In 1977, Jose Villar, a master’s student who just finished medical residency, joined a group of inquisitive scientists working in Guatemala to prevent diseases related to poor maternal nutrition and impaired fetal growth.
As budding experts on the links between maternal nutrition and infant health—including infants’ development and lifelong trajectory—they appreciated that maternal diet was involved in several pregnancy outcomes.
From this, a hypothesis developed: pregnant women low in calcium intake had a higher risk of preeclampsia and preterm birth. Dr. Villar and a colleague published the first scientific paper on the topic in 1980.
Along with colleagues, Dr. Villar conducted epidemiological research that found that despite being poor, Guatemalan women in rural areas were eating corn rich in calcium due to the presence of the mineral lime to soften the corn. Women in urban populations, meanwhile, were abandoning traditionally prepared corn-based diets (as were urban women in other countries). Thus, differences in calcium intake could account for the discrepancy in expected pregnancy complications across populations.
More than 25 years later, and after covering a wide range of pregnancy and newborn nutrition related issues as the Coordinator of Maternal and Perinatal Health at the World Health Organization (WHO) headquarters in Geneva, Dr. Villar conducted a historic trial on calcium in pregnancy.
In 2006, he and colleagues around the world published the landmark Randomized Controlled Trial (RCT) that led the WHO to recommend calcium supplementation for pregnant women deficient in the mineral.
And this past February, Dr. Villar won the 2024 March of Dimes Agnes Higgins Award in Maternal-Fetal Nutrition for all his work in the maternal-fetal nutrition field.
“[My colleagues and I] look at a woman’s pregnancy and what happens to her through a social, economic, and cultural lens, and work toward equities that allow all moms to have the opportunity to achieve nutritional goals that set babies up for lifelong success,” he said about his research and being recognized with the Agnes Higgins award.
“That is the challenge ahead, and I couldn’t be prouder to continue it alongside March of Dimes.”
Dr. Villar’s WHO paper on calcium published just as he was capping 17 prolific years at the WHO. Following his time there, he joined the University of Oxford, where he’s currently Professor of Perinatal Medicine at the university’s Nuffield Department of Women’s & Reproductive Health and Director Emeritus of the Oxford Maternal and Perinatal Health Institute at Green Templeton College.
And it was there, in 2014, that he published the most ambitious and influential work of his career: the first set of international standards for fetal growth, newborn size and body composition, and postnatal growth of preterm infants.
These standards, which are being widely adopted around the world, also included maternal weight gain, fundal height, and hemoglobin benchmarks during pregnancy, as well as neurodevelopmental assessments of children at two years old.
The standards represent a universal blueprint for healthy growth and development from early gestation to age two. They demonstrate that maternal nutrition, health status, diet, and environmental exposures largely dictate whether a fetus or a baby’s growth trajectory leans toward adequate or abnormal directions.
The standards, which at birth consist of head circumference, weight, and length benchmarks, are being used to replace the conflicting range of references that vary between countries, cities, and even healthcare practices in the same city. The newborn head circumference standard has been endorsed by the WHO and the US Centers for Disease Control and Prevention (CDC), which they used to define microcephaly during the Zika epidemic.
The comprehensive set of standards stem from the INTERGROWTH-21st Project, which Dr. Villar initiated in 2009. The project has involved 60,000 pregnant women and their infants, and has, to date, resulted in 149 scientific papers. It continues to produce valuable insights regarding normal and impaired fetal and infant growth.
Dr. Villar’s almost 50 years of research on the effect of maternal nutrition on the health, growth, and development of babies has also strengthened scientific understanding of the importance of breast milk as the basic feeding regimen for preterm infants.
Specifically, his work shows how reliably breast milk delivers the nutritional needs of uncomplicated preterm infants from birth. It also further establishes the importance of breast milk in helping preterm babies meet developmental benchmarks, prevent unnecessary weight gain, and potentially ward off obesity later in life.
Plus, his work shows that 20-25 weeks gestation represents a critical period of human development, during which observable changes occur to the fetal abdomen and head as a result of maternal nutrition, and persist into early childhood. That project, led by Dr. Villar, also resulted in the first digital atlas describing the normal maturation of the fetal brain, published in Nature in 2023.
“It's difficult to overstate the value of Dr. Villar’s contributions to maternal and infant nutrition and its impact on early development,” said Dr. Emre Self, Chief Scientific Advisor at March of Dimes.
“Dr. Villar deeply cares about moms and babies and is a heartfelt advocate for creating health equities that give pregnant women choice and allow them to make the diet, nutrition, and lifestyle choices that will benefit their babies for years to come.”