Can maternal dietary supplements help in preventing infant malnutrition?

Many nutritional intervention programmes throughout the world have targeted food supplements towards women during the "at risk" periods of pregnancy and lactation. Some of these programmes, together with a number of small-scale scientific studies, have attempted to evaluate the efficacy of supplementation in terms of birth outcome or lactational performance. After reviewing the available evidence it is concluded: (a) that supplementation during late pregnancy can have a significant beneficial effect on birthweight in women who are genuinely "at risk" due to an inadequate home diet; (b) that statistical projections would predict that the increase in birthweight should be accompanied by a significant decrease in neonatal mortality; (c) that supplementation during lactation is most unlikely to increase breast-milk output or significantly improve its composition except perhaps in extremely malnourished women. Since pregnant women form a small and easily identifiable target group, and since the potential benefits of extra food may be substantial, it is recommended that future efforts are focussed in this direction. Large-scale effectiveness and cost-benefit trials are required with neonatal mortality as the primary outcome.