A Synergistic Process Approach to the Study of Prenatal Malnutrition

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Abstract
The multifactorial relationship between nutrition and other intrauterine influences seems to exert a combined effect on birthweight, particularly during the third trimester. Full-term infants who may have suffered fetal malnutrition, as indicated by the weight for-length ratio of the ponderal index, were compared with full weight controls on the Brazelton Neonatal Behavioral Assessment Scale and on acoustic features of the infant's pain cry. The underweight infants showed poorer performance than the controls on the four Brazelton scale dimension scores of social interaction, motor processes, organization of state, and physiological organization. The cry of the underweight infants had a shorter fist cry length, longer expiratory period, fewer harmonics, and a higher fundamental frequency than the full weight infants. It was suggested that the Brazelton scale and cry analysis may be useful in the assessment of pediatrically healthy infants who may be at risk. A synergistic model was proposed in which nutritional effects are viewed within the obstetric and reproductive history of the mother and the broader sociocultural environment of the family. The infant at risk becomes part of a feedback system in which he affects and is affected by the caregiving environment.