Intervention strategies for preventing low birthweight in developing countries: importance of considering multiple interactive factors.

The need to prevent low birthweight (LBW) defined as a birthweight ≤2,500 g is presently well recognized, not only because of the immediate consequences increasing the risk of neonatal death and burden of disease but also in terms of the impact of being LBW on lifelong health and well-being. Children are born LBW (<2,500 g) either because they were born too early (true preterm LBW infants) or alternatively they failed to grow adequately despite a normal duration of gestation (intrauterine growth retardation IUGR). In this later case, the weight may be over 2,500 g, but the infant is lighter than expected for his/her gestational age. In fact, many preterm infants are to some degree growth retarded. Despite the differences in origin, all LBW categories are considered at increased risk of neonatal death and later morbidity. Preventive actions are more likely to succeed if we consider the nutritional interventions as part of a package that addresses in a holistic manner the full spectrum of needs of women from before conception as well as during pregnancy. We have gained sufficient experience with single nutrient and/or 'magic bullet' approaches to learn from this and avoid them in the future. New fetal growth standards (INTERGROWTH 2012) represent major progress in terms of evaluating the effect of early life events on later growth, health and well-being. Thus, for the first time, clinicians and researchers will have sequential longitudinal data that will serve to characterize whole body as well as brain, liver, and long bone growth, relating this indirectly to placental blood flow and transfer function, neonatal health, morbidity and mortality.