Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years

Context

The aim of this guideline is to improve nutrition during pregnancy and in babies and children under 5. The recommendations focus on supporting best practice on how to improve uptake of existing advice on nutrition in pregnancy and in early childhood.

Nutritional status, weight and health behaviours during pregnancy can have a significant impact on the short- and long-term health of the pregnant person and the growth and development of the baby, which in turn can have effects on the long-term health of the child. Among other things, social determinants of health, including poverty and food insecurity play a role in this. According to the National Maternal and Perinatal Audit (NMPA), more than half (54%) of pregnant people in England in 2018 to 2019 had a body mass index (BMI) outside the healthy weight category (18.5 to 24.9 kg/m²) at the booking appointment. The data shows that those living in the most deprived areas are more likely to have a BMI that is within the underweight or obesity weight categories.

It is estimated that up to 45% of pregnancies in the UK are unplanned or associated with feelings of ambivalence, which can have an impact on poor preconception health, including low uptake of preconception folic acid supplements. According to an analysis of national maternity services data from 2018 to 2019, just over a quarter of people take folic acid before pregnancy, with the lowest uptake observed among people living in the most deprived areas and those of minority ethnic background. This guideline includes recommendations on improving uptake of folic acid and other vitamin supplementation around pregnancy as well as guidance around healthy eating, physical activity and weight management during pregnancy.

The reports by the Scientific Advisory Committee on Nutrition (SACN) on feeding in the first year of life and feeding young children aged 1 to 5 years make recommendations on many areas of public health nutrition for children, but there are still areas of variation regarding implementation and uptake of advice. For example, exclusive breastfeeding is recommended for the first 6 months of age, with continued breastfeeding alongside solid foods for the first 1 to 2 years of life. However, according to the Office for Health Improvement and Disparities' report on breastfeeding at 6 to 8 weeks, in 2020 to 2021 in England, the rate of exclusive breastfeeding at 6 to 8 weeks was only 36.5%, and the rate of partial breastfeeding was 17.7%. Over time, breastfeeding rates drop even more. Again, there is a social gradient, with the lowest breastfeeding rates found among those living in the most deprived areas. There are also differences in breastfeeding rates according to ethnicity and age, with white or young mothers or parents having the lowest, and black or older mothers or parents having the highest breastfeeding rates. NICE's guideline on postnatal care includes recommendations on baby feeding that cover the antenatal period as well as the first 8 weeks after the birth. This guideline follows on by providing guidance on support for babies' feeding beyond the first 8 weeks after birth. This guideline also covers recommendations on vitamin supplements for children, introducing solid foods, and healthy eating in children up to 5 years.