nutrition plays an important role in pregnancy outcomes and in the health of the newborn, and providing simple nutritional interventions before pregnancy can prevent a significant proportion of maternal and neonatal mortality and morbidity. Evidence suggests that maternal prepregnancy overweight and obesity increase the propensity for gestational hypertension and diabetes, and the risk of stillbirths and congenital heart defects; underweight women have a higher incidence of stillbirths, and preterm birth, low-birthweight and small-for-gestational-age babies. While it is important to maintain normal body weight, preconception micronutrient status of women is also crucial. Substantial evidence exists for the potential of preconception folic acid supplementation to more than halve the risk of neural tube defects. Multivitamin supplementation lowers the rates of preeclampsia and multiple congenital anomalies. On the other hand, iron deficiency anemia is significantly associated with increased risk of fetal growth restriction and low birthweight. It is therefore important to scale up these interventions particularly in low- and middle-income countries, where the scenario is grave. Healthcare providers should be encouraged to provide preconception care to all adolescent girls, women and couples of reproductive age.