Malnutrition in Pregnancy

Malnutrition in Pregnancy

Welcome to the Malnutrition in Pregnancy (MIP) Systematic Review

Malnutrition is widely described as a state of nutritional imbalance in calories, macronutrients, vitamins and/or minerals. Yet, a consistent definition of malnutrition in pregnancy is lacking. In order to comprehensively evaluate the body of research, studies were considered as meeting the malnutrition definition if malnutrition conditions (in terms of anthropometric, biochemical, clinical, dietary, or other) in the target population were reported. For this systematic review, the expert workgroup focused on the following sub-topics:

  • Screening and Assessment
  • Hyperemesis Gravidarum
  • Health Effects
    • Famine
    • Micronutrient Deficiency
    • Nutrition Assessment
  • Diet and Supplements
    • Omega-3
    • Vitamin D
  • Weight Loss Surgery
  • Medical Nutrition Therapy (MNT)

Key Findings: The systematic review found that malnutrition in pregnancy generally had negative effects on health outcomes among offspring. Interventions, such as omega-3, vitamin D, weight loss surgery, and MNT, were effective in addressing some of the maternal and infant outcomes. More research is needed to 1) examine the validity and reliability of screening/assessment tools in identifying malnutrition in pregnancy, 2) investigate the effectiveness of nutrition interventions in preventing malnutrition in pregnant women with hyperemesis gravidarum, and 3) further explore the health outcomes of MNT by an RD/RDN in pregnant women with malnutrition.

Meta-Analysis: The number of included studies, as well as the nature of the data, allowed the workgroup to further conduct a meta-analysis for the vitamin D subtopic.

Project Team: Expand the section below for a listing of individuals who contributed to the development of this project, disclosures and funding of the systematic review.

Manuscripts: Expand the section below title Resources and Articles for additional information.

  • Resources and Articles

    The following resources have been developed from this project:

    • EAL Malnutrition in Pregnancy Systematic Review - This 83-slide powerpoint presentation includes all conclusions and grades for the EAL's Malnutrition in Pregnancy Systematic Review (2018) and is ready for use in meetings, in-service presenations and classes. Learn More ...  
    • Effects of Bariatric Surgery on Maternal and Infant Outcomes of Pregnancy - an Evidence Analysis Center Systematic Review. Al-Nimr RI, Hakeem R; Moreschi JM, Gallo S, McDermid JM, Pari-Keener M, Stahnke B, Papoutsakis C, Handu D, Cheng FW. J Acad Nutr Diet. 2019;119(11):1921-1943. DOI: https://org/10.1015/j.jand.2019.02.008   
    • 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. Pari-Keener M, Gallo S, Stahnke B, McDermid, JM, Al-Nimr RI, Moreschi JM, Hakeem R, Handu D, Cheng FW. J Acad Nutr Diet. 2020;120(10):1730-1744. DOI:    
    • Vitamin D Supplementation during Pregnancy: An Evidence Analysis Center Systematic Review and Meta-Analysis. Gallo S, McDermid JM, Al-Nimr RI, Hakeem R, Moreschi JM, Pari-Keener M, Stahnke B, Papoutsakis C, Handu D, Cheng FW. J Acad Nutr Diet 2020;120(5)::898-924. DOI:    
  • Project Team and Disclosures

    The following individuals contributed their valuable time and expertise in this project:

    Workgroup Members

    • Sina Gallo, PhD, MSc, RD, Chair
      Assistant Professor, George Mason University, Fairfax, VA, USA
    • Rubina Hakeem, PhD, RD, FAND, FAFN
      Professor, Raana Liaqat Ali Khan Government College of Home Economics, Karachi, Pakistan
    • Barbara Stahnke, MEd, RD, LD
      WIC Advisory Team Manager, Georgia Department of Public Health/Georgia WIC, Tucker, GA, USA
    • Irma Gutierrez, RDN, LD (resigned May 2016)
    • Rima Itani Al-Nimr, MS, RDN, LD
      Clinical Instructor in Medicine/Direction of Nutrition in Medical Education Program, Dartmouth Geisel School of Medicine, Hanover, NH, USA
    • Julie M. Moreschi, MS, RDN, LDN
      Dietetic Internship Director, Benedictine University, Lisle, IL, USA
    • Joann M. McDermid, M Sc, DipEpidBiostat,PhD, MS, RDN (joined September 2016)
      Assistant Professor, School of Medicine, University of Virginia, Charlottesville, VA, USA
    • Maria A. Pari-Keener, MS, RD, CDN (joined April 2016)
      Clinical Dietitian, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY USA

    Project Manager/Lead Analyst

    • Feon Cheng, PhD, MPH, RDN, CHTS-CP (starting October 2016)
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL
    • Constantina Papoutsakis, PhD, RD (October 2015-December 2016)
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL
    • Deepa Handu, PhD, RD (June 2015-October 2015)
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL
    • Taylor Wolfram, MS, RDN, LDN (through May 2015
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL

    Evidence Analysts

    • Katherine Bower, PhD, MPH, RDN
      Atlanta, GA, USA
    • Lyanne Chin, PhD candidate, RDN
      Madison, WI, USA
    • Heidi Gunderson, MS, RD, LD, CDE
      St. Paul, MN, USA
    • Amy Huang, MPH
      Basel, Switzerland
    • Lexi MacMillan Uribe, MS, RD
      Madison, WI, USA
    • Jessica G. Redmond, PhD, RD
      Minoa, NY, USA
    • Jessica West, MS, RD
      Bend, OR, USA


    • Deepa Handu, PhD, RD
      Senior Scientist , Academy of Nutrition and Dietetics, Chicago, IL, USA

    Financial Contributors

    • Women’s Health Dietetic Practice Group
    • Academy of Nutrition and Dietetics

    Disclosures of Potential Conflicts of Interest
    In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts interest by completing the Academy Conflict of Interest form. It should not be assumed that these financial interests will have adverse impact on the content but they are noted here to fully inform readers.

    • Hakeem R: Principal investigator on research project on the genomic and lifestyle predictors of fetal outcome relevant to diabetes and obesity and their relevance to prevent strategies in South Asia.
    • McDermid J: recipient of a Bill and Melinda Gates Foundation Grant on Early Life Interventions for Childhood Growth and Development in Tanzania
    • Pari-Keener M: past chair (2013) of the Women’s Health DPG