Effect of a micronutrient‐rich snack taken preconceptionally and throughout pregnancy on ultrasound measures of fetal growth: The Mumbai Maternal Nutrition Project (MMNP)

Abstract

Improving micronutrient intakes of under‐nourished mothers in low‐ and middle‐income countries increases birth weight, but there is little data on the nature and timing during gestation of any effects on fetal growth. Ultrasound measures of fetal size were used to determine whether and when a food‐based supplement affected fetal growth. Non‐pregnant women living in Mumbai slums, India (N = 6,513), were randomly assigned to receive either a daily micronutrient‐rich snack containing green leafy vegetables, fruit, and milk (treatment) or a snack made from lower‐micronutrient vegetables (control) in addition to their usual diet from before pregnancy until delivery. From 2,291 pregnancies, the analysis sample comprised 1,677 fetuses (1,335 fetuses of women supplemented for ≥3 months before conception). First‐trimester (median: 10 weeks, interquartile range: 9–12 weeks) fetal crown‐rump length was measured. Fetal head circumference, biparietal diameter, femur length, and abdominal circumference were measured during the second (19, 19–20 weeks) and third trimesters (29, 28–30 weeks). The intervention had no effect on fetal size or growth at any stage of pregnancy. In the second trimester, there were interactions between parity and allocation group for biparietal diameter (p = .02) and femur length (p = .04) with both being smaller among fetuses of primiparous women and larger among those of multiparous women, in the treatment group compared with the controls. Overall, a micronutrient‐rich supplement did not increase standard ultrasound measures of fetal size and growth at any stage of pregnancy. Additional ultrasound measures of fetal soft tissues (fat and muscle) may be informative.

Healthcare choices in Mumbai slums: A cross-sectional study

“…The study took place between January and May 2015 in the Bandra, Khar, Santa Cruz, and Andheri areas of the city of Mumbai, India, in 13 slum areas covered by the health and social programs of the nongovernmental organization the Centre for the Study of Social Change (CSSC). The study population and health system context has previously been described 13 , 28 . Briefly, Mumbai is home to about 12.4 million people, with population density of about 19,652 people per km2 29 .…”

The Association of Maternal Age With Fetal Growth and Newborn Measures: The Mumbai Maternal Nutrition Project (MMNP)

“…These women were taking part in a randomized controlled trial of a preconceptional nutritional intervention (a daily micronutrient-rich snack), which increased newborn birth weight when the mother was supplemented for > 3 months before conception but had no effect on fetal size or growth. 12…”

Protocol for the EMPHASIS study; epigenetic mechanisms linking maternal pre-conceptional nutrition and children’s health in India and Sub-Saharan Africa

“…Women who became pregnant continued supplementation until delivery, and were supplied with routine iron (100 mg) and folic acid (500 µg) supplements as per Indian government recommendations. Fetal biometry was recorded three times during pregnancy (at approximately 10, 20 and 29 weeks gestation, estimated from last menstrual period date and ultrasound measures) [21]. Plasma folate and vitamin B12 concentrations were measured in early pregnancy (~10 weeks gestation).…”

“…The intervention reduced the prevalence of gestational diabetes (intention to treat: 7.3% compared with 12.4% in controls; OR: 0.56; 95% CI: 0.36, 0.86; P = 0.008) [22]. It had no effect on fetal size assessed using standard ultrasound measures [21].…”