Improving women's diet quality preconceptionally and during gestation: effects on birth weight and prevalence of low birth weight--a randomized controlled efficacy trial in India (Mumbai Maternal Nutrition Project).
Am J Clin Nutr
; 100(5): 1257-68, 2014 Nov.
Article
em En
| MEDLINE
| ID: mdl-25332324
ABSTRACT
BACKGROUND:
Low birth weight (LBW) is an important public health problem in undernourished populations.OBJECTIVE:
We tested whether improving women's dietary micronutrient quality before conception and throughout pregnancy increases birth weight in a high-risk Indian population.DESIGN:
The study was a nonblinded, individually randomized controlled trial. The intervention was a daily snack made from green leafy vegetables, fruit, and milk (treatment group) or low-micronutrient vegetables (potato and onion) (control group) from ≥ 90 d before pregnancy until delivery in addition to the usual diet. Treatment snacks contained 0.69 MJ of energy (controls 0.37 MJ) and 10-23% of WHO Reference Nutrient Intakes of ß-carotene, riboflavin, folate, vitamin B-12, calcium, and iron (controls 0-7%). The primary outcome was birth weight.RESULTS:
Of 6513 women randomly assigned, 2291 women became pregnant, 1962 women delivered live singleton newborns, and 1360 newborns were measured. In an intention-to-treat analysis, there was no overall increase in birth weight in the treatment group (+26 g; 95% CI -15, 68 g; P = 0.22). There was an interaction (P < 0.001) between the allocation group and maternal prepregnant body mass index (BMI; in kg/m(2)) [birth-weight effect -23, +34, and +96 g in lowest (<18.6), middle (18.6-21.8), and highest (>21.8) thirds of BMI, respectively]. In 1094 newborns whose mothers started supplementation ≥ 90 d before pregnancy (per-protocol analysis), birth weight was higher in the treatment group (+48 g; 95% CI 1, 96 g; P = 0.046). Again, the effect increased with maternal BMI (-8, +79, and +113 g; P-interaction = 0.001). There were similar results for LBW (intention-to-treat OR 0.83; 95% CI 0.66, 1.05; P = 0.10; per-protocol OR = 0.76; 95% CI 0.59, 0.98; P = 0.03) but no effect on gestational age in either analysis.CONCLUSIONS:
A daily snack providing additional green leafy vegetables, fruit, and milk before conception and throughout pregnancy had no overall effect on birth weight. Per-protocol and subgroup analyses indicated a possible increase in birth weight if the mother was supplemented ≥ 3 mo before conception and was not underweight. This trial was registered at www.controlled-trials.com/isrctn/ as ISRCTN62811278.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Recém-Nascido de Baixo Peso
/
Fenômenos Fisiológicos da Nutrição Materna
/
Dieta
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Promoção da Saúde
Tipo de estudo:
Clinical_trials
/
Guideline
/
Prevalence_studies
/
Risk_factors_studies
Aspecto:
Equity_inequality
Limite:
Adult
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Female
/
Humans
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Newborn
/
Pregnancy
País/Região como assunto:
Asia
Idioma:
En
Revista:
Am J Clin Nutr
Ano de publicação:
2014
Tipo de documento:
Article