Maternal Nutrition and Child Outcomes: A Review of the Literature and Findings from the First 1000 Most Critical Days Programme Phase II Baseline Survey in Zambia

Inadequate maternal nutrition contributes to intrauterine growth restriction, increases the risk of newborn death and stunting in childhood, and raises the risk of obesity and non-communicable diseases in adulthood. The intergenerational impact of stunting can be seen at every stage of life, with women with short stature facing increased risk for preterm birth, small-for-gestational age, and a child who is stunted at 12 months of age. Maternal iron and calcium deficiencies in pregnancy substantially contribute to maternal death, while maternal iron deficiency is associated with low birthweight. Anaemia and iron deficiency cause fatigue and impair physical capacity and work performance, and anaemia during pregnancy is associated with mortality and morbidity in the mother and child. Postpartum anaemia is negatively associated with maternal caregiving practices and child development outcomes. Low body mass index (BMI), an indication of maternal undernutrition, continues to persist, while the prevalence of maternal overweight has steadily increased since 1980 and exceeds that of underweight. Maternal diets are closely linked with children's diets, with studies establishing the links between maternal diet diversity and child diet diversity. Children whose mothers consumed 5 or more food groups were 5 to 9 times more likely to meet minimum diet diversity recommendations, decreasing their risk of chronic undernutrition and stunting. Maternal food insecurity and inadequate diet are linked to sub-optimal breastfeeding practices, which increase the risk of undernutrition and stunting in children. The First 1000 Most Critical Days Programme Phase II (MCDP II) Baseline Survey was a cross-sectional survey carried out in 30 priority Scaling Up Nutrition 2.0 districts in Zambia in 2019. The survey collected data from 7,500 households with a child under 2 years of age and included key informant interviews with 51 district or provincial ministry officials or nongovernmental organisation representatives. Of these households, 7,191 included the biological mother as the primary caregiver. Table 1 presents maternal characteristics associated with child stunting and underweight. Maternal educational attainment, head of household, adolescence, BMI category, stature, household hunger, maternal dietary diversity, consumed nutrient-rich value chain commodities, eating during pregnancy, and eating during breastfeeding were all significant or near significant factors associated with child stunting and underweight outcomes. Mothers with a higher BMI (≥18.5 kg/m2) had children with a decreased likelihood of being stunted or underweight, compared to mothers with a low BMI (<18.5 kg/m2). The geographic distribution of underweight among mothers in Zambia shows that districts with the highest percentages of underweight women are Kalabo (21.7%), Kaoma (15.0%), and Mwinilunga (11.5%). Western province has the highest percentage of underweight mothers (13.9%). The geographic distribution of women with short stature shows that districts with the highest percentages of women with short stature are Kaputa (29.3%), Nchelenge (27.2%), and Luwingu (27.1%). Northern province has the highest percentage of women with short stature (25.8%). Maternal nutrition status was associated with child stunting and underweight outcomes. Women's dietary diversity among women of reproductive age is important to consider because women with micronutrient inadequacy are more likely to have stunted or underweight children. Factors inhibiting mothers from achieving dietary diversity are likely to be shared with their children, highlighting the importance of addressing maternal nutrition to improve child outcomes.