Maternal and Infant Health Outcomes Associated with Medical Nutrition Therapy by Registered Dietitian Nutritionists in Pregnant Women with Malnutrition: An Evidence Analysis Center Systematic Review

Published:February 06, 2020DOI:


      Malnutrition during the critical period of pregnancy has significant health outcomes for both the mother and her offspring. Medical nutrition therapy (MNT) by a registered dietitian nutritionist (RDN) may help mitigate negative health effects, although studies that support the role of the RDN have not been comprehensively evaluated. The objective was to explore the health effects of MNT by an RDN on maternal and infant outcomes in pregnant women with malnutrition. A systematic review of studies published between 2000 and 2014 that incorporated MNT by an RDN during pregnancy were retrieved from a PubMed search, using criteria established by the Academy of Nutrition and Dietetics Evidence Analysis Process. Among 94 identified studies, five controlled trials met the inclusion criteria. The initial search was extended to include one study published between 2014 and 2019. Outcomes included maternal gestational weight gain, maternal markers of glycemic control, maternal complications such as hypertension, incidence of caesarean section, infant birth weight both in grams and in clinical categories, infant gestational age, and infant complications. There was good/strong evidence that MNT by an RDN decreased gestational weight gain, although there was no effect on maternal complications, caesarean section deliveries, and gestational age among women with mixed body mass index status or those who were overweight/obese. The evidence was deemed fair in support of an effect on glycemic control, infant birth weight, and infant complications. The heterogeneity in the results are due to the variation among populations studied, types of interventions, and inconsistency among outcomes. In addition, the training and educational requirements of the RDN or the international equivalent may vary widely across the four countries in which studies were conducted. There was good evidence for MNT by an RDN during pregnancy on improving gestational weight gain among overweight/obese women. To better support the role of MNT by an RDN in the health care of pregnant women, research that clearly identifies the role of the RDN in the intervention, includes a control group, and studies more heterogeneous populations is needed.
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        • Cusick S.
        • Georgieff M.
        • Cusick S.
        • Georgieff M.
        The first 1,000 days of life: The brain’s window of opportunity.
        • Godfrey K.M.
        • Barker D.J.
        Fetal programming and adult health.
        Public Health Nutr. 2001; 4: 611-624
        • Fall C.H.
        Fetal malnutrition and long-term outcomes.
        Nestle Nutr Inst Workshop Ser. 2013; 74: 11-25
        • Black R.E.
        • Allen L.H.
        • Bhutta Z.A.
        • et al.
        Maternal and child undernutrition: Global and regional exposures and health consequences.
        Lancet. 2008; 371: 243-260
        • Kozuki N.
        • Katz J.
        • Lee A.C.
        • et al.
        Short maternal stature increases risk of small-for-gestational-age and preterm births in low- and middle-income countries: Individual participant data meta-analysis and population attributable fraction.
        J Nutr. 2015; 145: 2542-2550
        • Deputy N.P.
        • Dub B.
        • Sharma A.J.
        Prevalence and trends in prepregnancy normal weight— 8 states, New York City, and District of Columbia, 2011–2015.
        MMWR Morb Mortal Wkly Rep. 2018; 66: 1402-1407
        • Poston L.
        • Caleyachetty R.
        • Cnattingius S.
        • et al.
        Preconceptional and maternal obesity: epidemiology and health consequences.
        Lancet Diabetes Endocrinol. 2016; 4: 1025-1036
        • Amugsi D.A.
        • Dimbuene Z.T.
        • Mberu B.
        • et al.
        Prevalence and time trends in overweight and obesity among urban women: an analysis of demographics and health surveys data from 24 African countries, 1991-2004.
        BMJ Open. 2017; 7: e017344
        • Gunderson E.P.
        • Abrams B.
        • SS
        The relative importance of gestational gain and maternal characteristics associated with the risk of becoming overweight after pregnancy.
        Int J Obes Relat Metab Disord. 2000; 24: 1660-1668
        • Stotland N.E.
        • Hopkins L.M.
        • Caughey A.B.
        Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas.
        Obstet Gynecol. 2004; 104: 671-677
        • O’Brien T.E.
        • Ray J.G.
        • Chan W.-S.
        Maternal body mass index and the risk of preeclampsia: A systematic overview.
        Epidemiology. 2003; 14: 368-374
        • Guelinckx I.
        • Devlieger R.
        • Beckers K.
        • Vansant G.
        Maternal obesity: Pregnancy complications, gestational weight gain and nutrition.
        Obes Rev. 2008; 9: 140-150
        • Fraser A.
        • Tilling K.
        • MacDonald-Wallis C.
        • et al.
        Association of maternal weight gain in pregnancy with offspring obesity and metabolic and vascular traits in childhood.
        Circulation. 2010; 121: 2557-2564
        • Jarvie E.
        • Ramsay J.E.
        Obstetric management of obesity in pregnancy.
        Semin Fetal Neonatal Med. 2010; 15: 83-88
        • Waller D.
        • Shaw G.M.
        • Rasmussen S.A.
        • et al.
        Prepregnancy obesity as a risk factor for structural birth defects.
        Arch Pediatr Adolesc Med. 2007; 161: 745-750
        • Ota E.
        • Hori H.
        • Mori R.
        • Tobe-Gai R.
        • Farrar D.
        Antenatal dietary education and supplementation to increase energy and protein intake.
        Cochrane Database Syst Rev. 2015; : CD000032
        • Popa A.D.
        • Oleniuc M.
        • Graur M.
        [Prenatal care and weight gain during pregnancy].
        Rev Med Chir Soc Med Nat Iasi. 2011; 115: 1149-1154
        • Quinlivan J.A.
        • Julania S.
        • Lam L.
        Antenatal dietary interventions in obese pregnant women to restrict gestational weight gain to Institute of Medicine recommendations: A meta-analysis.
        Obstet Gynecol. 2011; 118: 1395-1401
      1. Academy of Nutrition and Dietetics. Academy of Nutrition and Dietetics’ definition of terms list. Updated July 2016. Accessed April 15, 2018.

        • Handu D.
        • Moloney L.
        • Wolfram T.
        • Ziegler P.
        • Acosta A.
        • Steiber A.
        Academy of Nutrition and Dietetics methodology for conducting systematic reviews for the evidence analysis library.
        J Acad Nutr Diet. 2016; 116: 311-318
      2. International Confederation of Dietetic Association.
        Date accessed: December 15, 2018
        • Papoutsakis C.
        • Moloney L.
        • Sinley R.C.
        • Acosta A.
        • Handu D.
        • Steiber A.L.
        Academy of Nutrition and Dietetics methodology for developing evidence-based nutrition practice guidelines.
        J Acad Nutr Diet. 2017; 117: 794-804
        • Dodd J.M.
        • Turnbull D.
        • McPhee A.J.
        • et al.
        Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial.
        BMJ. 2014; 348: g1285
        • Renault K.M.
        • Norgaard K.
        • Nilas L.
        • et al.
        The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women.
        Am J Obstet Gynecol. 2014; 210: 134.e1
        • Vesco K.
        • Karanja N.
        • King J.
        • et al.
        Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: A randomized trial.
        Obesity. 2014; 22: 1989-1996
        • Asbee S.M.
        • Jenkins T.R.
        • Butler J.R.
        • White J.
        • Elliot M.
        • Rutledge A.
        Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: A randomized controlled trial.
        Obstet Gynecol. 2009; 113: 305-312
        • Perichart-Perera O.
        • Balas-Nakash M.
        • Parra-Covarrubias A.
        • et al.
        A medical nutrition therapy program improves perinatal outcomes in Mexican pregnant women with gestational diabetes and type 2 diabetes mellitus.
        Diabetes Educ. 2009; 35: 1004-1013
        • Koivusalo S.B.
        • Rono K.
        • Klemetti M.M.
        • et al.
        Gestational diabetes mellitus can be prevented by lifestyle intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL). A randomized controlled trial.
        Diabetes Care. 2016; 39: 24-30
        • Girard A.W.
        • Olude O.
        Nutrition education and counselling provided during pregnancy: Effects on maternal, neonatal and child health outcomes.
        Paediatr Perinat Epidemiol. 2012; 26: 191-204
        • Bain E.
        • Crane M.
        • Tieu J.
        • Han S.
        • Crowther C.A.
        • Middleton P.
        Diet and exercise interventions for preventing gestational diabetes mellitus.
        Cochrane Database Syst Rev. 2015; 4: CD010443
        • Peccei A.
        • Blake-Lamb T.
        • Rahilly D.
        • Hatoum I.
        • Bryant A.
        Intensive prenatal nutrition counseling in a community health setting: A randomized controlled trial.
        Obstet Gynecol. 2017; 130: 423-432
        • Bogdanet D.
        • Egan A.M.
        • Reddin C.
        • et al.
        ATLANTIC DIP: Insulin therapy for women with IADPSG-diagnosed gestational diabetes mellitus. Does it work?.
        J Clin Endocrinol Metab. 2017; 102: 849-857
        • Centers for Disease Control and Prevention
        Weight gain during pregnancy.
        • Kohn J.B.
        • Schofield M.
        Is medical nutrition therapy considered a form of preventive care and is it reimbursable?.
        J Acad Nutr Diet. 2015; 115: 1904
        • Academy of Nutrition and Dietetics
        Position of the Academy of Nutrition and Dietetics: The role of nutrition in health promotion and chronic disease prevention.
        J Acad Nutr Diet. 2013; 113: 972-979


      M. Pari-Keener is a clinical dietitian, Outpatient Clinic, Department of Pediatrics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn.


      S. Gallo is an assistant professor, Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, VA.


      B. Stahnke is a WIC advisory team manager, Georgia Department of Health, Division of Health Promotion, Georgia Special Supplemental Nutrition Program for Women, Infants and Children, Program Integrity and Strategy Unit, Atlanta.


      J. M. McDermid is an assistant professor; Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia, Charlottesville.


      R. I. Al-Nimr is the director, Nutrition in Medical Education Program, and a clinical instructor in Medicine & Medical Education, The Geisel School of Medicine, Dartmouth College, Hanover, NH, and a clinical dietitian in research, Dartmouth-Hitchcock Medical Center, Lebanon, NH.


      J. M. Moreschi is a regional educator, University of Illinois Extension, SNAP-Ed, Ottawa.


      R. Hakeem is a principal and professor of nutrition, Raana Liaqat Ali Khan Government College of Home Economics, Karachi, Pakistan.


      D. Handu is a senior scientific director, Evidence Analysis Center, Research, International and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL.


      F. W. Cheng is a nutrition researcher, Evidence Analysis Center, Research, International and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL.