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Dewey KG, Wessells KR, Arnold CD, Adu-Afarwuah S, Arnold BF, Ashorn P, Ashorn U, Garcés A, Huybregts L, Krebs NF, Lartey A, Leroy JL, Maleta K, Matias SL, Moore SE, Mridha MK, Okronipa H, Stewart CP. Effects of prenatal small-quantity lipid-based nutrient supplements on pregnancy, birth, and infant outcomes: a systematic review and meta-analysis of individual participant data from randomized controlled trials in low- and middle-income countries. Am J Clin Nutr 2024; 120:814-835. [PMID: 39154665 DOI: 10.1016/j.ajcnut.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Undernutrition during pregnancy increases the risk of giving birth to a small vulnerable newborn. Small-quantity lipid-based nutrient supplements (SQ-LNSs) contain both macro- and micronutrients and can help prevent multiple nutritional deficiencies. OBJECTIVES We examined the effects of SQ-LNSs provided during pregnancy compared with 1) iron and folic acid or standard of care (IFA/SOC) or 2) multiple micronutrient supplements (MMSs) and identified characteristics that modified the estimates of effects of SQ-LNSs on birth outcomes. METHODS We conducted a 2-stage meta-analysis of individual participant data from 4 randomized controlled trials of SQ-LNSs provided during pregnancy (n = 5273). We generated study-specific and subgroup estimates of SQ-LNS compared with IFA/SOC or MMS and pooled the estimates. In sensitivity analyses, we examined whether the results differed depending on methods for gestational age dating, birth anthropometry, or study design. RESULTS SQ-LNSs (compared with IFA/SOC) increased birth weight [mean difference: +49 g; 95% confidence interval (CI): 26, 71 g] and all birth anthropometric z-scores (+0.10-0.13 standard deviation); they reduced risk of low birth weight by 11%, newborn stunting by 17%, newborn wasting by 11%, and small head size by 15%. Only 2 trials compared SQ-LNSs and MMSs; P values for birth outcomes were >0.10 except for head circumference (e.g., z-score for gestational age: +0.11; 95% CI: -0.01, 0.23). Effect estimates for SQ-LNSs compared with IFA/SOC were greater among female infants and, for certain outcomes, among mothers with body mass index <20 kg/m2, inflammation, malaria, or household food insecurity. Effect estimates for SQ-LNSs compared with MMSs were greater for certain outcomes among female infants, first-born infants, and mothers <25 y. CONCLUSIONS SQ-LNSs had positive impacts on multiple outcomes compared to IFA/SOC, but further research directly comparing SQ-LNSs and MMSs is needed. Targeting SQ-LNSs to vulnerable subgroups may be worth considering. CLINICAL TRIAL REGISTRY This study was registered at PROSPERO as CRD42021283391.
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Affiliation(s)
- Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, United States.
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ana Garcés
- Proyecto Salud y Nutrición, Jhpiego, Guatemala City, Guatemala
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States
| | - Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, United States
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States
| | - Kenneth Maleta
- Department of Nutrition and Dietetics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, United States
| | - Sophie E Moore
- Department of Women & Children's Health, King's College London, London, UK and MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh
| | - Harriet Okronipa
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States
| | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, United States
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Thorne‐Lyman AL, Kalbarczyk A, Tumilowicz A, Christian P, Afsana K. Using formative research to enhance our understanding of implementation contexts: Preparing for a trial of maternal nutrition interventions. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 6:e13639. [PMID: 39344039 PMCID: PMC11439738 DOI: 10.1111/mcn.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/25/2024] [Indexed: 10/01/2024]
Abstract
Formative research to understand the sociocultural and economic context into which interventions are introduced can help to maximize the uptake of interventions both in the context of effectiveness trials and ultimately for nutrition programs. Findings from the formative research study were used to inform different facets of the design of the effectiveness trial including providing evidence of the acceptability of the product, informing the decision to deliver the product to women's homes, and developing strategies to support adherence.
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Affiliation(s)
- Andrew L. Thorne‐Lyman
- Department of International Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Anna Kalbarczyk
- Department of International Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Alison Tumilowicz
- Maternal, Newborn, and Child Health, Bill & Melinda Gates FoundationSeattleWashingtonUSA
| | - Parul Christian
- Department of International Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Kaosar Afsana
- Humanitarian Hub, James P. Grant School of Public HealthBRAC UniversityDhakaBangladesh
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Zavala E, Rahman A, Kalbarczyk A, de Boer M, Khaled N, Chakraborty B, Rahman H, Ali H, Haque R, Ayesha K, Siddiqua TJ, Afsana K, Christian P, Thorne‐Lyman AL. Acceptability of a balanced energy protein (BEP) supplement for pregnant women in Bangladesh. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 6:e13587. [PMID: 37991138 PMCID: PMC11439734 DOI: 10.1111/mcn.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/23/2023]
Abstract
Balanced energy protein (BEP) supplementation in pregnancy is recommended in the context of undernutrition for the reduction of small-for-gestational age neonates and stillbirths. To inform an effectiveness trial, we evaluated the acceptability of a packaged, ready-to-eat fortified BEP product among women of reproductive age and their health care providers (HCPs) in rural Bangladesh and explored the feasibility of adhering to daily supplementation. We implemented a formative study using focus groups discussions with women (n = 29) and HCPs (n = 17) to introduce the product and investigate components of acceptability. A "trials of improved practice" activity was conducted in subset of women (n = 16) to evaluate adherence to BEP over a 2-week period, followed by focus group discussions to identify challenges with adherence and strategies employed. Contributors to BEP acceptability included the product's sensory attributes, such as taste, smell and texture; the attractive packaging and informative labelling; and the perceived benefits of use. Participants also identified household and community level factors influencing the adoption of BEP, such as trust in the provider, cultural beliefs on supplement use in pregnancy, and family member tasting and approval. Over the 2-week period, women consumed over 80% of the supplements provided to them and identified strategies for adherence, including visual aids and reminders from family members or providers. HCPs recommended targeted communication messages for mothers-in-law to foster a supportive home environment. Findings informed changes to the BEP product to improve acceptability and shaped the content of communication messages to optimise adherence in a forthcoming effectiveness trial.
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Affiliation(s)
- Eleonor Zavala
- Department of International HealthBloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Atiya Rahman
- Humanitarian HubJames P. Grant School of Public Health, BRAC UniversityDhakaBangladesh
| | - Anna Kalbarczyk
- Department of International HealthBloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Mary de Boer
- Department of International HealthBloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Nazrana Khaled
- Humanitarian HubJames P. Grant School of Public Health, BRAC UniversityDhakaBangladesh
| | - Barnali Chakraborty
- Humanitarian HubJames P. Grant School of Public Health, BRAC UniversityDhakaBangladesh
| | - Hafizur Rahman
- The JiVitA Maternal and Child Health and Nutrition Research ProjectRangpurBangladesh
| | - Hasmot Ali
- The JiVitA Maternal and Child Health and Nutrition Research ProjectRangpurBangladesh
| | - Rezwanul Haque
- The JiVitA Maternal and Child Health and Nutrition Research ProjectRangpurBangladesh
| | - Kaniz Ayesha
- The JiVitA Maternal and Child Health and Nutrition Research ProjectRangpurBangladesh
| | - Towfida J. Siddiqua
- Department of International HealthBloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMarylandUSA
- The JiVitA Maternal and Child Health and Nutrition Research ProjectRangpurBangladesh
| | - Kaosar Afsana
- Humanitarian HubJames P. Grant School of Public Health, BRAC UniversityDhakaBangladesh
| | - Parul Christian
- Department of International HealthBloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Andrew L. Thorne‐Lyman
- Department of International HealthBloomberg School of Public Health, Johns Hopkins UniversityBaltimoreMarylandUSA
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Morris RK, Johnstone E, Lees C, Morton V, Smith G. Investigation and Care of a Small-for-Gestational-Age Fetus and a Growth Restricted Fetus (Green-top Guideline No. 31). BJOG 2024; 131:e31-e80. [PMID: 38740546 DOI: 10.1111/1471-0528.17814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Key recommendations
All women should be assessed at booking (by 14 weeks) for risk factors for fetal growth restriction (FGR) to identify those who require increased surveillance using an agreed pathway [Grade GPP]. Findings at the midtrimester anomaly scan should be incorporated into the fetal growth risk assessment and the risk assessment updated throughout pregnancy. [Grade GPP]
Reduce smoking in pregnancy by identifying women who smoke with the assistance of carbon monoxide (CO) testing and ensuring in‐house treatment from a trained tobacco dependence advisor is offered to all pregnant women who smoke, using an opt‐out referral process. [Grade GPP]
Women at risk of pre‐eclampsia and/or placental dysfunction should take aspirin 150 mg once daily at night from 12+0–36+0 weeks of pregnancy to reduce their chance of small‐for‐gestational‐age (SGA) and FGR. [Grade A]
Uterine artery Dopplers should be carried out between 18+0 and 23+6 weeks for women at high risk of fetal growth disorders [Grade B]. In a woman with normal uterine artery Doppler and normal fetal biometry at the midtrimester scan, serial ultrasound scans for fetal biometry can commence at 32 weeks. Women with an abnormal uterine artery Doppler (mean pulsatility index > 95th centile) should commence ultrasound scans at 24+0–28+6 weeks based on individual history. [Grade B]
Women who are at low risk of FGR should have serial measurement of symphysis fundal height (SFH) at each antenatal appointment after 24+0 weeks of pregnancy (no more frequently than every 2 weeks). The first measurement should be carried out by 28+6 weeks. [Grade C]
Women in the moderate risk category are at risk of late onset FGR so require serial ultrasound scan assessment of fetal growth commencing at 32+0 weeks. For the majority of women, a scan interval of four weeks until birth is appropriate. [Grade B]
Maternity providers should ensure that they clearly identify the reference charts to plot SFH, individual biometry and estimated fetal weight (EFW) measurements to calculate centiles. For individual biometry measurements the method used for measurement should be the same as those used in the development of the individual biometry and fetal growth chart [Grade GPP]. For EFW the Hadlock three parameter model should be used. [Grade C]
Maternity providers should ensure that they have guidance that promotes the use of standard planes of acquisition and calliper placement when performing ultrasound scanning for fetal growth assessment. Quality control of images and measurements should be undertaken. [Grade C]
Ultrasound biometry should be carried out every 2 weeks in fetuses identified to be SGA [Grade C]. Umbilical artery Doppler is the primary surveillance tool and should be carried out at the point of diagnosis of SGA and during follow‐up as a minimum every 2 weeks. [Grade B]
In fetuses with an EFW between the 3rd and 10th centile, other features must be present for birth to be recommended prior to 39+0 weeks, either maternal (maternal medical conditions or concerns regarding fetal movements) or fetal compromise (a diagnosis of FGR based on Doppler assessment, fetal growth velocity or a concern on cardiotocography [CTG]) [Grade C]. For fetuses with an EFW or abdominal circumference less than the 10th centile where FGR has been excluded, birth or the initiation of induction of labour should be considered at 39+0 weeks after discussion with the woman and her partner/family/support network. Birth should occur by 39+6 weeks. [Grade B]
Pregnancies with early FGR (prior to 32+0 weeks) should be monitored and managed with input from tertiary level units with the highest level neonatal care. Care should be multidisciplinary by neonatology and obstetricians with fetal medicine expertise, particularly when extremely preterm (before 28 weeks) [Grade GPP]. Fetal biometry in FGR should be repeated every 2 weeks [Grade B]. Assessment of fetal wellbeing can include multiple modalities but must include computerised CTG and/or ductus venous. [Grade B]
In pregnancies with late FGR, birth should be initiated from 37+0 weeks to be completed by 37+6 weeks [Grade A]. Decisions for birth should be based on fetal wellbeing assessments or maternal indication. [Grade GPP]
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Nazzaro G, Saccone G, Miranda M, Ammendola A, Buonomo G, Neola D, Bartolini G, Locci M. Cervical elastography using E-Cervix™ for prediction of preterm birth in twin pregnancies with threatened preterm labor. Eur J Obstet Gynecol Reprod Biol 2024; 298:104-107. [PMID: 38739982 DOI: 10.1016/j.ejogrb.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/16/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE To evaluate the prediction performance of E-Cervix™ for preterm birth in twin pregnancies with threatened preterm labor. METHODS This was a single-center retrospective cohort study of twin pregnancies presenting to obstetrics triage for threatened preterm labor (PTL) between 23 0/7 - 33 6/7 weeks who received screening for PTL with transvaginal ultrasound cervical length (TVU CL) and cervical elastography with E-Cervix™ at the time of triage. Cervical elastography parameters were examined and compared between women who delivered preterm and those who did not. The quantification of cervical strain was calculated by a data analysis system that directly analyzes raw data from the region of interest (ROI) and described as hardness ratio (HR), mean strain level within 1 cm from internal (IOS) and external (EOS) os. RESULTS 63 twin gestations without prior preterm birth and with threatened PTL between 23 0/7 - 33 6/7 weeks of gestation were included in the study. 27 (42.9 %) had cervical length < 25 mm, and were admitted for true PLT. Out of the 36 women with cervical length ≥ 25 mm, 6 (16.7 %) were admitted. Women with threatened PTL had significantly higher HR compared to those with true PTL (p < 0.01), and significantly lower IOS and EOS. Women who delivered preterm had significantly higher HR compared to those who did not delivery preterm and significantly lower IOS and EOS, in overall cohort, and in the subset of women with true PTL. Incidences of HR < 50 % and < 35 % were statistically significantly higher in women who delivered preterm compared to those who did not (p < 0.01). CONCLUSION Cervical elastography with E-Cervix™ may be useful for assessment of twin gestations presenting to obstetrics triage for threatened PTL.
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Affiliation(s)
- Giovanni Nazzaro
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Marilena Miranda
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Alessandra Ammendola
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giorgia Buonomo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Daniele Neola
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giorgia Bartolini
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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McDonald CM, Wessells KR, Stewart CP, Dewey KG, de Pee S, Rana R, Hafeez-Ur-Rehman H, Mwangi MN, Hess SY. Perinatal intervention strategies providing food with micronutrients to pregnant and breastfeeding women in low- and middle-income countries: A scoping review. MATERNAL & CHILD NUTRITION 2024:e13681. [PMID: 38949186 DOI: 10.1111/mcn.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/03/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
In resource-constrained settings, pregnant and breastfeeding women and girls (PBW/G) are particularly vulnerable to undernutrition. Micronutrient-fortified balanced energy protein (BEP) supplementation may be provided to boost maternal nutritional status and improve birth and infant outcomes. We conducted a scoping review of the published literature to determine the impact of BEP and other related nutrition interventions that provided fortified food or cash along with a minimum of 3 micronutrients on maternal, birth, and infant/child outcomes in low- and middle-income countries. We conducted a PubMed search using pre-defined keywords and controlled vocabulary search terms. All titles and abstracts were reviewed for eligibility by two independent reviewers, and data were extracted according to outcome type. We identified 149 eligible research articles that reported on a total of 21 trials and/or programme evaluations which assessed the health impact of one or more products (fortified lipid-based nutrient supplement [LNS, n = 12], fortified blended flours [n = 5], milk-based beverages [n = 2], and local food/snacks [n = 3]) that provided 118-750 kcal/day and varying levels of protein and micronutrients. Only one of these programme evaluations assessed the impact of the provision of cash and fortified food. Effects on maternal outcomes such as gestational weight gain and duration of gestation were promising but inconsistent. Birth outcomes were reported in 15 studies, and the effects on birthweight and birth length were generally positive. Seven studies demonstrated sustained benefits on infant and child growth out of the 15 studies that reported at least one of these outcomes, although data were sparse. Additional research is needed to investigate issues of dose, cost-effectiveness, and incorporation into multi-component interventions.
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Affiliation(s)
- Christine M McDonald
- Departments of Pediatrics, and Epidemiology & Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Saskia de Pee
- Nutrition Division, World Food Programme HQ, Rome, Italy
| | - Ritu Rana
- Nutrition Division, World Food Programme HQ, Rome, Italy
| | | | | | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
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Eglovitch M, Abate FW, Shifraw T, Shiferie F, Amanuel H, Tadesse AW, Worku A, Isanaka S, Berhane Y, Lee ACC. Balanced Energy Protein Supplementation in Pregnancy: Adherence and Acceptability among Pregnant Women in Rural Ethiopia. Curr Dev Nutr 2024; 8:103796. [PMID: 39055242 PMCID: PMC11269774 DOI: 10.1016/j.cdnut.2024.103796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 07/27/2024] Open
Abstract
Background Balanced energy protein (BEP) supplementation in pregnant women in low-and middle-income countries may reduce the risk of stillbirth and low birth weight. Objectives The objective of this study was to assess the adherence to and acceptability of a corn-soy blend (CSB) BEP product among pregnant women in rural Ethiopia. Methods This formative study was conducted from October to November 2018 among pregnant women in the rural Amhara region of Ethiopia prior to initiation of a clinical effectiveness study (ISRCTN: 15116516). We assessed adherence and acceptability of a micronutrient-fortified CSB BEP supplement among 40 pregnant women during a 4-wk utilization period. Acceptability was assessed using a 7-point Likert-style scale about the hedonic characteristics of the BEP product at 2 wk and 4 wk. Adherence was assessed by weekly monitoring and empty sachet counts for BEP consumption over 4 wk. Results Adherence to the BEP was, on average, 89% over the month-long pilot. The BEP product was rated favorably (mean Likert score >6 of 7) for the following domains: color, taste, odor, and likeability at mid and endpoints. Women found the product convenient to eat [mean (standard deviation [SD] = 5.9 (1.0))] and filling (mean (SD) = 6.1 (1.5) out of 7). Scores on acceptability and perception of the product remained stable throughout the duration of use. A majority of women (63%) reported consuming the BEP as a snack to supplement meals and splitting the serving over 2 or more sessions (68%). A quarter of respondents reported sharing the supplement with family members. Conclusions Adherence and acceptability of the CSB BEP product were high among this population in rural Amhara, Ethiopia. This formative data was important to select the final product and shape the counseling and delivery of BEP in the parent study.
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Affiliation(s)
- Michelle Eglovitch
- Brigham and Women’s Hospital, Boston, MA, United States
- Virginia Commonwealth University, Richmond, VA, United States
| | | | - Tigest Shifraw
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Fisseha Shiferie
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | | | - Amare Worku Tadesse
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Sheila Isanaka
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Anne CC Lee
- Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Bai X, Zhou Z, Zheng Z, Li Y, Liu K, Zheng Y, Yang H, Zhu H, Chen S, Pan H. Development and evaluation of machine learning models for predicting large-for-gestational-age newborns in women exposed to radiation prior to pregnancy. BMC Med Inform Decis Mak 2024; 24:174. [PMID: 38902714 PMCID: PMC11188254 DOI: 10.1186/s12911-024-02556-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION The correlation between radiation exposure before pregnancy and abnormal birth weight has been previously proven. However, for large-for-gestational-age (LGA) babies in women exposed to radiation before becoming pregnant, there is no prediction model yet. MATERIAL AND METHODS The data were collected from the National Free Preconception Health Examination Project in China. A sum of 455 neonates (42 SGA births and 423 non-LGA births) were included. A training set (n = 319) and a test set (n = 136) were created from the dataset at random. To develop prediction models for LGA neonates, conventional logistic regression (LR) method and six machine learning methods were used in this study. Recursive feature elimination approach was performed by choosing 10 features which made a big contribution to the prediction models. And the Shapley Additive Explanation model was applied to interpret the most important characteristics that affected forecast outputs. RESULTS The random forest (RF) model had the highest average area under the receiver-operating-characteristic curve (AUC) for predicting LGA in the test set (0.843, 95% confidence interval [CI]: 0.714-0.974). Except for the logistic regression model (AUC: 0.603, 95%CI: 0.440-0.767), other models' AUCs displayed well. Thereinto, the RF algorithm's final prediction model using 10 characteristics achieved an average AUC of 0.821 (95% CI: 0.693-0.949). CONCLUSION The prediction model based on machine learning might be a promising tool for the prenatal prediction of LGA births in women with radiation exposure before pregnancy.
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Affiliation(s)
- Xi Bai
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Department of Endocrinology, Ministry of Education, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Zhibo Zhou
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Zeyan Zheng
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yansheng Li
- DHC Mediway Technology CO., Ltd, Beijing, China
| | - Kejia Liu
- DHC Mediway Technology CO., Ltd, Beijing, China
| | | | - Hongbo Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Shi Chen
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
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Zavala E, Mohan D, Ali H, Siddiqua TJ, Haque R, Ayesha K, Ahsan KB, Sujan HM, Khaled N, Rahman A, Chakraborty B, Dyer B, Wu LSF, Kalbarczyk A, Erchick DJ, Thorne-Lyman AL, Tumilowicz A, Afsana K, Christian P. Targeting strategies for balanced energy and protein (BEP) supplementation in pregnancy: study protocol for the TARGET-BEP cluster-randomized controlled trial in rural Bangladesh. Trials 2024; 25:315. [PMID: 38741174 DOI: 10.1186/s13063-024-08135-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends balanced energy and protein (BEP) supplementation be provided to all pregnant women living in undernourished populations, usually defined as having a prevalence > 20% of underweight women, to reduce the risk of stillbirths and small-for-gestational-age neonates. Few geographies meet this threshold, however, and a large proportion of undernourished women and those with inadequate gestational weight gain could miss benefiting from BEP. This study compares the effectiveness of individual targeting approaches for supplementation with micronutrient-fortified BEP vs. multiple micronutrient supplements (MMS) alone as control in pregnancy in improving birth outcomes. METHODS The TARGET-BEP study is a four-arm, cluster-randomized controlled trial conducted in rural northwestern Bangladesh. Eligible participants are married women aged 15-35 years old identified early in pregnancy using a community-wide, monthly, urine-test-based pregnancy detection system. Beginning at 12-14 weeks of gestation, women in the study area comprising 240 predefined sectors are randomly assigned to one of four intervention arms, with sector serving as the unit of randomization. The interventions involving daily supplementation through end of pregnancy are as follows: (1) MMS (control); (2) BEP; (3) targeted BEP for those with pre-pregnancy body mass index (BMI) < 18.5 kg/m2 and MMS for others; (4) targeted BEP for those with pre-pregnancy BMI < 18.5 kg/m2, MMS for others, and women with inadequate gestational weight gain switched from MMS to BEP until the end of pregnancy. Primary outcomes include birth weight, low birth weight (< 2500 g), and small for gestational age, defined using the 10th percentile of the INTERGROWTH-21st reference, for live-born infants measured within 72 h of birth. Project-hired local female staff visit pregnant women monthly to deliver the assigned supplements, monitor adherence biweekly, and assess weight regularly during pregnancy. Trained data collectors conduct pregnancy outcome assessment and measure newborn anthropometry in the facility or home depending on the place of birth. DISCUSSION This study will assess the effectiveness of targeted balanced energy and protein supplementation to improve birth outcomes among pregnant women in rural Bangladesh and similar settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05576207. Registered on October 5th, 2022.
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Affiliation(s)
- Eleonor Zavala
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Diwakar Mohan
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | | | | | | | | | - Nazrana Khaled
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Atiya Rahman
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Brian Dyer
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Lee S F Wu
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Anna Kalbarczyk
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Daniel J Erchick
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Andrew L Thorne-Lyman
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Kaosar Afsana
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
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Wang D, Shifraw T, Costa JC, Abdelmenan S, Tsegaye S, Berhane Y, Gulema H, Berhane H, Fasil N, Workneh F, Tarekegn W, Wang M, Menzies NA, Worku A, Berhane Y, Fawzi WW. Targeting strategies of antenatal balanced energy and protein supplementation in Addis Ababa, Ethiopia: study protocol for a randomized effectiveness study. Trials 2024; 25:291. [PMID: 38689304 PMCID: PMC11059725 DOI: 10.1186/s13063-024-08002-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Antenatal balanced energy and protein (BEP) supplements have well-documented benefits for pregnancy outcomes. However, considerable practical gaps remain in the effective and cost-effective delivery of antenatal BEP supplements at scale in low- and middle-income countries. METHODS A randomized effectiveness study will be conducted in two sub-cities of Addis Ababa, Ethiopia, to evaluate the effectiveness, cost-effectiveness, and implementation of different targeting strategies of antenatal BEP supplements. Pregnant women aged 18 to 49, with a gestational age of 24 weeks or less, and attending antenatal visits in one of the nine study health facilities are eligible for enrollment. In six of the health facilities, participants will be randomized to one of three study arms: control (Arm 1), targeted BEP provision based on baseline nutritional status (Arm 2), and targeted BEP supplementation based on baseline nutritional status and monthly gestational weight gain (GWG) monitoring (Arm 3). In the remaining three facilities, participants will be assigned to universal BEP provision (Arm 4). Participants in Arms 2 and 3 will receive BEP supplements if they have undernutrition at enrollment, as defined by a baseline body mass index less than 18.5 kg/m2 or mid-upper arm circumference less than 23 cm. In Arm 3, in addition to targeting based on baseline undernutrition, regular weight measurements will be used to identify insufficient GWG and inform the initiation of additional BEP supplements. Participants in Arm 4 will receive BEP supplements until the end of pregnancy, regardless of baseline nutritional status or GWG. All participants will receive standard antenatal care, including iron and folic acid supplementation. A total of 5400 pregnant women will be enrolled, with 1350 participants in each arm. Participants will be followed up monthly during their visits to the antenatal facilities until delivery. Maternal and infant health status will be evaluated within 72 h after delivery and at 6 weeks postpartum. The effectiveness and cost-effectiveness of the different BEP targeting strategies in preventing adverse pregnancy outcomes will be compared across arms. Qualitative data will be analyzed to assess the feasibility, acceptability, and implementation of different supplementation strategies. DISCUSSION This study will inform global recommendations and operational guidelines for the effective and cost-effective delivery of antenatal BEP supplements. The targeted approaches have the potential for broader scale-up in Ethiopia and other low-resource settings with a high burden of undernutrition among pregnant women. TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT06125860. Registered November 9, 2023.
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Affiliation(s)
- Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 1, Room 1108, Boston, MA, 02115, USA
| | - Tigest Shifraw
- Department of Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Janaina Calu Costa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 1, Room 1108, Boston, MA, 02115, USA
| | - Semira Abdelmenan
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Sitota Tsegaye
- Department of Nutrition and Behavioral Sciences, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Yoseph Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Hanna Gulema
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Hanna Berhane
- Department of Nutrition and Behavioral Sciences, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Nebiyou Fasil
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Firehiwot Workneh
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Workagegnhu Tarekegn
- Department of Nutrition and Behavioral Sciences, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 1, Room 1108, Boston, MA, 02115, USA
| | - Alemayehu Worku
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Department of Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 1, Room 1108, Boston, MA, 02115, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
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Xu J, Tang Y, Peng B, Zhang WH, Wang X. Effect of low-molecular-weight heparin on placenta-mediated fetal growth restriction in a tertiary referral hospital: A 7-year retrospective cohort study. Int J Gynaecol Obstet 2024; 165:220-228. [PMID: 37726961 DOI: 10.1002/ijgo.15098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To investigate the effect of low-molecular-weight heparin (LMWH) on placenta-mediated fetal growth restriction (FGR). METHODS A cohort of 570 pregnant women diagnosed with placenta-mediated FGR were enrolled from January 1, 2015 through to December 31, 2021. A birth database, including demographic data, antenatal complications, and detailed delivery and newborn data, was created to collect variables from the Hospital Information System (HIS) Database. The unique personal registration number, assigned to each patient on first registration with HIS in the West China Second University Hospital, was used to link these patients. LMWH use was defined as at least 1-week prescription from diagnosis of placenta-mediated FGR. Pregnant women received LMWH (Enoxaparin 4000 IU/day) by self-administered subcutaneous injection only when they agreed and signed informed consent. Primary outcome was intrauterine fetal death after 20 weeks of pregnancy. Secondary outcomes included preterm birth (PB), Apgar score less than 7 at 1 min, admission to neonatal intensive care unit (NICU), and birth weight. Logistic regression analysis was conducted to compute adjusted odds ratio (aOR) with 95% confidence intervals (CI) for outcomes. RESULTS After controlling for confounders, LMWH use was associated with a decreased risk of intrauterine fetal death (aOR 2.49, 95% CI 1.35-4.57, P = 0.003), PB before 37 weeks of pregnancy (aOR 3.35, 95% CI 2.14-5.23, P < 0.001), PB before 34 weeks of pregnancy (aOR 2.25, 95% CI 1.36-3.74, P = 0.002), Apgar score less than 7 at 1 min (aOR 2.25, 95% CI 1.36-3.74, P = 0.002), NICU admission (aOR 2.29, 95% CI 1.48-3.55, P < 0.001). Using LMWH increased the mean birth weight in PB before 32 weeks of pregnancy (mean ± standard deviation [SD] 1126.4 ± 520.0 g, P = 0.020), PB before 37 weeks of pregnancy (mean ± SD 1563.9 ± 502.7 g, P = 0.019), early-onset FGR (mean ± SD 2125.2 ± 665.7 g, P < 0.001), late-onset FGR (mean ± SD 2343.4 ± 507.9, P < 0.001), and non-severe FGR (mean ± SD 2231.1 ± 607.2 g, P < 0.001). CONCLUSION Use of LMWH can significantly improve the fetal and neonatal outcomes among pregnant women with placenta-mediated FGR, particularly reducing the risk of intrauterine fetal death.
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Affiliation(s)
- Jinfeng Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
- The Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
- International Center for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Yuxin Tang
- Department of Medical Record, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Bing Peng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- The Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Wei-Hong Zhang
- International Center for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- School of Public Health, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- The Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
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Lopes SS, Shi A, Chen L, Li J, Meschke LL. California's Comprehensive Perinatal Services Program and birth outcomes. Front Public Health 2023; 11:1321313. [PMID: 38179565 PMCID: PMC10764413 DOI: 10.3389/fpubh.2023.1321313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction California's Medicaid (Medi-Cal) sponsors Comprehensive Perinatal Services Program (CPSP), a program with enhanced perinatal care for women (more education, nutritional supplements, and psychosocial counseling/support). Past evaluations of CPSP's effectiveness in birth outcomes were limited to pilot programs and yielded mixed results. Methods We used 2012-2016 California's statewide data about singleton live births with any receipt of prenatal care (N = 2,385,811) to examine whether Medi-Cal with CPSP enrollment was associated with lower odds of preterm birth (PTB), spontaneous PTB, and low birthweight (LBW) than non-CPSP births. With three binary variables of PTB, spontaneous PTB, and LBW as the response variables, three multilevel logistic models were used to compare the outcomes of participants enrolled in Medi-Cal with CPSP against those with private insurance, adjusting for maternal factors and county-level covariates. Results Logistic models showed that participants enrolled to Medi-Cal with CPSP [n (%) = 89,009 (3.7)] had lower odds of PTB, spontaneous PTB and LBW, respectively, as compared with those with private insurance [n (%) = 1,133,140 (47.2)]. Within the Medi-Cal sub-population, the CPSP enrollment was associated with lower odds of PTB, SPTB and LBW than Medicaid beneficiaries without CPSP [n (%) = 967,094 (40.3)]. Discussion With statewide data, these findings revealed a robust link between CPSP enrollment and better birth outcomes. Expanding access to comprehensive prenatal services could be an important strategy to improve birth outcomes.
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Affiliation(s)
- Snehal S. Lopes
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Ahan Shi
- D.W. Daniel High School, Central, SC, United States
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jian Li
- Fielding School of Public Health, Environmental Health Sciences Department and the School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Laurie L. Meschke
- Department of Public Health, University of Tennessee, Knoxville, TN, United States
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Tesfaye A, Wondimagegne YA, Tamiru D, Belachew T. Exploring dietary perception, beliefs and practices among pregnant adolescents, their husbands and healthcare providers in West Arsi, Central Ethiopia: a phenomenological study. BMJ Open 2023; 13:e077488. [PMID: 38070937 PMCID: PMC10729068 DOI: 10.1136/bmjopen-2023-077488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The two most physically active stages of life, pregnancy and adolescence, put the pregnant adolescent under a lot of stress. Adolescence is a crucial era in women's nutrition that is frequently overlooked. OBJECTIVE This study aimed to explore dietary perceptions, beliefs and practices among pregnant Adolescents in West Arsi, Central Ethiopia. DESIGN A qualitative method, specifically, a phenomenological research design, was carried out from February to March 2023. SETTINGS This study was conducted in the West Arsi zone, Oromia, Ethiopia, in four randomly selected districts. PARTICIPANTS Thirty participants, 12 pregnant adolescents, 8 husbands of pregnant adolescents and 10 healthcare providers were purposefully selected and participated. METHODS In-depth and key informant interviews were conducted. To create relevant codes, subthemes and themes, ATLAS.ti V.7.1 software was used. An inductive qualitative data analysis approach was used. The results were presented using respondents' clear verbatim and thematic analysis. RESULTS The findings were organised into four major themes: (1) low nutritional awareness, (2) poor dietary practice, (3) barriers to good dietary practice and (4) facilitators for good dietary practice. A low perceived severity (one's belief of the seriousness) of undernutrition and low perceived benefits (one's belief of the benefits) of balanced nutrition have been reported. A monotonous diet (one type food usually cereal based), no change in dietary practices during pregnancy, and low intake of animal food sources (meat, egg and milk) were found under dietary practices. One of the most striking findings to emerge from this study is the Alliance for Development (AFD), the former Women Development Army, which can be a great facilitator of good dietary practice. Husbands' involvement in nutrition education and specific nutrition training for healthcare providers are the other facilitators identified in this study. The lack of nutrition education, misconceptions and economic problems are barriers to dietary practices. CONCLUSION This study found a low nutritional awareness and poor dietary practices. Further experimental studies are recommended to assess whether AFD is capable of delivering effective nutrition interventions that improve dietary practice of pregnant.
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Affiliation(s)
- Adane Tesfaye
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Nutrition, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Yohanness Addisu Wondimagegne
- Department of Nutrition, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Dessalegn Tamiru
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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14
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Ding Y, Li G, Zhang M, Shao Y, Wu J, Wang Z. Development and validation of a novel food exchange system for Chinese pregnant women. Nutr J 2023; 22:65. [PMID: 38037031 PMCID: PMC10690967 DOI: 10.1186/s12937-023-00902-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 11/28/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The dietary nutritional status of pregnant women is critical for maintaining the health of both mothers and infants. Food exchange systems have been employed in the nutritional guidance of patients in China, although their application in the dietary guidance of healthy pregnant women is quite limited. This study aimed to develop a novel food exchange system for Chinese pregnant women (NFES-CPW) and evaluate the relative validation of its application. METHODS NFES-CPW covers approximately 500 types of food from ten categories and has more elaborate food portion sizes. It established a recommendation index for guiding food selection and used energy, water content, and protein as the exchange basis to balance the supply of energy and important nutrients throughout pregnancy. Furthermore, dietitians used the NFES-CPW and traditional food exchange system to generate new recipes based on the sample recipe. There were 40 derived recipes for each of the two food exchange methods. The food consumption, energy, and key nutrients of each recipe were calculated, and the differences between the two food exchange systems were compared using the Wilcoxon rank sum test or the Chi-square test. RESULTS The results revealed that compared to those derived from traditional food exchange system, the NFES-CPW derived recipes had a better dietary structure, as evidenced by the intakes of whole-grain cereals, beans excluding soybeans, potatoes, fruits, fish, shrimp and shellfish, as well as eggs (P < 0.05), which were more conducive to reaching the recommended range of balanced dietary pagoda. After calculating energy and nutrients, although these two food exchange systems have similar effects on the dietary energy and macronutrient intake of pregnant women, the intake of micronutrients in NFES-CPW derived recipes was significantly higher than that from the traditional food exchange system, which was more conducive to meeting the dietary requirements of pregnant women. The outstanding improvement are primarily vitamin A, vitamin B2, folic acid, vitamin B12, vitamin C, calcium, iron, and iodine (P < 0.05). Moreover, when compared to recipes obtained from the traditional food exchange system, the error ranges of energy and most nutrients were significantly reduced after employing the NFES-CPW. CONCLUSIONS Therefore, NFES-CPW is an appropriate tool that adheres to Chinese dietary characteristics and can provide suitable dietary guidance to pregnant women.
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Affiliation(s)
- Ye Ding
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Genyuan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Man Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Yingying Shao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jieshu Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhixu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China.
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Lis N, Lamnisos D, Bograkou-Tzanetakou A, Hadjimbei E, Tzanetakou IP. Preterm Birth and Its Association with Maternal Diet, and Placental and Neonatal Telomere Length. Nutrients 2023; 15:4975. [PMID: 38068836 PMCID: PMC10708229 DOI: 10.3390/nu15234975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
Preterm birth (PTB), a multi-causal syndrome, is one of the global epidemics. Maternal nutrition, but also neonatal and placental telomere length (TL), are among the factors affecting PTB risk. However, the exact relationship between these factors and the PTB outcome, remains obscure. The aim of this review was to investigate the association between PTB, maternal nutrition, and placental-infant TL. Observational studies were sought with the keywords: maternal nutrition, placental TL, newborn, TL, and PTB. No studies were found that included all of the keywords simultaneously, and thus, the keywords were searched in dyads, to reach assumptive conclusions. The findings show that maternal nutrition affects PTB risk, through its influence on maternal TL. On the other hand, maternal TL independently affects PTB risk, and at the same time PTB is a major determinant of offspring TL regulation. The strength of the associations, and the extent of the influence from covariates, remains to be elucidated in future research. Furthermore, the question of whether maternal TL is simply a biomarker of maternal nutritional status and PTB risk, or a causative factor of PTB, to date, remains to be answered.
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Affiliation(s)
- Nikoletta Lis
- Department of Health Sciences, European University Cyprus, Nicosia 2404, Cyprus; (N.L.); (D.L.)
- Maternity Clinic, Cork University Maternity Hospital, T12 YE02 Cork, Ireland
| | - Demetris Lamnisos
- Department of Health Sciences, European University Cyprus, Nicosia 2404, Cyprus; (N.L.); (D.L.)
| | | | - Elena Hadjimbei
- Department of Life Sciences, European University Cyprus, Nicosia 2404, Cyprus;
| | - Irene P. Tzanetakou
- Department of Life Sciences, European University Cyprus, Nicosia 2404, Cyprus;
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Erchick DJ, Lama TP, Khatry SK, Katz J, Mullany LC, Zavala E, LeClerq SC, Christian P, Tielsch JM. Supplementation with fortified balanced energy-protein during pregnancy and lactation and its effects on birth outcomes and infant growth in southern Nepal: protocol of a 2×2 factorial randomised trial. BMJ Paediatr Open 2023; 7:e002229. [PMID: 37923345 PMCID: PMC10626787 DOI: 10.1136/bmjpo-2023-002229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/26/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION Many women in low and middle-income countries enter pregnancy with low nutritional reserves with increased risk of fetal growth restriction and poor birth outcomes, including small-for-gestational-age (SGA) and preterm birth. Balanced energy-protein (BEP) supplements have shown reductions in risk of stillbirth and SGA, yet variations in intervention format and composition and limited evidence on the impact of BEP during lactation on growth outcomes warrant further study. This paper describes the protocol of the Maternal Infant Nutrition Trial (MINT) Study, which aims to evaluate the impact of a fortified BEP supplement during pregnancy and lactation on birth outcomes and infant growth in rural Nepal. METHODS AND ANALYSIS MINT is a 2×2 factorial, household randomised, unblinded, efficacy trial conducted in a subarea of Sarlahi District, Nepal. The study area covers six rural municipalities with about 27 000 households and a population of approximately 100 000. Married women (15-30 years) who become pregnant are eligible for participation in the trial and are randomly assigned at enrolment to supplementation with fortified BEP or not and at birth to fortified BEP supplementation or not until 6 months post partum. The primary pregnancy outcome is incidence of SGA, using the INTERGROWTH-21st standard, among live born infants with birth weight measured within 72 hours of delivery. The primary infant growth outcome is mean length-for-age z-score at 6 months using the WHO international growth reference. ETHICS AND DISSEMINATION The study was approved by the Institutional Review Board (IRB) at Johns Hopkins Bloomberg School of Public Health, Baltimore, USA (IRB00009714), the Committee on Human Research IRB at The George Washington University, Washington, DC, USA (081739), and the Ethical Review Board of the Nepal Health Research Council, Kathmandu, Nepal (174/2018). TRIAL REGISTRATION NUMBER NCT03668977.
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Affiliation(s)
- Daniel J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tsering P Lama
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project Sarlahi (NNIPS), Kathmandu, Nepal
| | - Subarna K Khatry
- Nepal Nutrition Intervention Project Sarlahi (NNIPS), Kathmandu, Nepal
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eleonor Zavala
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project Sarlahi (NNIPS), Kathmandu, Nepal
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
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Perumal N, Wang D, Darling AM, Liu E, Wang M, Ahmed T, Christian P, Dewey KG, Kac G, Kennedy SH, Subramoney V, Briggs B, Fawzi WW. Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis. BMJ 2023; 382:e072249. [PMID: 37734757 PMCID: PMC10512803 DOI: 10.1136/bmj-2022-072249] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries. DESIGN Individual participant data meta-analysis. SETTING Prospective pregnancy studies from 24 low and middle income countries. MAIN OUTCOME MEASURES Nine neonatal outcomes related to timing (preterm birth) and anthropometry (weight, length, and head circumference) at birth, stillbirths, and neonatal death. ANALYSIS METHODS A systematic search was conducted in PubMed, Embase, and Web of Science which identified 53 prospective pregnancy studies published after the year 2000 with data on GWG, timing and anthropometry at birth, and neonatal mortality. GWG adequacy was defined as the ratio of the observed maternal weight gain over the recommended weight gain based on the Institute of Medicine body mass index specific guidelines, which are derived from data in high income settings, and the INTERGROWTH-21st GWG standards. Study specific estimates, adjusted for confounders, were generated and then pooled using random effects meta-analysis models. Maternal age and body mass index before pregnancy were examined as potential modifiers of the associations between GWG adequacy and neonatal outcomes. RESULTS Overall, 55% of participants had severely inadequate (<70%) or moderately inadequate (70% to <90%) GWG, 22% had adequate GWG (90-125%), and 23% had excessive GWG (≥125%). Severely inadequate GWG was associated with a higher risk of low birthweight (adjusted relative risk 1.62, 95% confidence interval 1.51 to 1.72; 48 studies, 93 337 participants; τ2=0.006), small for gestational age (1.44, 1.36 to 1.54; 51 studies, 93 191 participants; τ2=0.016), short for gestational age (1.47, 1.29 to 1.69; 40 studies, 83 827 participants; τ2=0.074), and microcephaly (1.57, 1.31 to 1.88; 31 studies, 80 046 participants; τ2=0.145) compared with adequate GWG. Excessive GWG was associated with a higher risk of preterm birth (1.22, 1.13 to 1.31; 48 studies, 103 762 participants; τ2=0.008), large for gestational age (1.44, 1.33 to 1.57; 47 studies, 90 044 participants; τ2=0.009), and macrosomia (1.52, 1.33 to 1.73; 29 studies, 68 138 participants; τ2=0) compared with adequate GWG. The direction and magnitude of the associations between GWG adequacy and several neonatal outcomes were modified by maternal age and body mass index before pregnancy. CONCLUSIONS Inadequate and excessive GWG are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes, however further research is needed to assess optimal ranges of GWG based on data from low and middle income countries.
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Affiliation(s)
- Nandita Perumal
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Tahmeed Ahmed
- Nutrition & Clinical Services, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, CA, USA
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | | | - Brittany Briggs
- Certara USA, on behalf of the Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
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18
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Nambiar D, Mathew B, Dubey S, Moola S. Interventions addressing maternal and child health among the urban poor and homeless: an overview of systematic reviews. BMC Public Health 2023; 23:492. [PMID: 36918855 PMCID: PMC10015840 DOI: 10.1186/s12889-023-15410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Inequalities in access to and utilization of maternal and child health (MCH) care are hampering progress on the path to achieving the Sustainable Development Goals. In a number of Low- and Middle-Income Countries (LMICs) population subgroups at disproportionate risk of being left behind are the urban poor. Within this neglected group is the further neglected group of the homeless. Concomitantly, a number of interventions from the antenatal period onward have been piloted, tested, and scaled in these contexts. We carried out an overview of systematic reviews (SRs) to characterize the evidence around maternal and child health interventions relevant to urban poor homeless populations in LMICs. METHODS We searched Medline, Cochrane Library, Health Systems Evidence and EBSCOhost databases for SRs published between January 2009 and 2020 (with an updated search through November 2021). Our population of interest was women or children from urban poor settings in LMICs; interventions and outcomes corresponded with the World Health Organization's (WHO) guidance document. Each SR was assessed by two reviewers using established standard critical appraisal checklists. The overview was registered in PROSPERO (ID: CRD42021229107). RESULTS In a sample of 33 high quality SRs, we found no direct relevant evidence for pregnant and lactating homeless women (and children) in the reviewed literature. There was a lack of emphasis on evidence related to family planning, safe abortion care, and postpartum care of mothers. There was mixed quality evidence that the range of nutritional interventions had little, unclear or no effect on several child mortality and development outcomes. Interventions related to water, sanitation, and hygiene, ensuring acceptability of community health services and health promotion type programs could be regarded as beneficial, although location seemed to matter. Importantly, the risk of bias reporting in different reviews did not match, suggesting that greater attention to rigour in their conduct is needed. CONCLUSION The generalizability of existing systematic reviews to our population of interest was poor. There is a clear need for rigorous primary research on MCH interventions among urban poor, and particularly homeless populations in LMICs, as it is as yet unclear whether the same, augmented, or altogether different interventions would be required.
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Affiliation(s)
- Devaki Nambiar
- The George Institute for Global Health, 308 Elegance Tower, Jasola District Centre, 110025, New Delhi, India.
| | | | - Shubhankar Dubey
- Indian Council of Medical Research- Regional Medical Research Center, Bhubaneswar, Odisha, India
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19
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Chea N, Tegene Y, Astatkie A, Spigt M. Prevalence of undernutrition among pregnant women and its differences across relevant subgroups in rural Ethiopia: a community-based cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:17. [PMID: 36899418 PMCID: PMC10007751 DOI: 10.1186/s41043-023-00358-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Maternal undernutrition is one of the commonest public health problems in many low- and middle-income countries where generally more than 20% of women are undernourished. It is more common in rural areas due to unclear factors. Therefore, the aim of this study was to investigate the prevalence of undernutrition in general and in subgroups and determine risk factors among pregnant women in rural Ethiopia. METHODS A community-based cross-sectional survey was conducted from April 30 to May 30, 2019 on 550 pregnant women who were randomly selected from six districts in southern Ethiopia. Trained and experienced nurses measured undernutrition using mid-upper arm circumference and collected other data. We used multilevel mixed-effect logistic regression to identify factors associated with undernutrition among pregnant women. RESULTS The prevalence of undernutrition among pregnant women was 38% (95% CI: (34.2-42.3). The odds of undernutrition was higher among women who got pregnant previously (adjusted odds ratio [AOR]: 1.66; 95% CI: 1.02-2.71), who had a history of miscarriage (AOR: 3.18; 95% CI: 1.77-5.70), who practiced food taboos (AOR: 2.23; 95% CI: 1.47-3.39), and who did not get any nutritional counseling during pregnancy (AOR: 2.97; 95% CI: 1.79- 4.95). The prevalence of undernutrition was higher among pregnant women who had multiple risk factors and the difference was statistically significant (p < 0.001). CONCLUSION Undernutrition is a highly prevalent problem among rural Ethiopian pregnant women, especially with those who avoid food, do not get counseled, and had two or more pregnancies and a history of miscarriage. Improving the integration of nutrition programs with routine healthcare services and encouraging a multi-sectorial intervention strategy would help to reduce maternal undernutrition in the country.
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Affiliation(s)
- Nana Chea
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, P.O.Box: 1560, Hawassa, Ethiopia.
| | - Yadessa Tegene
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, P.O.Box: 1560, Hawassa, Ethiopia
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, P.O.Box: 1560, Hawassa, Ethiopia
| | - Mark Spigt
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- General Practice Research Unit, Department of Community Medicine, The Arctic University of Tromsø, Tromsø, Norway
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20
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Tabata F, Wada Y, Shibasaki T, Kawakami S, Inubashiri M, Hosaka M, Noshiro K, Umazume T, Miyaji K. A lower ratio of reduced to total albumin in serum is associated with protein nutritional status of pregnant women in Japan. Nutr Res 2023; 114:1-12. [PMID: 37079948 DOI: 10.1016/j.nutres.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/07/2023]
Abstract
Protein-energy undernutrition is potentially prevalent among Japanese pregnant women, and biomarkers that objectively indicate the protein nutritional status during pregnancy may help in implementing appropriate protein supplementation to these women. We hypothesized that a serum parameter of pregnant women, the ratio of reduced to total albumin (reduced ALB ratio), would be associated with protein intake during pregnancy. The serum reduced ALB ratio of pregnant women was compared with protein intake and with gestation outcomes (gestation length and infant birth weight) in an observational study of 115 Japanese pregnant women. The serum reduced ALB ratio in the third trimester tended to be positively correlated with gestation length (P = .07). Infant birth weights tended to be different between protein intake tertiles (P = .09); the mean infant birth weight was higher in the third tertile compared with the first and second tertiles. The protein intake of pregnant women was significantly and positively correlated with the serum reduced ALB ratio in the second trimester. The serum reduced ALB ratio reflects protein nutritional status during pregnancy and may contribute to healthier gestation outcomes.
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21
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Gernand AD, Gallagher K, Bhandari N, Kolsteren P, Lee AC, Shafiq Y, Taneja S, Tielsch JM, Abate FW, Baye E, Berhane Y, Chowdhury R, Dailey-Chwalibóg T, de Kok B, Dhabhai N, Jehan F, Kang Y, Katz J, Khatry S, Lachat C, Mazumder S, Muhammad A, Nisar MI, Sharma S, Martin LA, Upadhyay RP, Christian P. Harmonization of maternal balanced energy-protein supplementation studies for individual participant data (IPD) meta-analyses - finding and creating similarities in variables and data collection. BMC Pregnancy Childbirth 2023; 23:107. [PMID: 36774497 PMCID: PMC9919738 DOI: 10.1186/s12884-023-05366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/09/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Public health and clinical recommendations are established from systematic reviews and retrospective meta-analyses combining effect sizes, traditionally, from aggregate data and more recently, using individual participant data (IPD) of published studies. However, trials often have outcomes and other meta-data that are not defined and collected in a standardized way, making meta-analysis problematic. IPD meta-analysis can only partially fix the limitations of traditional, retrospective, aggregate meta-analysis; prospective meta-analysis further reduces the problems. METHODS We developed an initiative including seven clinical intervention studies of balanced energy-protein (BEP) supplementation during pregnancy and/or lactation that are being conducted (or recently concluded) in Burkina Faso, Ethiopia, India, Nepal, and Pakistan to test the effect of BEP on infant and maternal outcomes. These studies were commissioned after an expert consultation that designed recommendations for a BEP product for use among pregnant and lactating women in low- and middle-income countries. The initiative goal is to harmonize variables across studies to facilitate IPD meta-analyses on closely aligned data, commonly called prospective meta-analysis. Our objective here is to describe the process of harmonizing variable definitions and prioritizing research questions. A two-day workshop of investigators, content experts, and advisors was held in February 2020 and harmonization activities continued thereafter. Efforts included a range of activities from examining protocols and data collection plans to discussing best practices within field constraints. Prior to harmonization, there were many similar outcomes and variables across studies, such as newborn anthropometry, gestational age, and stillbirth, however, definitions and protocols differed. As well, some measurements were being conducted in several but not all studies, such as food insecurity. Through the harmonization process, we came to consensus on important shared variables, particularly outcomes, added new measurements, and improved protocols across studies. DISCUSSION We have fostered extensive communication between investigators from different studies, and importantly, created a large set of harmonized variable definitions within a prospective meta-analysis framework. We expect this initiative will improve reporting within each study in addition to providing opportunities for a series of IPD meta-analyses.
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Affiliation(s)
- Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA.
| | - Kelly Gallagher
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Nita Bhandari
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Sunita Taneja
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - James M Tielsch
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, D.C, USA
| | - Firehiwot Workneh Abate
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Adaba, Ethiopia
| | - Estifanos Baye
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Adaba, Ethiopia
| | - Ranadip Chowdhury
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Neeta Dhabhai
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Yunhee Kang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Subarna Khatry
- Nepal Nutrition Intervention Project-Sarlahi, Lalitpur, Nepal
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Sarmila Mazumder
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | | | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sitanshi Sharma
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Leigh A Martin
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA
| | - Ravi Prakash Upadhyay
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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22
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Maykondo BK, Horwood C, Haskins L, Mapumulo S, Mapatano MA, Kilola BM, Mokanisa MB, Hatloy A, John VM, Bitadi PMBW. A qualitative study to explore dietary knowledge, beliefs, and practices among pregnant women in a rural health zone in the Democratic Republic of Congo. JOURNAL OF HEALTH, POPULATION AND NUTRITION 2022; 41:51. [DOI: 10.1186/s41043-022-00333-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
A nutritious and healthy diet during pregnancy is essential for the health of both mother and baby. Inadequate dietary intake during pregnancy contributes to maternal malnutrition and can have lifelong effects on the health of the child. Maternal malnutrition is common in many low-income countries, including the Democratic Republic of Congo (DRC). Kwango province, DRC, has a high prevalence of malnutrition among all population groups, including macro and micronutrient deficiencies among pregnant women. The study aimed to explore the dietary knowledge and practices of a pregnant woman in this area.
Methods
This study adopted a qualitative approach using in-depth interviews (IDIs) with pregnant women and key informants, and focus group discussions (FGDs) with fathers and grandmothers in the community, to explore women’s knowledge and practice about diet during pregnancy. Data were collected between January and April 2018. IDIs were conducted with pregnant women who were recruited at antenatal clinics during their second and third trimesters. IDIs were undertaken with selected key informants, who were health workers providing care to pregnant women, and included doctors, nurses, nutritionists, and community health workers. All IDIs and FGDs were audio-recorded, transcribed verbatim, and translated to English. The triangulation method and thematic analyses were used.
Results
Overall, women showed good general knowledge about nutrition and the need for increased and varied foods during pregnancy, but little technical knowledge about nutrients and sources of nutrition. Healthcare facilities, media, NGOs, and family members were the main sources of nutritional information. However, women were unable to put this knowledge into practice, primarily due to poverty and poor access to a variety of foods. The Popokabaka community accessed food from farming, fishing, and the market, although purchasing food was frequently unaffordable. Cassava flour was the most common daily food. Food taboos, traditional practices, and late ANC attendance were identified as factors that influenced dietary practices.
Conclusions
Various social, economic, and environmental factors within the local community influenced dietary practices among pregnant women in rural DRC. A comprehensive approach is required to improve nutrition, and address food insecurity, cultural practices and improve the health outcomes of both mother and child.
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23
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Chowdhury M, Raynes-Greenow C, Kelly P, Alam NA, Afsana K, Billah SM, Dibley MJ. The Impact of Antenatal Balanced Plate Nutrition Education for Pregnant Women on Birth Weight: A Cluster Randomised Controlled Trial in Rural Bangladesh. Nutrients 2022; 14:4687. [PMID: 36364949 PMCID: PMC9655499 DOI: 10.3390/nu14214687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 08/31/2023] Open
Abstract
Low birth weight (LBW) is a global public health problem with the highest prevalence in South Asia. It is strongly associated with maternal undernutrition. In South Asia, intra-household food distribution is inequitable, with lower dietary adequacy in women. Evidence that nutrition education improves diet during pregnancy and reduces LBW is weak. We assessed the impact of nutrition education for pregnant women on birth weight in rural Bangladesh. We conducted a parallel, two-arm, cluster-randomised controlled trial, with 36 clusters allocated equally to intervention (n = 445) or standard care (n = 448). From their first trimester until delivery, intervention participants received education about eating balanced meals to meet daily dietary requirements with diverse food groups. The primary outcome of mean birth weight was 127.5 g higher in the intervention compared to control women, and the intervention reduced the risk of LBW by 57%. Post hoc analyses showed a significantly higher birth weight and a greater reduction in LBW amongst adolescent mothers. The mean number of food groups consumed was significantly higher in the intervention from the third month of pregnancy than in the control. A community-based balanced plate nutrition education intervention effectively increased mean birth weight and reduced LBW, and improved dietary diversity in rural Bangladeshi women.
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Affiliation(s)
- Morseda Chowdhury
- Health Nutrition and Population Programme, BRAC, BRAC Centre, 75 Mohakhali, Dhaka 1212, Bangladesh
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Camille Raynes-Greenow
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Patrick Kelly
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Neeloy Ashraful Alam
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Kaosar Afsana
- James P Grant School of Public Health (JPGSPH), BRAC University, 28 Mohakhali, Bir Uttom A. K. Khandakar Road, Dhaka 1213, Bangladesh
| | - Sk Masum Billah
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Michael John Dibley
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
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24
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Zavala E, Rhodes M, Christian P. Pregnancy Interventions to Improve Birth Outcomes: What Are the Effects on Maternal Outcomes? A Scoping Review. Int J Public Health 2022; 67:1604620. [PMID: 36405527 PMCID: PMC9666362 DOI: 10.3389/ijph.2022.1604620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives: Interventions in pregnancy are commonly evaluated for their effects on birth outcomes because maternal infection and poor nutrition are the primary contributors to adverse pregnancy outcomes, especially in low- and middle-income countries (LMICs). However, the extent to which such interventions directly impact maternal health and nutrition has not been succinctly characterized. Methods: We conducted a scoping review of systematic reviews and meta-analyses of 27 pregnancy interventions to summarize the evidence of impact on maternal outcomes. Results: Overall, these were reported incompletely, and we failed to find any evidence for eight interventions. Influenza vaccination, insecticide-treated bed nets, intermittent preventive treatment for malaria, anthelmintic therapy, and treatment of bacterial vaginosis, asymptomatic bacteriuria, and periodontal disease during pregnancy provided direct benefit to women, with reductions in infection risk. Nutritional interventions such as micronutrient supplementation and balanced energy and protein improved outcomes of maternal anemia and gestational weight gain, particularly in deficient populations. Calcium and low dose aspirin significantly reduced the risk of pre-eclampsia. Conclusion: These findings highlight antenatal interventions benefitting maternal health and provide insights into pathways for impacting birth and infant outcomes.
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Affiliation(s)
| | | | - Parul Christian
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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25
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Lama TP, Khatry SK, Isanaka S, Moore K, Jones L, Bedford J, Katz J, de Pee S, LeClerq SC, Tielsch JM. Acceptability of 11 fortified balanced energy-protein supplements for pregnant women in Nepal. MATERNAL & CHILD NUTRITION 2022; 18:e13336. [PMID: 35263004 PMCID: PMC9218317 DOI: 10.1111/mcn.13336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 06/01/2023]
Abstract
Evidence suggests that multiple micronutrient and balanced energy protein (BEP) supplementation during pregnancy can decrease the risk of stillbirth and small-for-gestational-age births and increase birth weight. We conducted a mixed-methods formative research study to identify the most acceptable among a range of 11 candidates fortified BEP supplements for use in pregnancy and lactation in a rural district in Nepal. Forty pregnant women aged 15-40 years participated in a test meal tasting of 11 different sweet and savoury candidate BEP supplements. Each participant rated the products on organoleptic properties using a 7-point hedonic scale (1 = Dislike it very much to 7 = Like it very much), ranked her 'top 3' most liked supplements, and subsequently discussed each product with peers in focus group discussions (FGDs). Five supplements (sweet lipid-based nutrient supplement (LNS), savoury LNS, sweet vanilla biscuits, vanilla instant drinks and seasoned pillows) achieved the maximum overall median hedonic score of 7, with sweet LNS and seasoned pillows ranking as the top 2. This was consistent with the assessments in FGDs. Women in the FGDs expressed dislike of the smell and taste of the cocoa drink, savoury masala bar, sweet mango bar and savoury curry biscuit, which was consistent with the hedonic scale scores. This study provides valuable insights into our understanding of women's acceptance of different BEP supplements during pregnancy in rural Nepal and has helped identify the two most accepted BEP supplements to be used in a two-month home trial to assess utilisation and compliance in this setting.
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Affiliation(s)
- Tsering P. Lama
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Subarna K. Khatry
- Nepal Nutrition Intervention Project – Sarlahi (NNIPS)KathmanduNepal
| | - Sheila Isanaka
- Departments of Nutrition and Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | | | | | | | - Joanne Katz
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Saskia de Pee
- Department of Global Health, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Steven C. LeClerq
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Nepal Nutrition Intervention Project – Sarlahi (NNIPS)KathmanduNepal
| | - James M. Tielsch
- Department of Global Health, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
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26
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Carbonneau E, Dumas A, Brodeur-Doucet A, Fontaine-Bisson B. A Community Prenatal Intervention in Social Nutrition: Evaluating the Impact on Pregnancy and Birthweight Outcomes. Nutrients 2022; 14:nu14061151. [PMID: 35334807 PMCID: PMC8951613 DOI: 10.3390/nu14061151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
This study aims to assess the associations between structural features of the Montreal Diet Dispensary’s social nutrition intervention and pregnancy (i.e., anemia, gestational diabetes mellitus (GDM), gestational weight gain (GWG), hypertension) and birthweight outcomes (i.e., small- or large-for-gestational-age) among pregnant women, most of them recent immigrants. The study consists of a secondary analysis of the digital client database of the Montreal Diet Dispensary (n = 2925). Logistic regressions were used to estimate the odds of pregnancy and birthweight outcomes, depending on structural features of the intervention. Pregnant women who attended a welcoming group session presented lower odds of GDM and anemia compared to those who did not attend. A longer duration of intervention was also associated with lower odds of GDM and anemia. Each additional appointment with a dietitian was associated with higher odds of excessive GWG and lower odds of insufficient GWG only among women with a pre-pregnancy BMI lower than 25 kg/m2. This study emphasizes the importance of providing nutritional services early in pregnancy to reduce the risk of GDM and anemia. It also stresses the importance of using appropriate nutritional guidelines to avoid increasing the risk of excessive GWG.
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Affiliation(s)
- Elise Carbonneau
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Centre NUTRISS—Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Quebec, QC G1V 0A6, Canada
- School of Nutrition, Université Laval, Quebec, QC G1V 0A6, Canada
- Correspondence:
| | - Alex Dumas
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON K1K 0T2, Canada
| | | | - Bénédicte Fontaine-Bisson
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON K1K 0T2, Canada
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Lee AC, Abate FW, Mullany LC, Baye E, Berhane YY, Derebe MM, Eglovitch M, Fasil N, Olson IE, Kidane WT, Shiferaw T, Shiferie F, Tsegaye F, Tsegaye S, Yibeltal K, Chan GJ, Christian P, Isanaka S, Kang Y, Lu C, Mengistie MM, Molina RL, Stojanov MD, Van Dyk F, Tadesse AW, Wondale AT, Wylie BJ, Worku A, Berhane Y. Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study: protocol of a pragmatic clinical effectiveness study to improve birth outcomes in Ethiopia. BMJ Paediatr Open 2022; 6:e001327. [PMID: 36053580 PMCID: PMC8762145 DOI: 10.1136/bmjpo-2021-001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/07/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The WHO Nutrition Target aims to reduce the global prevalence of low birth weight by 30% by the year 2025. The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study will test the impact of packages of pregnancy interventions to enhance maternal nutrition and infection management on birth outcomes in rural Ethiopia. METHODS AND ANALYSIS ENAT is a pragmatic, open-label, 2×2 factorial, randomised clinical effectiveness study implemented in 12 rural health centres in Amhara, Ethiopia. Eligible pregnant women presenting at antenatal care (ANC) visits at <24 weeks gestation are enrolled (n=2400). ANC quality is strengthened across all centres. Health centres are randomised to receive an enhanced nutrition package (ENP) or standard nutrition care, and within each health centre, individual women are randomised to receive an enhanced infection management package (EIMP) or standard infection care. At ENP centres, women receive a regular supply of adequately iodised salt and iron-folate (IFA), enhanced nutrition counselling and those with mid-upper arm circumference of <23 cm receive a micronutrient fortified balanced energy protein supplement (corn soya blend) until delivery. In standard nutrition centres, women receive routine counselling and IFA. EIMP women have additional screening/treatment for urinary and sexual/reproductive tract infections and intensive deworming. Non-EIMP women are managed syndromically per Ministry of Health Guidelines. Participants are followed until 1-month post partum, and a subset until 6 months. The primary study outcomes are newborn weight and length measured at <72 hours of age. Secondary outcomes include preterm birth, low birth weight and stillbirth rates; newborn head circumference; infant weight and length for age z-scores at birth; maternal anaemia; and weight gain during pregnancy. ETHICS AND DISSEMINATION ENAT is approved by the Institutional Review Boards of Addis Continental Institute of Public Health (001-A1-2019) and Mass General Brigham (2018P002479). Results will be disseminated to local and international stakeholders. REGISTRATION NUMBER ISRCTN15116516.
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Affiliation(s)
- Anne Cc Lee
- Department of Pediatric Newborn Medicine, Global Advancement of Infants and Mothers, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Estifanos Baye
- Department of Pediatric Newborn Medicine, Global Advancement of Infants and Mothers, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Michelle Eglovitch
- Department of Pediatric Newborn Medicine, Global Advancement of Infants and Mothers, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nebiyou Fasil
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Ingrid E Olson
- Department of Pediatric Newborn Medicine, Global Advancement of Infants and Mothers, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Tigest Shiferaw
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Fisseha Shiferie
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Fitsum Tsegaye
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Sitota Tsegaye
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | | | - Grace J Chan
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medical Critical Care, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheila Isanaka
- Departments of Nutrition and Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Yunhee Kang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chunling Lu
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Rose L Molina
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michele D Stojanov
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Fred Van Dyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amare Worku Tadesse
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Asresie T Wondale
- Debretabor Referral Hospital, Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | - Blair J Wylie
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Bliznashka L, Sudfeld CR, Garba S, Guindo O, Soumana I, Adehossi I, Langendorf C, Grais RF, Isanaka S. Prenatal supplementation with multiple micronutrient supplements or medium-quantity lipid-based nutrient supplements has limited effects on child growth up to 24 months in rural Niger: a secondary analysis of a cluster randomized trial. Am J Clin Nutr 2021; 115:738-748. [PMID: 34871344 PMCID: PMC8895211 DOI: 10.1093/ajcn/nqab404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/06/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Prenatal multiple micronutrient supplementation (MMS) and lipid-based nutrient supplementation (LNS) can improve birth outcomes relative to iron-folic acid supplementation (IFA); however, effects on child postnatal growth remain unclear. OBJECTIVES The aim was to compare the effect of prenatal MMS, medium-quantity LNS (MQ-LNS), and IFA on child growth up to 2 y of age. METHODS We conducted a cluster randomized controlled trial of prenatal nutritional supplementation in Madarounfa, Niger. Villages were randomly assigned for pregnant women to receive IFA (17 villages, 1105 women), MMS (18 villages, 1083 women) or MQ-LNS (18 villages, 1144 women). Pregnant women received nutritional supplements weekly until delivery, and children were followed up monthly from 6-8 wk to 24 mo of age. We assessed the effect of prenatal MMS and MQ-LNS compared with IFA and the effect of prenatal MMS compared with MQ-LNS on child length-for-age z scores (LAZ), weight-for-age z scores (WAZ), and weight-for-length z scores (WLZ) at 24 mo of age using generalized linear models. In secondary analyses, we used mixed-effects models to assess the trajectories of anthropometric z scores longitudinally from 6-8 wk to 24 mo. RESULTS Compared with IFA, MMS and MQ-LNS had no effect on child LAZ, WAZ, or WLZ at 24 mo of age (P > 0.05). Children in the MQ-LNS arm had significantly higher mid-upper arm circumference at 24 mo than children in the MMS arm: mean difference 0.50 cm (95% CI 0.10, 0.91 cm). WAZ and WLZ trajectories were more negative in the MQ-LNS arm compared with IFA and MMS, with lower z scores from 14 to 20 mo of age. However, WAZ and WLZ trajectories converged after 20 mo of age, and there were no differences by 24 mo of age. CONCLUSIONS Prenatal MMS and MQ-LNS had limited effect on anthropometric measures of child growth up to 24 mo of age as compared with IFA in rural Niger.
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Affiliation(s)
- Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Perumal N, Blakstad MM, Fink G, Lambiris M, Bliznashka L, Danaei G, Sudfeld CR. Impact of scaling up prenatal nutrition interventions on human capital outcomes in low- and middle-income countries: a modeling analysis. Am J Clin Nutr 2021; 114:1708-1718. [PMID: 34320177 PMCID: PMC8574629 DOI: 10.1093/ajcn/nqab234] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/18/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Prenatal nutrition interventions can lead to improved birth outcomes, which in turn are associated with better education and human capital outcomes later in life. OBJECTIVE We estimated the impact of scaling up iron-folic acid (IFA), calcium, multiple micronutrient (MMS), and balanced energy protein (BEP) supplementation for pregnant women, on human capital outcomes in low- and middle-income countries (LMIC). METHODS We used mathematical modeling with proportional reductions in adverse birth outcomes to estimate the potential gains in school years and lifetime income due to scaling up each prenatal nutrition intervention. Estimates of intervention effects on birth outcomes were derived from meta-analyses of randomized trials. Estimates of the associations between birth outcomes and schooling and lifetime income were derived from de novo meta-analyses of observational studies. RESULTS Across 132 LMIC, scaling up prenatal nutrition interventions to 90% coverage was estimated to increase school years and lifetime income per birth cohort by: 2.28 million y (95% uncertainty intervals (UI): -0.44, 6.26) and $8.26 billion (95% UI: -1.60, 22.4) for IFA; 4.08 million y (95% UI: 0.12, 9.68) and $18.9 billion (95% UI: 0.59, 44.6) for calcium; 5.02 million y (95% UI: 1.07, 11.0) and $18.1 billion (95% UI: 3.88, 39.1) for MMS; and 0.53 million y (95% UI: -0.49, 1.70) and $1.34 billion (95% UI: -1.10, 3.10 billion) for BEP supplementation. South Asia and Sub-Saharan Africa tended to have the largest estimated regional gains in school years for scaling up each intervention due to the large population size and high burden of poor birth outcomes. Absolute income benefits for each intervention were estimated to be the largest in Latin America, where returns to education and incomes are higher relative to other regions. CONCLUSION Increasing coverage of prenatal nutrition interventions in LMIC may lead to substantial gains in schooling and lifetime income. Decision makers should consider the potential long-term human capital returns of investments in maternal nutrition.
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Affiliation(s)
- Nandita Perumal
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mia M Blakstad
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mark Lambiris
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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SEZER A, KADIOĞLU H. Effect of text messages intervention on pregnancy healthcare practices: A three group non-randomized controlled trial. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.883191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Leroy JL, Koch B, Roy S, Gilligan D, Ruel M. Social Assistance Programs and Birth Outcomes: A Systematic Review and Assessment of Nutrition and Health Pathways. J Nutr 2021; 151:3841-3855. [PMID: 34590144 PMCID: PMC8643580 DOI: 10.1093/jn/nxab292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/01/2021] [Accepted: 08/06/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Poor birth outcomes are an important global public health problem. Social assistance programs that provide cash or in-kind transfers, such as food or vouchers, hold potential to improve birth outcomes but the evidence on their effectiveness has not been reviewed. OBJECTIVES We systematically reviewed studies that used experimental or quasi-experimental methods to evaluate the impacts of social assistance programs on outcomes in low- and middle-income countries. METHODS The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to assess the certainty of the evidence for birth weight and neonatal mortality (most common outcomes reported). We summarized the evidence on hypothesized nutrition and health pathways of impact. RESULTS We included 6 evaluations of 4 different cash transfer programs and 1 evaluation of a community-based participatory learning and action program that provided food and cash transfers. The 4 studies that assessed birth weight impacts found significant (P < 0.05) effects ranging from 31 to 578 g. Out of 3 studies that assessed neonatal mortality impacts, 2 found significant effects ranging from 0.6 to 3.1 deaths/1000 live births. The certainty of the evidence for both outcomes was rated as very low due to several methodological limitations. In terms of potential pathways, some studies documented positive effects on maternal diet, antenatal care (ANC) utilization, and delivery in a health facility. CONCLUSIONS Better-designed evaluations are needed to strengthen the evidence base on these programs. Evaluation studies should elucidate underlying mechanisms of impact by including outcomes related to maternal diet, ANC seeking, use of skilled delivery, and women's empowerment in nutrition and health domains. Studies should also assess potential unintended negative consequences of social assistance, such as reduced birth spacing and excess pregnancy weight gain.
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Affiliation(s)
| | - Bastien Koch
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Shalini Roy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Daniel Gilligan
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Marie Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
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Dearden KA, Bishwakarma R, Crookston BT, Masau BT, Mulokozi GI. Health facility-based counselling and community outreach are associated with maternal dietary practices in a cross-sectional study from Tanzania. BMC Nutr 2021; 7:45. [PMID: 34412681 PMCID: PMC8377836 DOI: 10.1186/s40795-021-00447-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/26/2021] [Indexed: 11/22/2022] Open
Abstract
Background Anemia and underweight among women are major public health challenges. Access to health services can improve dietary behaviors and women’s nutritional status. We examined whether exposure to health services is associated with women’s dietary practices in Tanzania. Methods Data come from a cross-sectional baseline survey among 5000 female primary caregivers who were randomly selected via two-stage sampling, prior to implementing a maternal and child nutrition program. We ran frequencies on women’s exposure to existing health facility-based counselling, community health worker visits, and attendance at women’s support groups. We examined associations between exposure to these interventions and maternal diets and adjusted for sociodemographic covariates using ordinary least squares regression and ordered logistic regression. Results A third of the sample (34.1%) had received any antenatal care (ANC) during their most recent pregnancy or had been advised by anyone about nutrition (37.0%). 68.0% had never had a community health worker (CHW) speak to them about their children’s health and 9.4% had participated in a women’s group. Only 8.0% of mothers ate more than usual during pregnancy and 7.1% ate more types of foods. After adjusting for mother’s age, education and household assets, women who received nutrition advice were 1.3 times (95% CI: 1.1, 1.7) more likely than mothers who did not to eat more during pregnancy. Receiving antenatal care (ANC) and advice on nutrition before, during, and after pregnancy and delivery were highly associated with the mother eating more types of foods. Hearing from a CHW about children’s health but not support group attendance was often associated with various dietary practices. Almost all measures of access to health services were significantly associated with mothers’ frequency of eating in the previous 24 h. Receiving advice on nutrition during pregnancy and after giving birth and CHW contact were associated with mothers’ dietary diversity in the previous 24 h. Conclusions Several program exposure variables—especially being counselled about nutrition—were associated with improved dietary practices. Improving service delivery at scale may contribute to improved dietary behaviors in larger populations, given the associations we describe, along with findings from the existing literature.
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Affiliation(s)
- Kirk A Dearden
- IMA World Health/Corus International, Washington DC, USA.
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von Salmuth V, Brennan E, Kerac M, McGrath M, Frison S, Lelijveld N. Maternal-focused interventions to improve infant growth and nutritional status in low-middle income countries: A systematic review of reviews. PLoS One 2021; 16:e0256188. [PMID: 34407128 PMCID: PMC8372927 DOI: 10.1371/journal.pone.0256188] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/01/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Small and nutritionally at-risk infants under 6 months (<6m) are a vulnerable group at increased risk of mortality, morbidity, poor growth and sub-optimal development. Current national and international (World Health Organization) management guidelines focus mainly on infants' needs, yet growing evidence suggests that maternal factors also influence infant outcomes. We aimed to inform future guidelines by exploring the impacts of maternal-focused interventions on infant feeding and growth. METHODS We conducted a systematic review of reviews published since 2008 (PROSPERO, register number CRD 42019141724). We explored five databases and a wide variety of maternal-focused interventions based in low- and middle-income countries. Infant outcomes of interest included anthropometric status, birthweight, infant mortality, breastfeeding and complementary feeding practices. Given heterogenous interventions, we present a narrative synthesis of the extracted data. RESULTS We included a total of 55 systematic reviews. Numerous maternal interventions were effective in improving infant growth or feeding outcomes. These included breastfeeding promotion, education, support and counselling interventions. Maternal mental health, while under-researched, showed potential to positively impact infant growth. There was also some evidence for a positive impact of: women's empowerment, m-health technologies, conditional cash transfers, water, sanitation and hygiene and agricultural interventions. Effectiveness was increased when implemented as part of a multi-sectoral program. Antenatal supplementation with macronutrient, multiple micronutrients, Vitamin D, zinc, iron folic acid and possibly calcium, iodine and B12 in deficient women, improved birth outcomes. In contrast, evidence for postnatal supplementation was limited as was evidence directly focusing on small and nutritionally at-risk infants; most reviews focused on the prevention of growth faltering. CONCLUSION Our findings suggest sufficient evidence to justify greater inclusion of mothers in more holistic packages of care for small and nutritionally at-risk infants aged <6m. Context specific approaches are likely needed to support mother-infant dyads and ensure infants survive and thrive.
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Affiliation(s)
- Victoria von Salmuth
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eilise Brennan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Emergency Nutrition Network, Kidlington, Oxford, United Kingdom
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marie McGrath
- Emergency Nutrition Network, Kidlington, Oxford, United Kingdom
| | - Severine Frison
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Mate A, Reyes-Goya C, Santana-Garrido Á, Vázquez CM. Lifestyle, Maternal Nutrition and Healthy Pregnancy. Curr Vasc Pharmacol 2021; 19:132-140. [PMID: 32234002 DOI: 10.2174/1570161118666200401112955] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 02/07/2023]
Abstract
Healthy lifestyle habits spanning from preconception to postpartum are considered as a major safeguard for achieving successful pregnancies and for the prevention of gestational diseases. Among preconception priorities established by the World Health Organization (WHO) are healthy diet and nutrition, weight management, physical activity, planned pregnancy and physical, mental and psychosocial health. Most studies covering the topic of healthy pregnancies focus on maternal diet because obesity increases the risks for adverse perinatal outcomes, including gestational diabetes mellitus, large for gestational age newborns, or preeclampsia. Thus, foods rich in vegetables, essential and polyunsaturated fats and fibre-rich carbohydrates should be promoted especially in overweight, obese or diabetic women. An adequate intake of micronutrients (e.g. iron, calcium, folate, vitamin D and carotenoids) is also crucial to support pregnancy and breastfeeding. Moderate physical activity throughout pregnancy improves muscle tone and function, besides decreasing the risk of preeclampsia, gestational diabesity (i.e. diabetes associated with obesity) and postpartum overweight. Intervention studies claim that an average of 30 min of exercise/day contributes to long-term benefits for maternal overall health and wellbeing. Other factors such as microbiome modulation, behavioural strategies (e.g. smoking cessation, anxiety/stress reduction and sleep quality), maternal genetics and age, social class and education might also influence the maternal quality of life. These factors contribute to ensure a healthy pregnancy, or at least to reduce the risk of adverse maternal and foetal outcomes during pregnancy and later in life.
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Affiliation(s)
- Alfonso Mate
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, E-41012 Sevilla, Spain
| | - Claudia Reyes-Goya
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, E-41012 Sevilla, Spain
| | - Álvaro Santana-Garrido
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, E-41012 Sevilla, Spain
| | - Carmen M Vázquez
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, E-41012 Sevilla, Spain
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Lassi ZS, Padhani ZA, Rabbani A, Rind F, Salam RA, Bhutta ZA. Effects of nutritional interventions during pregnancy on birth, child health and development outcomes: A systematic review of evidence from low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1150. [PMID: 37131924 PMCID: PMC8356342 DOI: 10.1002/cl2.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Optimal nutrition plays a crucial role in pregnancy. Poor maternal nutrition and maternal obesity has risk factors for serious fetal complications and neonatal outcomes, including intrauterine growth restriction, congenital abnormalities, stillbirth, low birth weight (LBW), preterm birth, fetal macrosomia, increased risk of neonatal infections, neonatal hypothermia, and neonatal death. The prevalence of maternal malnutrition is higher in low- and middle-income countries (LMICs) (10-19%) when compared with high-income countries, with variation by region and by country. Several behavioral interventions, including dietary control and exercise, have been found to reduce the risk of these adverse outcomes. However, none has reviewed dietary interventions to prevent maternal obesity in pregnant women. Objectives The review aims to assess the effectiveness of balanced energy protein (BEP) supplementation, food distribution programs (FDPs), and dietary interventions to prevent maternal obesity during pregnancy on birth, child health, and developmental outcomes. Search Methods We searched Cochrane Controlled Trials Register (CENTRAL), MEDLINE, Embase, CINAHL, and 12 other databases, and trials registers for ongoing studies up until April 2019. We also searched for gray literature from different sources and for citations on Google Scholar and Web of Sciences. We also checked the reference lists of included studies and relevant reviews and contacted the authors of studies for any ongoing and unpublished studies. The search was followed by title/abstract screening, full-text screening and data extraction. Selection Criteria We included randomized control trials, and quasi experimental trials to evaluate the impact of nutritional interventions (BEP, FDP, and dietary interventions to prevent maternal obesity) compared to control or standard of care, among healthy pregnant women of any age living in LMICs. Data Collection and Analysis Two review authors independently assessed and screened studies for eligibility, extracted data, and assessed quality of the studies included in the review. We conducted a meta-analysis of all reported primary and secondary outcomes. Subgroup analysis and GRADE assessment was performed for all reported primary outcomes. Main Results The review included 15 studies, of these, eight were on BEP supplementation, five on FDP, and two on interventions for obesity prevention. BEP supplementation may show a reduction in the rate of stillbirths by 61% (risk ratio [RR], 0.39; 95% CI, 0.19-0.80; three studies, n = 1913; low quality on GRADE), perinatal mortality by 50% (RR, 0.50; 95% CI, 0.30-0.84; one study, n = 1446; low quality on GRADE), LBW infants by 40% (RR, 0.60; 95% CI, 0.41-0.86; three studies, n = 1830; low quality of evidence on GRADE); small for gestational age (SGA) by 29% (RR, 0.71; 95% CI, 0.54-0.94; five studies, n = 1844) and increased birth weight by 107.28 g (mean difference [MD], 107.28 g; 95% CI, 68.51-146.04, eight studies, n = 2190). An increase of 107.28 g of birthweight is clinically significant in the countries where the intervention was provided. BEP supplementation had no effect on miscarriage, neonatal mortality, infant mortality, preterm birth, birth length, and head circumference. FDP may show improvement in mean birth weight by 46 g (MD, 46.00 g; 95% CI, 45.10-46.90, three studies, n = 5272), in birth length by 0.20 cm (MD, 0.20 cm; 95% CI, 0.20-0.20, three studies, n = 5272), and reduction in stunting by 18% (RR, 0.82; 95% CI, 0.71-0.94; two studies; n = 4166), and wasting by 13% (RR, 0.87; 95% CI, 0.78-0.97; two studies, n = 3883). There was no effect of FDP on miscarriage, maternal mortality, perinatal mortality, neonatal mortality, infant mortality, preterm birth, LBW, SGA, head circumference, and underweight babies. Studies on interventions for obesity prevention among pregnant women failed to report on the primary outcomes. The studies showed a 195.57 g reduction in mean birth weight (MD, -195.57 g, 95% CI, -349.46 to -41.68, two studies, n = 180), and had no effect on birth length, and macrosomia. Authors' Conclusions Our review highlights improvement in maternal, birth, and child outcomes through BEP supplementation and FDP during pregnancy. But, due to the small number of included studies and low quality of evidence, we are uncertain of the effect of BEP supplementation, FDP and dietary interventions for prevention of obesity on maternal, and child outcomes. Thus, further good quality research is recommended to assess the effect of these interventions on maternal, child and developmental outcomes.
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Affiliation(s)
- Zohra S. Lassi
- Robinson Research InstituteUniversity of AdelaideAdelaideSouth AustraliaSA 5005Australia
| | - Zahra A. Padhani
- Center of Excellence in Women and Child HealthAga Khan University HospitalKarachiPakistan
| | - Amna Rabbani
- Center of Excellence in Women and Child HealthAga Khan University HospitalKarachiPakistan
| | - Fahad Rind
- Center of Excellence in Women and Child HealthAga Khan University HospitalKarachiPakistan
| | - Rehana A. Salam
- Center of Excellence in Women and Child HealthAga Khan University HospitalKarachiPakistan
| | - Zulfiqar A. Bhutta
- Center of Excellence in Women and Child HealthAga Khan University HospitalKarachiPakistan
- Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoCanada
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Nguyen PH, Kachwaha S, Tran LM, Avula R, Young MF, Ghosh S, Sharma PK, Escobar-Alegria J, Forissier T, Patil S, Frongillo EA, Menon P. Strengthening Nutrition Interventions in Antenatal Care Services Affects Dietary Intake, Micronutrient Intake, Gestational Weight Gain, and Breastfeeding in Uttar Pradesh, India: Results of a Cluster-Randomized Program Evaluation. J Nutr 2021; 151:2282-2295. [PMID: 34038529 PMCID: PMC8349122 DOI: 10.1093/jn/nxab131] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/19/2021] [Accepted: 04/16/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Maternal nutrition interventions are inadequately integrated into antenatal care (ANC). Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization through government ANC services. OBJECTIVES We compared nutrition-intensified ANC (I-ANC) with standard ANC (S-ANC) on coverage of nutrition interventions and maternal nutrition practices. METHODS We used a cluster-randomized design with cross-sectional baseline (2017) and endline (2019) surveys (n ∼660 pregnant and 1800 recently delivered women per survey) and a repeated-measures longitudinal study in 2018-2019 (n = 400). We derived difference-in-difference effect estimates (DIDs) for diet diversity, consumption of micronutrient supplements, weight monitoring, and early breastfeeding practices. RESULTS Despite substantial secular improvements in service coverage from India's national nutrition program, women in the I-ANC arm received more home visits [DID: 7-14 percentage points (pp)] and counseling on core nutrition messages (DID: 10-23 pp) than in the S-ANC arm. One-third of women got ≥3 home visits and one-fourth received ≥4 ANC check-ups in the I-ANC arm. Improvements were greater in the I-ANC arm than in the S-ANC arm for any receipt and consumption of iron-folic acid (DID: 7.5 pp and 9.5 pp, respectively) and calcium supplements (DID: 14.1 pp and 11.5 pp, respectively). Exclusive breastfeeding improved (DID: 7.5 pp) but early initiation of breastfeeding did not. Maternal food group consumption (∼4 food groups) and probability of adequacy of micronutrients (∼20%) remained low in both arms. Repeated-measures longitudinal analyses showed similar results, with additional impact on consumption of vitamin A-rich foods (10 pp, 11 g/d), other vegetables and fruits (22-29 g/d), and gestational weight gain (0.4 kg). CONCLUSIONS Intensifying nutrition in government ANC services improved maternal nutrition practices even with strong secular trends in service coverage. Dietary diversity, supplement consumption, and breastfeeding practices remained suboptimal. Achieving greater behavior changes will require strengthening the delivery and use of maternal nutrition services integrated into ANC services in the health system. This trial was registered at clinicaltrials.gov as NCT03378141.
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Affiliation(s)
| | - Shivani Kachwaha
- International Food Policy Research Institute, Washington, DC, USA
| | | | - Rasmi Avula
- International Food Policy Research Institute, Washington, DC, USA
| | - Melissa F Young
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | | | | | | | | | - Sumeet Patil
- Network for Engineering, Economics, Research and Management (NEERMAN), Delhi,
India
| | - Edward A Frongillo
- Health Department of Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Purnima Menon
- International Food Policy Research Institute, Washington, DC, USA
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Wada Y, Ehara T, Tabata F, Komatsu Y, Izumi H, Kawakami S, Noshiro K, Umazume T, Takeda Y. Maternal Serum Albumin Redox State Is Associated with Infant Birth Weight in Japanese Pregnant Women. Nutrients 2021; 13:nu13061764. [PMID: 34067270 PMCID: PMC8224550 DOI: 10.3390/nu13061764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Plasma albumin (ALB) reflects protein nutritional status in rats, but it is not clear whether it is associated with dietary protein insufficiency in pregnant women and/or their risk of low birth weight delivery. This study aimed to investigate whether maternal serum ALB redox state reflects maternal protein nutritional status and/or is associated with infant birth weights. Methods: The relationship between the serum reduced ALB ratio and infant birth weight was examined in an observational study of 229 Japanese pregnant women. A rat model simulating fetal growth restriction, induced by protein-energy restriction, was used to elucidate the relationship between maternal nutritional status, maternal serum ALB redox state, and birth weight of the offspring. Results: In the human study, serum reduced ALB ratio in the third trimester was significantly and positively correlated with infant birth weight. In the rat study, serum reduced ALB ratio and birth weight in the litter decreased as the degree of protein-energy restriction intensified, and a significant and positive correlation was observed between them in late pregnancy. Conclusions: Maternal serum reduced ALB ratio in the third trimester is positively associated with infant birth weight in Japanese pregnant women, which would be mediated by maternal protein nutritional status.
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Affiliation(s)
- Yasuaki Wada
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan; (T.E.); (F.T.); (Y.K.); (H.I.); (S.K.); (Y.T.)
- Center for Food and Medical Innovation Promotion, Institute for the Promotion of Business-Regional Collaboration of Hokkaido University, Kita-21, Nishi-11, Kita-ku, Sapporo, Hokkaido 001-0021, Japan
- Correspondence: ; Tel.: +81-46-252-3046 (ext. 3055)
| | - Tatsuya Ehara
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan; (T.E.); (F.T.); (Y.K.); (H.I.); (S.K.); (Y.T.)
- Center for Food and Medical Innovation Promotion, Institute for the Promotion of Business-Regional Collaboration of Hokkaido University, Kita-21, Nishi-11, Kita-ku, Sapporo, Hokkaido 001-0021, Japan
| | - Fuka Tabata
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan; (T.E.); (F.T.); (Y.K.); (H.I.); (S.K.); (Y.T.)
- Center for Food and Medical Innovation Promotion, Institute for the Promotion of Business-Regional Collaboration of Hokkaido University, Kita-21, Nishi-11, Kita-ku, Sapporo, Hokkaido 001-0021, Japan
| | - Yosuke Komatsu
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan; (T.E.); (F.T.); (Y.K.); (H.I.); (S.K.); (Y.T.)
- Center for Food and Medical Innovation Promotion, Institute for the Promotion of Business-Regional Collaboration of Hokkaido University, Kita-21, Nishi-11, Kita-ku, Sapporo, Hokkaido 001-0021, Japan
| | - Hirohisa Izumi
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan; (T.E.); (F.T.); (Y.K.); (H.I.); (S.K.); (Y.T.)
- Center for Food and Medical Innovation Promotion, Institute for the Promotion of Business-Regional Collaboration of Hokkaido University, Kita-21, Nishi-11, Kita-ku, Sapporo, Hokkaido 001-0021, Japan
| | - Satomi Kawakami
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan; (T.E.); (F.T.); (Y.K.); (H.I.); (S.K.); (Y.T.)
- Center for Food and Medical Innovation Promotion, Institute for the Promotion of Business-Regional Collaboration of Hokkaido University, Kita-21, Nishi-11, Kita-ku, Sapporo, Hokkaido 001-0021, Japan
| | - Kiwamu Noshiro
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, Hokkaido 060-8648, Japan; (K.N.); (T.U.)
| | - Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, Hokkaido 060-8648, Japan; (K.N.); (T.U.)
| | - Yasuhiro Takeda
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan; (T.E.); (F.T.); (Y.K.); (H.I.); (S.K.); (Y.T.)
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Vanslambrouck K, de Kok B, Toe LC, De Cock N, Ouedraogo M, Dailey-Chwalibóg T, Hanley-Cook G, Ganaba R, Lachat C, Huybregts L, Kolsteren P. Effect of balanced energy-protein supplementation during pregnancy and lactation on birth outcomes and infant growth in rural Burkina Faso: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e038393. [PMID: 33762226 PMCID: PMC7993280 DOI: 10.1136/bmjopen-2020-038393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 01/06/2021] [Accepted: 01/23/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Adequate nutrition during pregnancy is crucial to both mother and child. Maternal malnutrition can be the cause of stillbirth or lead to poor birth outcomes such as preterm delivery and small-for-gestational-age newborns. There is a probable positive effect of providing pregnant women a balanced energy-protein (BEP) food supplement, but more evidence is needed. The MIcronutriments pour la SAnté de la Mère et de l'Enfant (MISAME) III project aims to improve birth outcomes and infant growth by testing a BEP supplement during pregnancy and lactation in rural Burkina Faso. This paper describes the study protocol. METHODS AND ANALYSIS MISAME-III is a four-arm individually randomised efficacy trial implemented in six rural health centre catchments areas in the district of Houndé. Eligible pregnant women, aged between 15 and 40 years old and living in the study areas, will be enrolled. Women will be randomly assigned to one of the four study groups: (1) prenatal intervention only, (2) postnatal intervention only, (3) prenatal and postnatal intervention or (4) no prenatal or postnatal intervention. The intervention group will receive the BEP supplement and iron/folic acid (IFA) tablets, while the control group will only receive the IFA tablets following the national health protocol. Consumption will be supervised by trained village women on a daily basis by means of home visits. The primary outcomes are small-for-gestational age at birth and length-for-age z-score at 6 months of age. Secondary outcomes will be measured at birth and during the first 6 months of the infants' life. Women will be enrolled from October 2019 until the total sample size is reached. ETHICS AND DISSEMINATION MISAME-III has been reviewed and approved by the University Hospital of Ghent and the ethics committee of Centre Muraz, Burkina Faso. Informed consent will be obtained. Results will be published in relevant journals and shared with other researchers and public health institutions. TRIAL REGISTRATION NUMBER NCT03533712.
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Affiliation(s)
- Katrien Vanslambrouck
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
| | - Laeticia Celine Toe
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
- Institut de Recherche en Sciences de la Sante, Bobo-Dioulasso, Burkina Faso
| | - Nathalie De Cock
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
| | | | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
| | - Giles Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
| | | | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
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Qamar H, Perumal N, Papp E, Gernand AD, Al Mahmud A, Roth DE. Higher maternal parathyroid hormone concentration at delivery is not associated with smaller newborn size. Endocr Connect 2021; 10:345-357. [PMID: 33640873 PMCID: PMC8052570 DOI: 10.1530/ec-21-0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 11/08/2022]
Abstract
Intrauterine growth restriction (IUGR) reflects inadequate growth in-utero and is prevalent in low resource settings. This study aimed to assess the association of maternal delivery parathyroid hormone (PTH) - a regulator of bone turnover and calcium homeostasis - with newborn anthropometry, to identify regulators of PTH, and to delineate pathways by which maternal PTH regulates birth size using path analysis. This was a cross-sectional analysis of data from participants (n = 537) enrolled in the Maternal Vitamin D for Infant Growth trial in Dhaka, Bangladesh. Primary exposures were maternal delivery intact PTH (iPTH) or whole PTH (wPTH) and outcomes were gestational age- and sex-standardized z-scores for birth length (LAZ), weight (WAZ), and head circumference (HCAZ). Hypothesized regulators of PTH included calcium and protein intake, vitamin D, magnesium, fibroblast-like growth factor-23 (FGF23), and C-reactive protein. Maternal iPTH was not associated with birth size in linear regression analyses; however, in path analysis models, every SD increase in log(iPTH) was associated with 0.08SD (95% CI: 0.002, 0.162) higher LAZ. In linear regression and path analysis models, wPTH was positively associated with WAZ. Vitamin D suppressed PTH, while FGF23 was positively associated with PTH. In path analysis models, higher magnesium was negatively associated with LAZ; FGF23 was positively associated and protein intake was negatively associated with LAZ, WAZ, and HCAZ. Higher maternal PTH in late pregnancy is unlikely to contribute to IUGR. Future studies should investigate maternal FGF23, magnesium and protein intake as regulators of fetal growth, particularly in settings where food insecurity and IUGR are public health problems.
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Affiliation(s)
- Huma Qamar
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Nandita Perumal
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eszter Papp
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alison D Gernand
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Abdullah Al Mahmud
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Daniel E Roth
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
- Correspondence should be addressed to D E Roth:
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Young MF, Ramakrishnan U. Maternal Undernutrition before and during Pregnancy and Offspring Health and Development. ANNALS OF NUTRITION & METABOLISM 2021; 76:1-13. [PMID: 33524980 DOI: 10.1159/000510595] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022]
Abstract
Maternal undernutrition remains a critical public health problem. There are large regional and within-country disparities in the burden of underweight, anemia, and micronutrient deficiencies across the globe. Driving these disparities are complex and multifactorial causes, including access to health services, water and sanitation, women's status, and food insecurity as well as the underlying social, economic, and political context. Women's health, nutrition, and wellbeing across the continuum of preconception to pregnancy are critical for ensuring positive pregnancy and long-term outcomes for both the mother and child. In this review, we summarize the evidence base for nutrition interventions before and during pregnancy that will help guide programs targeted towards women's nutrition. Growing evidence from preconception nutrition trials demonstrates an impact on offspring size at birth. Preconception anemia and low preconception weight are associated with an increased risk of low birth weight and small for gestational age births. During pregnancy, several evidence-based strategies exist, including balanced-energy protein supplements, multiple micronutrient supplements, and small-quantity lipid nutrient supplements for improving birth outcomes. There, however, remain several important priority areas and research gaps for improving women's nutrition before and during pregnancy. Further progress is needed to prioritize preconception nutrition and access to health and family planning resources. Additional research is required to understand the long-term effects of preconception and pregnancy interventions particularly on offspring development. Furthermore, while there is a strong evidence base for maternal nutrition interventions, the next frontier requires a greater focus on implementation science and equity to decrease global maternal undernutrition disparities.
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Affiliation(s)
- Melissa F Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA,
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Kinshella MLW, Omar S, Scherbinsky K, Vidler M, Magee LA, von Dadelszen P, Moore SE, Elango R. Effects of Maternal Nutritional Supplements and Dietary Interventions on Placental Complications: An Umbrella Review, Meta-Analysis and Evidence Map. Nutrients 2021; 13:472. [PMID: 33573262 PMCID: PMC7912620 DOI: 10.3390/nu13020472] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/26/2021] [Indexed: 01/08/2023] Open
Abstract
The placenta is a vital, multi-functional organ that acts as an interface between maternal and fetal circulation during pregnancy. Nutritional deficiencies during pregnancy alter placental development and function, leading to adverse pregnancy outcomes, such as pre-eclampsia, infants with small for gestational age and low birthweight, preterm birth, stillbirths and maternal mortality. Maternal nutritional supplementation may help to mitigate the risks, but the evidence base is difficult to navigate. The primary purpose of this umbrella review is to map the evidence on the effects of maternal nutritional supplements and dietary interventions on pregnancy outcomes related to placental disorders and maternal mortality. A systematic search was performed on seven electronic databases, the PROSPERO register and references lists of identified papers. The results were screened in a three-stage process based on title, abstract and full-text by two independent reviewers. Randomized controlled trial meta-analyses on the efficacy of maternal nutritional supplements or dietary interventions were included. There were 91 meta-analyses included, covering 23 types of supplements and three types of dietary interventions. We found evidence that supports supplementary vitamin D and/or calcium, omega-3, multiple micronutrients, lipid-based nutrients, and balanced protein energy in reducing the risks of adverse maternal and fetal health outcomes. However, these findings are limited by poor quality of evidence. Nutrient combinations show promise and support a paradigm shift to maternal dietary balance, rather than single micronutrient deficiencies, to improve maternal and fetal health. The review is registered at PROSPERO (CRD42020160887).
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Affiliation(s)
- Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
| | - Shazmeen Omar
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
| | - Kerri Scherbinsky
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
| | - Laura A. Magee
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
- Department of Women & Children’s Health, King’s College London, London WC2R 2LS, UK;
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
- Department of Women & Children’s Health, King’s College London, London WC2R 2LS, UK;
| | - Sophie E. Moore
- Department of Women & Children’s Health, King’s College London, London WC2R 2LS, UK;
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, P.O. Box 273 Banjul, The Gambia
| | - Rajavel Elango
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Division of Neonatology, BC Women’s Hospital and Health Centre, Vancouver, BC V6H 3N1, Canada
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Old Question Revisited: Are High-Protein Diets Safe in Pregnancy? Nutrients 2021; 13:nu13020440. [PMID: 33572843 PMCID: PMC7911198 DOI: 10.3390/nu13020440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background: A previous randomized dietary intervention in pregnant women from the 1970s, the Harlem Trial, reported retarded fetal growth and excesses of very early preterm births and neonatal deaths among those receiving high-protein supplementation. Due to ethical challenges, these findings have not been addressed in intervention settings. Exploring these findings in an observational setting requires large statistical power due to the low prevalence of these outcomes. The aim of this study was to investigate if the findings on high protein intake could be replicated in an observational setting by combining data from two large birth cohorts. Methods: Individual participant data on singleton pregnancies from the Danish National Birth Cohort (DNBC) (n = 60,141) and the Norwegian Mother, Father and Child Cohort Study (MoBa) (n = 66,302) were merged after a thorough harmonization process. Diet was recorded in mid-pregnancy and information on birth outcomes was extracted from national birth registries. Results: The prevalence of preterm delivery, low birth weight and fetal and neonatal deaths was 4.77%, 2.93%, 0.28% and 0.17%, respectively. Mean protein intake (standard deviation) was 89 g/day (23). Overall high protein intake (>100 g/day) was neither associated with low birth weight nor fetal or neonatal death. Mean birth weight was essentially unchanged at high protein intakes. A modest increased risk of preterm delivery [odds ratio (OR): 1.10 (95% confidence interval (CI): 1.01, 1.19)] was observed for high (>100 g/day) compared to moderate protein intake (80–90 g/day). This estimate was driven by late preterm deliveries (weeks 34 to <37) and greater risk was not observed at more extreme intakes. Very low (<60 g/day) compared to moderate protein intake was associated with higher risk of having low-birth weight infants [OR: 1.59 (95%CI: 1.25, 2.03)]. Conclusions: High protein intake was weakly associated with preterm delivery. Contrary to the results from the Harlem Trial, no indications of deleterious effects on fetal growth or perinatal mortality were observed.
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de Kok B, Moore K, Jones L, Vanslambrouck K, Toe LC, Ouédraogo M, Ganaba R, de Pee S, Bedford J, Lachat C, Kolsteren P, Isanaka S. Home consumption of two fortified balanced energy protein supplements by pregnant women in Burkina Faso. MATERNAL AND CHILD NUTRITION 2021; 17:e13134. [PMID: 33405368 PMCID: PMC8189188 DOI: 10.1111/mcn.13134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 01/14/2023]
Abstract
Balanced energy protein (BEP) supplementation for pregnant and lactating women in low‐ and middle‐income countries is a promising strategy to improve birth outcomes and child growth. The objective of this study was to assess and compare the acceptability of new formulations of two fortified BEP supplements, a lipid‐based peanut paste and a vanilla biscuit, among 80 pregnant women in rural Burkina Faso, prior to an efficacy trial. A 10‐week individually randomized cross‐over study was designed, in which women received a weekly supply of each supplement for 4 weeks, and a daily choice between the supplements in the last 2 weeks. Questionnaires to assess daily consumption and supplement acceptability (n = 80) and home observations (n = 20) were combined with focus group discussions (n = 6) and in‐depth interviews with women (n = 80) and stakeholders (n = 24). Results showed that the two supplements were well accepted. Quantitative findings indicated high compliance (>99.6%) and high overall appreciation (Likert score >6 out of 7) of both supplements. The assessment of preferred choice in Weeks 9 and 10 indicated a slight preference for the vanilla biscuit. Qualitative findings indicated that perceived health benefits, support from household members and educational messages from health professionals were important drivers for acceptance and compliance. Sharing was not often reported but was identified during interviews as a possible risk. We recommend that future studies use a combination of methods to identify appropriate food supplements and context‐specific factors that influence acceptability, compliance and subsequent impact of nutritious food supplements.
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Affiliation(s)
- Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | | | | | - Katrien Vanslambrouck
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Laeticia Celine Toe
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.,Institut de Recherche en Sciences de la Santé (IRSS), Unité Nutrition et Maladies Métaboliques, Bobo-Dioulasso, Burkina Faso
| | | | | | - Saskia de Pee
- Applying Evidence for Nutrition (AE4N), Wassenaar, The Netherlands.,Nutrition Division, World Food Programme, Rome, Italy.,Division of Food and Nutrition Policy and Programs, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Juliet Bedford
- Institut de Recherche en Sciences de la Santé (IRSS), Unité Nutrition et Maladies Métaboliques, Bobo-Dioulasso, Burkina Faso
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Sheila Isanaka
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Jones L, de Kok B, Moore K, de Pee S, Bedford J, Vanslambrouck K, Toe LC, Lachat C, De Cock N, Ouédraogo M, Ganaba R, Kolsteren P, Isanaka S. Acceptability of 12 fortified balanced energy protein supplements - Insights from Burkina Faso. MATERNAL & CHILD NUTRITION 2021; 17:e13067. [PMID: 32757351 PMCID: PMC7729548 DOI: 10.1111/mcn.13067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022]
Abstract
Poor maternal nutrition contributes to poor birth outcomes, including low birth weight and small for gestational age births. Fortified balanced energy protein (BEP) supplements may be beneficial, although evidence is limited. This mixed method study, conducted among pregnant women in Burkina Faso, is part of a larger clinical trial that seeks to understand the impact of fortified BEP supplements on pregnancy outcomes and child growth. The formative research reported here, a single-meal rapid assessment of 12 product formulations, sought to understand product preferences for provision of BEP supplements and contextual factors that might affect product acceptability and use. Results indicate a preference for products perceived as sweet rather than salty/savoury and for products perceived as familiar, as well as a sensitivity to product odours. Women expressed a willingness and intention to use the products even if they did not like them, because of the health benefits for their babies. Data also indicate that household food sharing practices may impact supplement use, although most women denied any intention to share the products. Sharing behaviour should therefore be monitored, and strategies to avoid sharing should be developed during the succeeding parts of the research.
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Affiliation(s)
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
| | | | - Saskia de Pee
- Applying Evidence for Nutrition (AE4N)WassenaarThe Netherlands
- Nutrition DivisionWorld Food ProgrammeRomeItaly
- Division of Food and Nutrition Policy and ProgramsFriedman School of Nutrition Science and Policy, Tufts UniversityBostonMassachusettsUSA
| | | | - Katrien Vanslambrouck
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
| | - Laeticia Celine Toe
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
- Institut de Recherche en Sciences de la Santé (IRSS), Unité de nutrition et maladies métaboliquesGhent UniversityGhentBelgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
| | - Nathalie De Cock
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
| | | | | | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
| | - Sheila Isanaka
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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Ota E, da Silva Lopes K, Middleton P, Flenady V, Wariki WM, Rahman MO, Tobe-Gai R, Mori R. Antenatal interventions for preventing stillbirth, fetal loss and perinatal death: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev 2020; 12:CD009599. [PMID: 33336827 PMCID: PMC8078228 DOI: 10.1002/14651858.cd009599.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Stillbirth is generally defined as a death prior to birth at or after 22 weeks' gestation. It remains a major public health concern globally. Antenatal interventions may reduce stillbirths and improve maternal and neonatal outcomes in settings with high rates of stillbirth. There are several key antenatal strategies that aim to prevent stillbirth including nutrition, and prevention and management of infections. OBJECTIVES To summarise the evidence from Cochrane systematic reviews on the effects of antenatal interventions for preventing stillbirth for low risk or unselected populations of women. METHODS We collaborated with Cochrane Pregnancy and Childbirth's Information Specialist to identify all their published reviews that specified or reported stillbirth; and we searched the Cochrane Database of Systematic Reviews (search date: 29 Feburary 2020) to identify reviews published within other Cochrane groups. The primary outcome measure was stillbirth but in the absence of stillbirth data, we used perinatal mortality (both stillbirth and death in the first week of life), fetal loss or fetal death as outcomes. Two review authors independently evaluated reviews for inclusion, extracted data and assessed quality of evidence using AMSTAR (A Measurement Tool to Assess Reviews) and GRADE tools. We assigned interventions to categories with graphic icons to classify the effectiveness of interventions as: clear evidence of benefit or harm; clear evidence of no effect or equivalence; possible benefit or harm; or unknown benefit or harm or no effect or equivalence. MAIN RESULTS We identified 43 Cochrane Reviews that included interventions in pregnant women with the potential for preventing stillbirth; all of the included reviews reported our primary outcome 'stillbirth' or in the absence of stillbirth, 'perinatal death' or 'fetal loss/fetal death'. AMSTAR quality was high in 40 reviews with scores ranging from 8 to 11 and moderate in three reviews with a score of 7. Nutrition interventions Clear evidence of benefit: balanced energy/protein supplementation versus no supplementation suggests a probable reduction in stillbirth (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.39 to 0.94, 5 randomised controlled trials (RCTs), 3408 women; moderate-certainty evidence). Clear evidence of no effect or equivalence for stillbirth or perinatal death: vitamin A alone versus placebo or no treatment; and multiple micronutrients with iron and folic acid versus iron with or without folic acid. Unknown benefit or harm or no effect or equivalence: for all other nutrition interventions examined the effects were uncertain. Prevention and management of infections Possible benefit for fetal loss or death: insecticide-treated anti-malarial nets versus no nets (RR 0.67, 95% CI 0.47 to 0.97, 4 RCTs; low-certainty). Unknown evidence of no effect or equivalence: drugs for preventing malaria (stillbirth RR 1.02, 95% CI 0.76 to 1.36, 5 RCTs, 7130 women, moderate certainty in women of all parity; perinatal death RR 1.24, 95% CI 0.94 to 1.63, 4 RCTs, 5216 women, moderate-certainty in women of all parity). Prevention, detection and management of other morbidities Clear evidence of benefit: the following interventions suggest a reduction: midwife-led models of care in settings where the midwife is the primary healthcare provider particularly for low-risk pregnant women (overall fetal loss/neonatal death reduction RR 0.84, 95% CI 0.71 to 0.99, 13 RCTs, 17,561 women; high-certainty), training versus not training traditional birth attendants in rural populations of low- and middle-income countries (stillbirth reduction odds ratio (OR) 0.69, 95% CI 0.57 to 0.83, 1 RCT, 18,699 women, moderate-certainty; perinatal death reduction OR 0.70, 95% CI 0.59 to 0.83, 1 RCT, 18,699 women, moderate-certainty). Clear evidence of harm: a reduced number of antenatal care visits probably results in an increase in perinatal death (RR 1.14 95% CI 1.00 to 1.31, 5 RCTs, 56,431 women; moderate-certainty evidence). Clear evidence of no effect or equivalence: there was evidence of no effect in the risk of stillbirth/fetal loss or perinatal death for the following interventions and comparisons: psychosocial interventions; and providing case notes to women. Possible benefit: community-based intervention packages (including community support groups/women's groups, community mobilisation and home visitation, or training traditional birth attendants who made home visits) may result in a reduction of stillbirth (RR 0.81, 95% CI 0.73 to 0.91, 15 RCTs, 201,181 women; low-certainty) and perinatal death (RR 0.78, 95% CI 0.70 to 0.86, 17 RCTs, 282,327 women; low-certainty). Unknown benefit or harm or no effect or equivalence: the effects were uncertain for other interventions examined. Screening and management of fetal growth and well-being Clear evidence of benefit: computerised antenatal cardiotocography for assessing infant's well-being in utero compared with traditional antenatal cardiotocography (perinatal mortality reduction RR 0.20, 95% CI 0.04 to 0.88, 2 RCTs, 469 women; moderate-certainty). Unknown benefit or harm or no effect or equivalence: the effects were uncertain for other interventions examined. AUTHORS' CONCLUSIONS While most interventions were unable to demonstrate a clear effect in reducing stillbirth or perinatal death, several interventions suggested a clear benefit, such as balanced energy/protein supplements, midwife-led models of care, training versus not training traditional birth attendants, and antenatal cardiotocography. Possible benefits were also observed for insecticide-treated anti-malarial nets and community-based intervention packages, whereas a reduced number of antenatal care visits were shown to be harmful. However, there was variation in the effectiveness of interventions across different settings, indicating the need to carefully understand the context in which these interventions were tested. Further high-quality RCTs are needed to evaluate the effects of antenatal preventive interventions and which approaches are most effective to reduce the risk of stillbirth. Stillbirth (or fetal death), perinatal and neonatal death need to be reported separately in future RCTs of antenatal interventions to allow assessment of different interventions on these rare but important outcomes and they need to clearly define the target populations of women where the intervention is most likely to be of benefit. As the high burden of stillbirths occurs in low- and middle-income countries, further high-quality trials need to be conducted in these settings as a priority.
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Affiliation(s)
- Erika Ota
- Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University , Tokyo, Japan
| | | | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Windy Mv Wariki
- Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
| | - Md Obaidur Rahman
- Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | | | - Rintaro Mori
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Saran A, White H, Albright K, Adona J. Mega-map of systematic reviews and evidence and gap maps on the interventions to improve child well-being in low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1116. [PMID: 37018457 PMCID: PMC8356294 DOI: 10.1002/cl2.1116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Despite a considerable reduction in child mortality, nearly six million children under the age of five die each year. Millions more are poorly nourished and in many parts of the world, the quality of education remains poor. Children are at risk from multiple violations of their rights, including child labour, early marriage, and sexual exploitation. Research plays a crucial role in helping to close the remaining gaps in child well-being, yet the global evidence base for interventions to meet these challenges is mostly weak, scattered and often unusable by policymakers and practitioners. This mega-map encourages the generation and use of rigorous evidence on effective ways to improve child well-being for policy and programming. Objectives The aim of this mega-map is to identify, map and provide an overview of the existing evidence synthesis on the interventions aimed at improving child well-being in low- and middle-income countries (LMICs). Methods Campbell evidence and gap maps (EGMs) are based on a review of existing mapping standards (Saran & White, 2018) which drew in particular of the approach developed by 3ie (Snilstveit, Vojtkova, Bhavsar, & Gaarder, 2013). As defined in the Campbell EGM guidance paper; "Mega-map is a map of evidence synthesis, that is, systematic reviews, and does not include primary studies" (Campbell Collaboration, 2020). The mega-map on child well-being includes studies with participants aged 0-18 years, conducted in LMICs, and published from year 2000 onwards. The search followed strict inclusion criteria for interventions and outcomes in the domains of health, education, social work and welfare, social protection, environmental health, water supply and sanitation (WASH) and governance. Critical appraisal of included systematic reviews was conducted using "A Measurement Tool to Assess Systematic Reviews"-AMSTAR-2 rating scale (Shea, et al., 2017). Results We identified 333 systematic reviews and 23 EGMs. The number of studies being published has increased year-on-year since 2000. However, the distribution of studies across World Bank regions, intervention and outcome categories are uneven. Most systematic reviews examine interventions pertaining to traditional areas of health and education. Systematic reviews in these traditional areas are also the most funded. There is limited evidence in social work and social protection. About 69% (231) of the reviews are assessed to be of low and medium quality. There are evidence gaps with respect to key vulnerable populations, including children with disabilities and those who belong to minority groups. Conclusion Although an increasing number of systematic reviews addressing child well-being topics are being published, some clear gaps in the evidence remain in terms of quality of reviews and some interventions and outcome areas. The clear gap is the small number of reviews focusing explicitly on either equity or programmes for disadvantaged groups and those who are discriminated against.
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Affiliation(s)
| | | | | | - Jill Adona
- Philippines Institute of Development StudiesManilaPhilippines
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Scott N, Delport D, Hainsworth S, Pearson R, Morgan C, Huang S, Akuoku JK, Piwoz E, Shekar M, Levin C, Toole M, Homer CSE. Ending malnutrition in all its forms requires scaling up proven nutrition interventions and much more: a 129-country analysis. BMC Med 2020; 18:356. [PMID: 33183301 PMCID: PMC7661178 DOI: 10.1186/s12916-020-01786-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/16/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sustainable Development Goal (SDG) 2.2 calls for an end to all forms of malnutrition, with 2025 targets of a 40% reduction in stunting (relative to 2012), for wasting to occur in less than 5% of children, and for a 50% reduction in anaemia in women (15-49 years). We assessed the likelihood of countries reaching these targets by scaling up proven interventions and identified priority interventions, based on cost-effectiveness. METHODS For 129 countries, the Optima Nutrition model was used to compare 2019-2030 nutrition outcomes between a status quo (maintained intervention coverage) scenario and a scenario where outcome-specific interventions were scaled up to 95% coverage over 5 years. The average cost-effectiveness of each intervention was calculated as it was added to an expanding package of interventions. RESULTS Of the 129 countries modelled, 46 (36%), 66 (51%) and 0 (0%) were on track to achieve the stunting, wasting and anaemia targets respectively. Scaling up 18 nutrition interventions increased the number of countries reaching the SDG 2.2 targets to 50 (39%), 83 (64%) and 7 (5%) respectively. Intermittent preventative treatment of malaria during pregnancy (IPTp), infant and young child feeding education, vitamin A supplementation and lipid-based nutrition supplements for children produced 88% of the total impact on stunting, with average costs per case averted of US$103, US$267, US$556 and US$1795 when interventions were consecutively scaled up, respectively. Vitamin A supplementation and cash transfers produced 100% of the total global impact on prevention of wasting, with average costs per case averted of US$1989 and US$19,427, respectively. IPTp, iron and folic acid supplementation for non-pregnant women, and multiple micronutrient supplementation for pregnant women produced 85% of the total impact on anaemia prevalence, with average costs per case averted of US$9, US$35 and US$47, respectively. CONCLUSIONS Prioritising nutrition investment to the most cost-effective interventions within the country context can maximise the impact of funding. A greater focus on complementing nutrition-specific interventions with nutrition-sensitive ones that address the social determinants of health is critical to reach the SDG targets.
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Affiliation(s)
- Nick Scott
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Dominic Delport
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Samuel Hainsworth
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Ruth Pearson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Christopher Morgan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Jhpiego, Baltimore, MD USA
| | - Shan Huang
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | | | - Ellen Piwoz
- Nutrition Global Development Program, Bill and Melinda Gates Foundation, Seattle, USA
| | | | - Carol Levin
- Department of Global Health, University of Washington, Seattle, USA
| | - Mike Toole
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Caroline SE Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
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Xiong T, Wu Y, Huang L, Chen X, Zhang Y, Zhong C, Gao Q, Hong M, Hu X, Yang X, Yang N, Hao L. Association between the maternal protein nutrition status during pregnancy and the risk of preterm birth. MATERNAL AND CHILD NUTRITION 2020; 17:e13043. [PMID: 32815668 PMCID: PMC7729649 DOI: 10.1111/mcn.13043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 04/07/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022]
Abstract
We aimed to assess protein nutrition status during pregnancy by maternal plasma total protein (MTP) levels in urban pregnant women and to explore the association between the trimester-specific MTP levels and risk of preterm birth (PTB). A prospective design was conducted in 3,382 mother-newborn pairs with the second-trimester maternal MTP information and in 3,478 mother-newborn pairs with the third-trimester MTP information. Multiple Cox proportional hazard regression and multiple linear regression were used to analyse the associations between MTP levels and PTB risk as well as gestational duration, respectively. Nearly all the second-trimester MTP levels were within the clinical reference range, but more than 40% of the third-trimester MTP levels were less than the lower limit of normal. No significant association was found between the second-trimester MTP level and PTB risk. However, the adjusted hazard ratios (HRs) of PTB across increasing quartiles of the third-trimester MTP levels were 1.00 (reference), 0.59 (0.36, 0.95), 0.35 (0.20, 0.60), and 0.32 (0.19, 0.53) (p for trend < 0.001), respectively. Each standard deviations increment of the third-trimester MTP was associated with increase of 0.13 weeks in gestational duration. Moreover, stratified analyses showed that the effects of third-trimester MTP on PTB risk and gestational duration were stronger in pregnant women carrying female offspring than those carrying male offspring (p for interaction < 0.05). The third-trimester MTP level was inversely associated with PTB risk and was positively associated with gestational duration. Improving third-trimester MTP level may be helpful for preventing PTB.
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Affiliation(s)
- Ting Xiong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China
| | - Yuanjue Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China
| | - Li Huang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China
| | - Xi Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China
| | - Yu Zhang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China
| | - Chunrong Zhong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China
| | - Qin Gao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China
| | - Miao Hong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China
| | - Xingwen Hu
- Hubei Maternal and Child Health Hospital, Wuhan, China
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China
| | - Nianhong Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China
| | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China
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Kinra S, Gregson J, Prabhakaran P, Gupta V, Walia GK, Bhogadi S, Gupta R, Aggarwal A, Mallinson PAC, Kulkarni B, Prabhakaran D, Davey Smith G, Radha Krishna KV, Ebrahim S, Kuper H, Ben-Shlomo Y. Effect of supplemental nutrition in pregnancy on offspring's risk of cardiovascular disease in young adulthood: Long-term follow-up of a cluster trial from India. PLoS Med 2020; 17:e1003183. [PMID: 32692751 PMCID: PMC7373266 DOI: 10.1371/journal.pmed.1003183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/16/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Undernutrition during intrauterine life and early childhood is hypothesised to increase the risk of cardiovascular disease (Developmental Origins of Health and Disease Hypothesis), but experimental evidence from humans is limited. This hypothesis has major implications for control of the cardiovascular disease epidemic in South Asia (home to a quarter of world's population), where a quarter of newborns have low birth weight. We investigated whether, in an area with prevalent undernutrition, supplemental nutrition offered to pregnant women and their offspring below the age of 6 years was associated with a lower risk of cardiovascular disease in the offspring when they were young adults. METHODS AND FINDINGS The Hyderabad Nutrition Trial was a community-based nonrandomised controlled intervention trial conducted in 29 villages near Hyderabad, India (1987-1990). Protein-calorie food supplement was offered daily to pregnant and lactating women (2.09 MJ energy and 20-25 g protein) and their offspring (1.25 MJ energy and 8-10 g protein) until the age of six years in the 15 intervention villages, but not in the 14 control villages. A total of 1,826 participants (949 from the intervention villages and 877 from the control villages, representing 70% of the cohort) at a mean age of 21.6 years (62% males) were examined between 2009 and 2012. The mean body mass index (BMI) of the participants was 20 kg/m2 and the mean systolic blood pressure was 115 mm Hg. The age, sex, socioeconomic position, and urbanisation-adjusted effects of intervention (beta coefficients and 95% confidence intervals) on outcomes were as follows: carotid intima-media thickness, 0.01 mm (-0.01 to 0.03), p = 0.36; arterial stiffness (augmentation index), -1.1% (-2.5 to 0.3), p = 0.097; systolic blood pressure, 0.5 mm Hg (-0.6 to 1.6), p = 0.36; BMI, -0.13 kg/m2 (-0.75 to 0.09), p = 0.093; low-density lipoprotein (LDL) cholesterol, 0.06 mmol/L (-0.07 to 0.2), p = 0.37; and fasting insulin (log), -0.06 mU/L (-0.19 to 0.07), p = 0.43. The limitations of this study include nonrandomised allocation of intervention and lack of data on compliance, and potential for selection bias due to incomplete follow-up. CONCLUSIONS Our results showed that in an area with prevalent undernutrition, protein-calorie food supplements offered to pregnant women and their offspring below the age of 6 years were not associated with lower levels of cardiovascular risk factors among offspring when they were young adults. Our findings, coupled with evidence from other intervention studies to date, suggest that policy makers should attach limited value to cardiovascular health benefits of maternal and child protein-calorie food supplementation programmes.
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Affiliation(s)
- Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - John Gregson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Vipin Gupta
- Department of Anthropology, University of Delhi, Delhi, India
| | | | | | - Ruby Gupta
- Public Health Foundation of India, Delhi, India
| | | | - Poppy Alice Carson Mallinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | | | - Shah Ebrahim
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Christian P, Smith ER, Zaidi A. Addressing inequities in the global burden of maternal undernutrition: the role of targeting. BMJ Glob Health 2020; 5:e002186. [PMID: 32231793 PMCID: PMC7101036 DOI: 10.1136/bmjgh-2019-002186] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Parul Christian
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily R Smith
- George Washington University, Washington, DC, USA.,Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Anita Zaidi
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
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