1
|
Shao Y, Meng C, Liang YZ. Digital versus non-digital health interventions to improve iron supplementation in pregnant women: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1375622. [PMID: 38873205 PMCID: PMC11173591 DOI: 10.3389/fmed.2024.1375622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/20/2024] [Indexed: 06/15/2024] Open
Abstract
Objective To investigate the effects of digital health interventions for improving adherence to oral iron supplementation in pregnant women. Literature search Five databases were searched from their inception to October 2023 with no date restrictions. Study selection Randomized controlled trials (RCTs) that assessed the effects of digital health interventions on adherence to oral iron supplementation (e.g., tablets and capsules) compared to non-digital health interventions for pregnant women were eligible. Data synthesis We calculated standardized mean differences (SMDs) and mean differences (MDs) with 95% confidence intervals (CIs) for continuous variables using the inverse variance method. We calculated odds ratios (OR) with 95%CI for categorical variables using the Mantel-Haenszel model. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The risk of bias of the included RCTs was assessed using the Cochrane risk of bias tool 2.0. Results Ten trials with 1,633 participants were included. Based on 7 trials, digital health interventions can improve objective adherence rate comparing with non-digital health interventions (1,289 participants, OR = 4.07 [2.19, 7.57], p < 0.001, I2 = 69%) in pregnant women. Digital health interventions can improve subjective adherence behavior comparing with non-digital health interventions (3 trials, 434 participants, SMD = 0.82 [0.62, 1.01], p < 0.001, I2 = 0%) in pregnant women. Based on 3 trials, digital health interventions can improve tablets consumption comparing with non-digital health interventions (333 participants, SMD = 1.00 [0.57, 1.42], p < 0.001, I2 = 66%) in pregnant women. Digital health interventions can improve hemoglobin level comparing with non-digital health interventions (7 trials, 1,216 participants, MD = 0.59 [0.31, 0.88], p < 0.001, I2 = 93%) in pregnant women. Conclusion Digital health interventions were effective at improving adherence to oral iron supplementation and hemoglobin levels in pregnant women.
Collapse
Affiliation(s)
| | | | - Ying-Zhi Liang
- Department of Maternal Health, Beijing Haidian Maternal and Child Health Hospital, Beijing, China
| |
Collapse
|
2
|
Koivu AM, Haapaniemi T, Askari S, Bhandari N, Black RE, Chico RM, Dewey KG, Duggan CP, Klein N, Kumar S, Lawn JE, Manji K, Näsänen-Gilmore PK, Salasibew M, Semrau KEA, Ashorn U, Ashorn P. What more can be done? Prioritizing the most promising antenatal interventions to improve birth weight. Am J Clin Nutr 2023; 117 Suppl 2:S107-S117. [PMID: 37331758 PMCID: PMC10447483 DOI: 10.1016/j.ajcnut.2022.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/13/2022] [Accepted: 10/28/2022] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Low birth weight (LBW) is associated with neonatal mortality and sequelae of lifelong health problems; prioritizing the most promising antenatal interventions may guide resource allocation and improve health outcomes. OBJECTIVE We sought to identify the most promising interventions that are not yet included in the policy recommendations of the World Health Organization (WHO) but could complement antenatal care and reduce the prevalence of LBW and related adverse birth outcomes in low- and middle-income settings. METHODS We utilized an adapted Child Health and Nutrition Research Initiative (CHNRI) prioritization method. RESULTS In addition to procedures already recommended by WHO for the prevention of LBW, we identified six promising antenatal interventions that are not currently recommended by WHO with an indication for LBW prevention, namely: (1) provision of multiple micronutrients; (2) low-dose aspirin; (3) high-dose calcium; (4) prophylactic cervical cerclage; (5) psychosocial support for smoking cessation; and (6) other psychosocial support for targeted populations and settings. We also identified seven interventions for further implementation research and six interventions for efficacy research. CONCLUSION These promising interventions, coupled with increasing coverage of currently recommended antenatal care, could accelerate progress toward the global target of a 30% reduction in the number of LBW infants born in 2025 compared to 2006-10.
Collapse
Affiliation(s)
- Annariina M Koivu
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Tiia Haapaniemi
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sufia Askari
- Children's Investment Fund Foundation, London, United Kingdom
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - R Matthew Chico
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Christopher P Duggan
- Center for Nutrition, Boston Children's Hospital/Harvard Medical School; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Pieta K Näsänen-Gilmore
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Katherine E A Semrau
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - 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
| |
Collapse
|
3
|
Research priorities for maternal and perinatal health clinical trials and methods used to identify them: A systematic review. Eur J Obstet Gynecol Reprod Biol 2023; 280:120-131. [PMID: 36455392 DOI: 10.1016/j.ejogrb.2022.11.022] [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: 08/28/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Research prioritisation helps to target research resources to the most pressing health and healthcare needs of a population. This systematic review aimed to report research priorities in maternal and perinatal health and to assess the methods that were used to identify them. METHODS A systematic review was undertaken. Projects that aimed to identify research priorities that were considered to be amenable to clinical trials research were eligible for inclusion. The search, limited to the last decade and publications in English, included MEDLINE, EMBASE, CINHAL, relevant Cochrane priority lists, Cochrane Priority Setting Methods Group homepage, James Lind Alliance homepage, Joanna Brigg's register, PROSPERO register, reference lists of all included articles, grey literature, and the websites of relevant professional bodies, until 13 October 2020. The methods used for prioritisation were appraised using the Reporting Guideline for Priority Setting of Health Research (REPRISE). FINDINGS From the 62 included projects, 757 research priorities of relevance to maternal and perinatal health were identified. The most common priorities related to healthcare systems and services, pregnancy care and complications, and newborn care and complications. The least common priorities related to preconception and postpartum health, maternal mental health, contraception and pregnancy termination, and fetal medicine and surveillance. The most commonly used prioritisation methods were Delphi (20, 32%), Child Health Nutrition Research Initiative (17, 27%) and the James Lind Alliance (10, 16%). The fourteen projects (23%) that reported on at least 80% of the items included in the REPRISE guideline all used an established research prioritisation method. CONCLUSIONS There are a large number of diverse research priorities in maternal and perinatal health that are amenable to future clinical trials research. These have been identified by a variety of research prioritisation methods.
Collapse
|
4
|
Food-based nutrition counselling and education intervention for improved diets of pregnant women in rural Malawi: a qualitative study of factors influencing dietary behaviour change. Public Health Nutr 2022; 25:2436-2447. [PMID: 35369896 PMCID: PMC9991754 DOI: 10.1017/s1368980022000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We wanted to identify factors related to dietary behavioural change among impoverished pregnant women in the face of nutrition education and counselling, describing what creates an enabling environment and barriers for dietary change. DESIGN We used qualitative data from a cluster-randomised maternal education trial and conducted a thematic analysis using a social ecological framework to describe the factors that influenced dietary adherence. SETTING Mangochi district in rural Malawi. PARTICIPANTS We interviewed ten pregnant women and conducted four sets of focus group discussions with twenty-two significant family members (husbands and mothers-in-law) and twelve counsellors. RESULTS The participants' experiences showed that the main barriers of adherence to the intervention were taste, affordability and poverty. The use of powders and one-pot dishes, inclusion of both women and significant family members and a harmonisation with local food practices enabled adherence to the intervention. We found it crucial to focus the dietary education and counselling intervention on locally available ingredients and food processing methods. CONCLUSIONS Use of contextualised food-based solutions to combat maternal malnutrition was observed to be relatively cheap and sustainable. However, there is need for more research on local foods used as nutrition supplements. We suggest that investments need to be directed not only to nutrition education and counselling but also to the enabling factors that enhance adherence. The original cluster-randomised controlled trial was registered with Clinical trials.gov ID: NCT03136393.
Collapse
|
5
|
Shinde S, Wang D, Yussuf MH, Mwanyika-Sando M, Aboud S, Fawzi WW. Effectiveness of micronutrient supplementation for pregnant and lactating women on maternal and infant nutritional status in low- and middle-income countries: protocol for a systematic review and meta-analysis (Preprint). JMIR Res Protoc 2022; 11:e40134. [PMID: 36040761 PMCID: PMC9472043 DOI: 10.2196/40134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions Trial Registration International Registered Report Identifier (IRRID)
Collapse
Affiliation(s)
- Sachin Shinde
- T H Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Dongqing Wang
- T H Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Mashavu H Yussuf
- Africa Academy for Public Health, Dar es Salaam, United Republic of Tanzania
| | - Mary Mwanyika-Sando
- Africa Academy for Public Health, Dar es Salaam, United Republic of Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Wafaie W Fawzi
- T H Chan School of Public Health, Harvard University, Boston, MA, United States
| |
Collapse
|
6
|
The influence of the dietary exposome on oxidative stress in pregnancy complications. Mol Aspects Med 2022; 87:101098. [DOI: 10.1016/j.mam.2022.101098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 12/16/2022]
|
7
|
Interventions to improve vitamin D status in at-risk ethnic groups during pregnancy and early childhood: a systematic review. Public Health Nutr 2021; 24:3498-3519. [PMID: 33593453 DOI: 10.1017/s1368980021000756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To systematically review the literature with the primary aim of identifying behavioural interventions to improve vitamin D stores in children from at-risk ethnic groups. DESIGN Review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PROSPERO registration number: CRD42017080932. Health Behaviour Model and Behaviour Change Wheel framework constructs used to underpin evaluation of interventions. Methodological quality evaluated using Cochrane Risk of Bias, Cochrane ROBINS-I and NHLBI tools. SETTING Databases Cochrane Library, MEDLINE, EMBASE, CINAHL with secondary search of Google Scholar. No country limits set. Papers between January 1990 and February 2018, published in English included. Anticipating study heterogeneity, outcome measures not pre-specified and identified from individual full papers. Updated literature search November 2020. PARTICIPANTS Patient or population including pregnant women, newborns and children aged under 18 years, from Asian or African ethnic groups. RESULTS Of 10 690 articles screened, 298 underwent full-text review, with 24 ultimately included for data extraction. All identified studies conducted a vitamin D pharmacological supplementation intervention, with two also incorporating a behavioural intervention strategy. No study explicitly defined a primary aim of evaluating a behavioural intervention, undertaken to study its effect on vitamin D supplement uptake. CONCLUSIONS There is a need to address the paucity of data in ethnic at-risk children on how behavioural interventions ideally developed and co-produced with the community under study, affect and help improve vitamin D uptake, within the antenatal and pregnancy phase as well as during childhood.
Collapse
|
8
|
Gomes F, King SE, Dallmann D, Golan J, da Silva ACF, Hurley KM, Bergeron G, Bourassa MW, Mehta S. Interventions to increase adherence to micronutrient supplementation during pregnancy: a systematic review. Ann N Y Acad Sci 2021; 1493:41-58. [PMID: 33400303 PMCID: PMC8169578 DOI: 10.1111/nyas.14545] [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: 09/04/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Abstract
Prenatal micronutrient supplements are cost‐effective in reducing nutritional deficiencies and adverse pregnancy and birth outcomes. However, poor adherence remains a potential barrier to the successful implementation of these supplementation programs. This systematic review assessed the effectiveness of interventions designed to increase adherence to prenatal micronutrient supplementation. Following the Cochrane Collaboration Methodology, literature searches were conducted in six electronic databases and gray literature (on July 24, 2020), and abstract screening, data extraction, and risk of bias assessment were conducted independently by two reviewers. We included 22 studies. Interventions that resulted in increased adherence were most of the education‐based strategies, consumption monitoring by volunteer health workers or family members, SMS reminders, free provision of supplements, a multicomponent intervention with community mobilization, and a participatory action research intervention. In several studies, increased adherence was accompanied by beneficial effects on pregnancy and birth outcomes. Given the heterogeneity of study designs and methods used to define and measure adherence, a meta‐analysis was not appropriate. We identified several potentially effective strategies to improve supplementation adherence, which may need to be adapted to specific contexts when considered for program implementation. However, additional high‐quality studies are critically needed to effectively guide policies and programs.
Collapse
Affiliation(s)
- Filomena Gomes
- The New York Academy of Sciences, New York City, New York
| | - Shannon E King
- Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Diana Dallmann
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
| | - Jenna Golan
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | | | - Kristen M Hurley
- Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Vitamin Angels, Santa Barbara, California
| | | | | | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| |
Collapse
|
9
|
Gomes F, Bergeron G, Bourassa MW, Dallmann D, Golan J, Hurley KM, King SE, da Silva ACF, Mehta S. Interventions to increase adherence to micronutrient supplementation during pregnancy: a protocol for a systematic review. Ann N Y Acad Sci 2020; 1470:25-30. [PMID: 32052867 PMCID: PMC7384083 DOI: 10.1111/nyas.14319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 01/09/2023]
Abstract
Micronutrient supplementation during pregnancy has been shown to be a cost‐effective method to reduce the risk of adverse pregnancy and birth outcomes. However, one of the main barriers to the successful implementation of a micronutrient supplementation program in pregnancy is poor adherence. Our review will assess the effectiveness of interventions designed to increase adherence to micronutrient supplements in pregnancy. Following the Cochrane Collaboration Methodology, we will start by conducting the literature searches on Medline (via PubMed), Embase, Scopus, Web of Science, and Cochrane Library, in addition to sources of gray literature, to retrieve all the available relevant studies. We will include randomized controlled trials and nonrandomized studies with a control group, where participants are pregnant women taking any micronutrient supplements in the context of antenatal care globally. We will include studies with targeted interventions designed to improve adherence to micronutrient supplementation in pregnant women compared with (1) usual care or no intervention or (2) other targeted micronutrient adherence intervention. Abstract selection, data extraction, and risk of bias assessment (according to the type of studies) will be conducted by two independent reviewers. The pooled results will be reported using the standardized mean differences for continuous data, and odds ratio or risk ratio for dichotomous data. We will assess sources of heterogeneity and publication bias. By following this protocol, we will systematically assess and synthesize the existing evidence about interventions designed to increase adherence to micronutrient supplementation in pregnant women. Understanding which strategies are more effective to increase the consumption of micronutrient supplements during this critical stage of life will have significant implications for clinicians and policymakers involved in the delivery of prenatal micronutrient supplementation interventions.
Collapse
Affiliation(s)
- Filomena Gomes
- The New York Academy of Sciences, New York City, New York
| | | | | | - Diana Dallmann
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
| | - Jenna Golan
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Kristen M Hurley
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shannon E King
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Vitamin Angels, Santa Barbara, California
| | | | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| |
Collapse
|