Growth from Birth Through Six Months for Infants of Mothers in the “Women First” Preconception Maternal Nutrition Trial

Krebs, Nancy F.; Hambidge, K. Michael; Westcott, Jay Y.; Garcés, Ana; Figueroa, Lester; Tsefu, Antoinette K; Lokangaka, Adrien; Goudar, Shivaprasad S.; Dhaded, Sangappa; Saleem, Sarah; Ali, Sumera Aziz; Bose, Carl; Derman, Richard; Goldenberg, Robert L.; Thorsten, Vanessa; Sridhar, Amaanti; Chowdhury, Dhuly; Das, Abhik

doi:10.1016/j.jpeds.2020.09.032

Cited by 16 publications

(21 citation statements)

References 22 publications

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“…Consistent with our findings, a Ugandan study conducted in the pre-ART era also concluded that duration of breastfeeding was not associated with adverse growth outcomes in IEH [29]. No matter how long women breastfed, if nutritionally compromised themselves, they are more likely to provide inadequate nutrition to their infants via breastfeeding [25,26].…”

Section: Discussionsupporting

confidence: 89%

“…The occurrence of stunting even among the longer breastfed infants is suggestive of other factors that could contribute to the high prevalence of stunting such as mixed feeding or poor quality of breastmilk as a result of poor nutrition in lactating mothers [23,24]. More recent studies have underscored the role of maternal nutrition among lactating mothers [25,26]. Maternal nutrition supplementation preconception or early pregnancy was shown to improve linear growth in infants in the first six months, suggesting that poor nutrition in lactating mothers could influence infant growth despite optimal breastfeeding practice [25,26].…”

Section: Discussionmentioning

confidence: 99%

“…More recent studies have underscored the role of maternal nutrition among lactating mothers [25,26]. Maternal nutrition supplementation preconception or early pregnancy was shown to improve linear growth in infants in the first six months, suggesting that poor nutrition in lactating mothers could influence infant growth despite optimal breastfeeding practice [25,26].…”

Section: Discussionmentioning

confidence: 99%

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Growth Patterns and Clinical Outcomes in Association with Breastfeeding in HIV Exposed and Unexposed Infants in KwaZulu Natal, South Africa

Pillay

Moodley

Emel

et al. 2020

Preprint

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BackgroundExclusive breastfeeding for six months and breastfeeding with complementary feeds until 12 months for infants exposed to HIV (IEH) or 24 months for infants unexposed to HIV (IUH) is the current World Health Organisation (WHO) recommendation for LMICs to improve clinical outcomes and growth trajectories in infants. In a post hoc evaluation of IEH and IUH cohorts, we examine growth patterns and clinical outcomes in the first six months of infancy in association with breastfeeding duration. MethodsTwo non–contemporaneous cohorts of infants born to women living with HIV and women without HIV, from a low-socioeconomic township in South Africa, were evaluated from birth until nine months of age. Clinical, anthropometric and infant feeding data were analysed. Standard descriptive statistics and regression analysis were performed to determine the effect of HIV exposure and breastfeeding duration on growth and clinical outcomes. ResultsIncluded in this secondary analysis were 123 IEH and 157 IUH infants breastfed for a median of 26 weeks and 14 weeks respectively. Median WLZ score was consistently and significantly lower in IEH than IUH at 3, 6 and 9 months (-0.19 vs 2.09; -0.81 vs 0.28; 0.05 vs 0.97 respectively). In contrast, the median LAZ score was significantly lower among IUH at 3 and 6 (-1.63 vs 0.91; -0.37 vs 0.51). A significantly higher proportion of IUH was classified as stunted (LAZ<-2SD) at 3 and 6 months (3.9% vs 44.9%, 4.8% vs 20.9% respectively) and a higher proportion of IEH experienced one or more episodes of skin rash (44.5% vs 12.8%) and upper respiratory tract infection (30.1% vs 10.9%) (p<0.0001). In a multivariable analysis, the odds of occurrence of wasting, skin rash, URTI or any clinical adverse event in IEH were 2.86, 7.06, 3.01 and 8.89 times higher than IUH after adjusting for breastfeeding duration. ConclusionOur study has generated additional evidence that IEH is at substantial risk of infectious morbidity and decreased growth trajectories independent of breastfeeding duration. We further report shorter breastfeeding duration in infants not exposed to HIV and the higher prevalence of stunting in this cohort is also independent of breastfeeding duration.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Growth Patterns and Clinical Outcomes in Association with Breastfeeding in HIV Exposed and Unexposed Infants in KwaZulu Natal, South Africa

Pillay

Moodley

Emel

et al. 2020

Preprint

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“…It is now becoming clear that randomised trials of maternal nutritional interventions that initiate after pregnancy is established, usually after the first trimester, are unsuitably timed, missing the peri-conception window [148][149][150][151]. Preconception interventions with power for child health follow-up offer improved opportunities for success, for example in child growth [152,153]. Moreover, preconception supplementation also influenced the epigenome of children up to 9 years [154].…”

Section: Conclusion and Thinking Aheadmentioning

confidence: 99%

Environmental Exposures around Conception: Developmental Pathways Leading to Lifetime Disease Risk

Fleming

Sun

Denisenko

et al. 2021

IJERPH

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Environment around conception can influence the developmental programme with lasting effects on gestational and postnatal phenotype and with consequences for adult health and disease risk. Peri-conception exposure comprises a crucial part of the ‘Developmental Origins of Health and Disease’ (DOHaD) concept. In this review, we consider the effects of maternal undernutrition experienced during the peri-conception period in select human models and in a mouse experimental model of protein restriction. Human datasets indicate that macronutrient deprivation around conception affect the epigenome, with enduring effects on cardiometabolic and neurological health. The mouse model, comprising maternal low protein diet exclusively during the peri-conception period, has revealed a stepwise progression in altered developmental programming following induction through maternal metabolite deficiency. This progression includes differential effects in extra-embryonic and embryonic cell lineages and tissues, leading to maladaptation in the growth trajectory and increased chronic disease comorbidities. The timeline embraces an array of mechanisms across nutrient sensing and signalling, cellular, metabolic, epigenetic and physiological processes with a coordinating role for mTORC1 signalling proposed. Early embryos appear active participants in environmental sensing to optimise the developmental programme for survival but with the trade-off of later disease. Similar adverse health outcomes may derive from other peri-conception environmental experiences, including maternal overnutrition, micronutrient availability, pollutant exposure and assisted reproductive treatments (ART) and support the need for preconception health before pregnancy.

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“…8 In this volume of The Journal, Krebs et al report 6-month postnatal follow-up results for 2421 infants in the Women First trial. 9 For these infants, there was a 3-to 4-mm difference in length and 60-g difference in weight at birth between both intervention arms and the control. In a 6-month follow-up, the differences remained essentially the same, indicating a persistence of growth benefits that resulted from maternal nutritional supplementation initiated before conception or at the end of the first trimester.…”

mentioning

confidence: 90%

Infant Growth After Maternal Dietary Supplementation Before and During Pregnancy

Ashorn

2021

The Journal of Pediatrics

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Growth from Birth Through Six Months for Infants of Mothers in the “Women First” Preconception Maternal Nutrition Trial

Cited by 16 publications

References 22 publications

Growth Patterns and Clinical Outcomes in Association with Breastfeeding in HIV Exposed and Unexposed Infants in KwaZulu Natal, South Africa

Growth Patterns and Clinical Outcomes in Association with Breastfeeding in HIV Exposed and Unexposed Infants in KwaZulu Natal, South Africa

Environmental Exposures around Conception: Developmental Pathways Leading to Lifetime Disease Risk

Infant Growth After Maternal Dietary Supplementation Before and During Pregnancy

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