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)

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 β-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/m2) [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.

An Epidemiological Model Investigating the Association between Mothers Nutritional Status and Low Birth Weight in India

“…Low birth weight proportion was higher in teenage pregnancies & primiparous women [12]. Healthy diet providing before conception and throughout pregnancy had no overall effect on birth weight [13].…”

Association of Milk and Dairy Products Consumption During Pregnancy with Fetal and Neonatal Head Circumferences: A Systematic Review

“…Among the seven studies, four studies reported results of maternal milk or dairy products consumption in relation to neonatal birth head circumference (12,14,15,17), one study reported results of maternal milk or dairy products consumption in relation to fetal head circumference (18) and two studies reported results of maternal milk or dairy products consumption in relation to both fetal and neonatal birth head circumferences (13,16).…”

“…One cohort study, one cross-sectional study and one randomized controlled trial (12)(13)(14) showed that maternal milk or dairy products consumption was not associated with neonatal birth head circumference, while three cohort studies (15)(16)(17) reported that maternal milk or dairy products intake had a positive effect on neonatal birth head circumference.…”

“…In this systematic literature review, one cohort study (12), one cross-sectional study (13) and one randomized controlled trial study (14) declared that maternal milk or dairy products consumption were not associated with neonatal birth head circumference, while three cohort studies (15)(16)(17) reported that maternal milk or dairy products consumption had a positive effect on neonatal birth head circumference. Two cohort studies (16,18) showed that there was no relationship between maternal milk or dairy products intake and fetal head circumference while one cross-sectional study (13) was suggestive of a positive relationship between milk or dairy products consumption during pregnancy and fetal head circumference.…”

“…Three studies, one cohort study (12), one cross-sectional study (13) and one randomized controlled trial (14) showed that maternal milk or dairy products intake were not associated with neonatal birth head circumference.…”