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Maternal nutrition and pregnancy outcome
  1. P YUDKIN,
  2. A NEIL
  1. Department of Zoology
  2. University of Oxford
  3. South Parks Road
  4. Oxford OX1 3PS, UK
  5. fmathews{at}
  6. Division of Public Health and Primary Health Care
  7. University of Oxford, UK

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Editor,—Symonds et alraise interesting issues about the potential use of animal models in examining the impact of nutrition during pregnancy on future risk of adult disease.1 However, their discussion of recent epidemiological research in humans includes several important factual inaccuracies. The authors imply that our analyses and those of Godfreyet al grouped women into categories of energy intake, and suggest that different results might have been obtained had “all the raw data points [been used] to determine potential relations between maternal nutrition and birth weight”. Yet as clearly indicated in both papers,2 ,3 this is precisely the analysis that was conducted. For information, figure 1 shows the relationship of maternal energy intake to birth weight in our study. In each paper, the cut points used in tables to illustrate the relationships between energy intake and birth weight were neither “unclear” nor “arbitrary” but were, as stated, tertiles. Symonds et al draw attention to the “striking difference” in energy intake between our study and that of Godfrey et al whilst also suggesting that we should combine our data in a meta-analysis. We argue that the differences are not particularly striking given the different methodologies used for dietary assessment. It would not be appropriate to combine in a meta-analysis data collected in contrasting ways from women at different stages of pregnancy. In any case, our study individually has sufficient statistical power to detect clinically important effects.

Figure 1

Birth weights were individually adjusted to the mean sex and gestational age of the cohort and for maternal smoking and height

In advocating animal experiments above observational epidemiology in humans, Symonds et al confuse two separate issues. First, there is the biologically interesting question of whether maternal diet can influence the outcome of pregnancy. This has clearly already been demonstrated in animals. Secondly, there is the question of whether maternal dietdoes influence the outcome of human pregnancy. This question is of clinical and public health importance. It cannot be answered by animal experiments (unless one were to make the dubious argument that the errors associated with extrapolating data from animal models to humans are less than those from using self reported data on human dietary intake). We do not argue that maternal energy intake can never be associated with birth weight. Under extreme circumstances, such as those in the animal experiments cited by Symonds, or in Third World countries, it may be. However, this is no basis for suggesting is has any importance to populations in industrialised countries.