twice as prevalent among low-income women in their reproductive years, in comparison with those who are more advantaged (Looker et al., 1997), but the three tests required to determine iron deficiency are not a routine part of health care or of WIC services.
In addition, mounting evidence indicates that practices during pregnancy may have a long-term impact on health. For example, periconceptional intake of folic acid is important not only in the prevention of central nervous system and other birth defects but also in reducing the risk of cancer and other chronic disease in later life (Toren et al., 1996). Likewise, increasing maternal intake of omega-3 fatty acids is associated with increased gestation duration (Allen and Harris, 2001), improved fetal neurological development (Innis, 2000), and lowered maternal cardiovascular risk (Mori and Beilin, 2001).
Little attention has been paid to maternal nutrition after pregnancy, particularly among women who are not lactating, possibly because they have had a low priority for receipt of WIC services. Two studies were identified that address postpartum, nonlactating women. Caan and colleagues (1987) examined the influence of extended maternal food supplementation (5–7 months) in the interpregnancy interval compared with more limited supplementation (0–2 months). All women received WIC benefits during both the index and subsequent pregnancies. In comparison to those with limited feeding, women with extended supplementation had significantly improved outcomes in the subsequent pregnancy: birth length was increased by 0.3 cm and birth weight was 120 g higher after controlling for gestational duration and other potential confounding variables (e.g., maternal smoking and the birth weight of the prior infant). Maternal iron status was improved—hemoglobin levels were increased significantly, on average by 0.3 mg/dL with extended feeding. In addition, risk of maternal overweight and obesity (defined as > 120 percent of ideal weight in this study) was reduced twofold among women on extended supplementation (Caan et al., 1987). Pehrsson and coworkers (2001) examined three indicators of iron status among postpartum, nonlactating participants and eligible nonparticipants (women unserved because of lack of funds). Women who participated in WIC for the full 6 months were significantly less likely to become anemic than were the eligible nonparticipants.
The years prior to age 5 are a time of rapid growth and development. The results of a shortfall during the first 4 years of life can be very serious, including both stunted physical growth and cognitive deficits. Compared with children