Maternal energy depletion is buffered among malnourished women in Punjab, Pakistan

Women's nutritional status is believed to deteriorate with increasing reproductive stress (so-called maternal depletion). To evaluate this phenomenon, a new theoretical framework has been suggested that incorporates the concepts of a full reproductive cycle, relative lengths of potential depletion and repletion phases, and initial plane of nutrition. We developed the corresponding statistical model and tested predictions provided by the framework about the effect of reproductive pattern on maternal overall weight change (deltaW) during one reproductive cycle. Seventy-six Pakistani women were classified as well-nourished, marginally nourished or malnourished. The relationship between deltaW and length of all phases of the reproductive cycle, each of which is characterized by varying degrees of reproductive stress, was evaluated with multiple regression analysis. Across the reproductive cycle, well-nourished women had a slight weight increase. Surprisingly, malnourished women gained weight in contrast to marginally nourished women. Also surprisingly, for the latter two groups, periods of moderate reproductive stress were associated with weight loss but periods of high reproductive stress were associated with weight gain. Mechanisms such as efficiency and nutrient partitioning are discussed.