Impact of Dietary Interventions during Pregnancy on Maternal, Neonatal, and Child Outcomes in Low- and Middle-Income Countries

Abstract

Optimal nutrition plays a crucial role in pregnancy. Maternal malnutrition is a risk factor for maternal, fetal, and neonatal complications and is more prevalent in low and middle-income countries (LMICs). This review aims to study the effectiveness of antenatal macronutrient nutritional interventions on maternal, neonatal, and child outcomes. We searched the CENTRAL, PubMed, Embase, and other databases for randomized controlled trials and quasi-experimental designs on healthy pregnant women in LMICs. We also searched grey literature and reports from Google Scholar, Web of Science, and websites of different organizations. Title/abstract screening, full-text screening, and data extraction filtered 15 studies for inclusion. Balanced energy protein (BEP) supplementation (n = 8) studies showed a reduced incidence of perinatal mortality, stillbirths, low birth weight (LBW) infants, small for gestational age (SGA) babies and increased birth weight. Food distribution programs (FDPs) (n =5) witnessed reduced rates of SGA, stunting, wasting, and increased birth weight and birth length. Studies on intervention for obesity prevention (n = 2) showed reductions in birth weight. Other findings were statistically insignificant. Subgroup analyses were conducted to study the effectiveness of supplementation between regions, location, the timing of supplementation and nutritional status; however, there were a limited number of studies in each subgroup. Data from our review supports the antenatal supplementation of BEP and FDP for the prevention of adverse maternal, neonatal, and child outcomes that can be utilized for future policymaking. However, more research is required before recommending obesity prevention programs.Nutrients 2020, 12, 531 2 of 16 malnutrition in LMICs, with one study quoting rates from 20% in sub-Saharan Africa and south/central America to approximately 40% in India [3].Life course theory demonstrates the childhood experiences affecting health conditions at adulthood (e.g., diabetes, depression) [6]. Likewise, antenatal malnutrition forces a fetus to adapt to an environment of scarcity and, consequently, the adverse effects extend beyond the perinatal period and end up with the child having long-term chronic diseases such as cognitive dysfunction, obesity, diabetes mellitus, and hypertension. Conversely, evidence also suggests the harmful effects of overnutrition [7] in all phases of pregnancy. Nutrition transition has engulfed developing countries, which has caused reduced mortality leading to increased populations, followed by a decrease in fertility. The increase in intake of sugar and fats has also reduced physical activity, contributing to obesity in pregnant women that lead to complicated pregnancies, which also affects the neonate at birth and in future life [8]. It was found that obesity increases the risk of fetal macrosomia, stillbirth, congenital obesity [9][10][11], and infant mortality [12].Current guidelines have reported on the use and effectiveness of iron and other multi-nutrient formulations...

Dietary Diversity and Micronutrients Adequacy in Women of Childbearing Age: Results from ELANS Study

“…The consumption of a varied and balanced diet during this critical age window is essential, as a woman's current and future wellbeing may be affected by nutrient inadequacy in terms of increased susceptibility to diseases and impaired growth, development, and productivity. Moreover, micronutrient deficiencies can adversely influence fertility, pregnancy outcomes, and risk of congenital disabilities, compromising both the mother and offspring's health [4]. Studies describing micronutrient intake in WCA of Latin American countries within representative samples of the population are scarce.…”

Child growth and neurodevelopment after maternal antenatal antibiotic treatment

“…In contrast to intrauterine gains in weight-for-length, which are often lost postnatally, [7][8][9] intrauterine gains in length seem to be more sustainable. Weight-for-length follows the child's postnatal nutritional status, whereas accrued bone length will not be reduced even in subsequent adverse growth conditions.…”

“…6 Nutritional interventions during pregnancy seem to modestly increase mean birth length and weight but these gains are typically lost in infancy. [7][8][9] Intermittent preventive treatment of pregnant women (IPTp) with monthly sulfadoxinepyrimethamine (SP) compared with SP twice during pregnancy increases birth weight, but birth length data have rarely been reported. 10 There is evidence that adding maternal azithromycin (AZI) treatment during pregnancy reduces the prevalence of preterm birth and fetal and neonatal growth faltering in malaria-endemic areas.…”

A novel intervention combining supplementary food and infection control measures to improve birth outcomes in undernourished pregnant women in Sierra Leone: A randomized, controlled clinical effectiveness trial

“…RUSF is a balanced protein energy supplement, providing ample amounts of micronutrients and substantial quantities of essential amino acids required in pregnancy that were not provided in the blended flour provided to the standard of care group. Balanced protein energy supplementation has demonstrated modest increases in birth weight when provided to undernourished pregnant women [ 9 , 32 ]. A similar effect on birth length has been observed in some, but not all, trials distributing nutritional supplementation to undernourished pregnant women in Africa [ 9 , 33 ].…”