The Timing of Initiating Complementary Feeding in Preterm Infants and Its Effect on Overweight: A Systematic Review.

BACKGROUND: What is the appropriate time to start complementary feeding for preterm infants? The answer to this question is yet under debate. The timing of initiating complementary feeding may be associated with overweight in term infants. This systematic review aimed to study the effect of the timing of initiating complementary feeding on overweight in preterm infants. Predefined search items included preterm infants, complementary feeding, overweight, and their synonyms. SUMMARY: The search identified 15,749 articles, of which 5 articles were included. Three studies presented data of randomized controlled trials and 2 studies were cohort studies. Two randomized controlled trials found no significant difference in body mass index (BMI) Z-score between the intervention groups at 12 months of age. One randomized controlled trial presented a significant greater mean rate of growth in length per week until 12 months in the preterm weaning strategy-group compared with the current best practices. One observational study concluded that each month the infants received complementary food later, the Z-score for length and weight was reduced by 0.1. Key Messages: No clear conclusion could be drawn from the included studies. This review illustrates the need for further research to access the effect of the timing of initiating complementary feeding on overweight in preterm infants.

The timing of complementary feeding in preterm infants and the effect on overweight: study protocol for a systematic review.

BACKGROUND: In term infants, there is evidence that early complementary feeding is a risk factor for childhood obesity. Therefore, timely introduction of complementary feeding during infancy is necessary. The World Health Organization (WHO) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) both developed recommendations for the start of complementary feeding for term-born infants. However, these guidelines cannot be directly translated to preterm infants. Recent literature looking at the introduction of complementary feeding in preterm infants gives contrasting information. Given these contrasting reports on the introduction of solid foods in premature born infants, a systematic review is needed. The primary objective of this study is to analyze the effect of the time starting complementary feeding on overweight (including obesity) in preterm infants. METHODS: An electronic systematic literature search with pre-defined terms will be conducted in Cochrane, PubMed, EMBASE, Web of Science, Scopus, and CINAHL. There will be no restriction for time period. Primarily, data from randomized controlled trials (RCTs) will be included in this systematic review. Search terms will include preterm infants, complementary feeding, overweight, and their synonyms. Article selection, including risk of bias assessment, will be performed by three reviewers independently. Body mass index standard deviation score (BMI-SDS or BMI-Z-score) will be used to compare studies. The consistency of results across the studies will influence the decision whether or not to combine results in a meta-analysis. Studies that cannot be included in the meta-analysis will be described in a narrative analysis. DISCUSSION: This systematic review will give an overview of the existing knowledge on the timing of complementary feeding in preterm infants and the effect on overweight. It will form a basis for future guidelines for complementary feeding for preterm infants. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015014215.

Maternal body mass index and adverse pregnancy outcomes: A ghanaian cohort study.

OBJECTIVE: To examine the association between maternal weight at <17 weeks gestation and maternal and infant outcomes of pregnancy, delivery, and the postpartum period in pregnant Ghanaian women. METHODS: A prospective cohort study of 1,000 women in Accra, Ghana (2012-2014), was conducted. Women were classified as having overweight (BMI 25-30) and obesity (BMI ≥ 30), and their obstetric and infant outcomes were analyzed using multivariate logistic regression. RESULTS: The analysis included 824 women, average 28 years (SD 5.1); 313 (31.3%) had overweight and 169 (16.9%) obesity. Women with obesity had a two-fold increased risk for cesarean sections (RR 2.20, 95% CI 1.21-4.02) and more than a six-fold higher risk for pregnancy-induced hypertension (RR 6.17, 95% CI 2.90-13.13) and chronic hypertension (RR 6.00, 95% CI 1.40-25.76). Infants of women with overweight or obesity were more likely to be macrosomic (RR 2.37, 95% CI 1.13-4.97). CONCLUSIONS: The global obesity epidemic has reached women in low- and middle-income countries (LMIC) with important adverse consequences for maternal and infant health. Antenatal care in LMIC will need to anticipate this potential expansion of complications, including the development of guidelines for optimal maternity care for pregnant women with overweight and obesity.