PROTOCOL: Effects of nutritional interventions during pregnancy on birth, child health, and development outcomes: A systematic review of evidence from low‐ and middle‐income countries

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...

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“…This systematic review was conducted following the protocol registered on Campbell Systematic Reviews [14].…”

Section: Methodsmentioning

confidence: 99%

“…Before attempting data extraction, we assured compatibility for comparison. Data extraction was divided by the intervention groups specified in the protocol [14]. If studies referred to old data as a part of their analysis, it was cross-checked to prevent repeated analysis of the datasets.…”

Section: Data Extraction and Analysismentioning

confidence: 99%

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

et al. 2020

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“…We conducted an extensive electronic search on the pre‐specified databases. The methodology was followed religiously as per the protocol (Lassi et al, 2019 ). We included 15 studies out of which eight were on BEP supplementation.…”

Section: Discussionmentioning

confidence: 99%

“…The methodology was followed religiously as per the protocol (Lassi et al, 2019). We included 15 studies out of which eight were on BEP supplementation.…”

Section: Potential Biases In the Review Processmentioning

confidence: 99%

Effects of nutritional interventions during pregnancy on birth, child health and development outcomes: A systematic review of evidence from low‐ and middle‐income countries

Lassi

Padhani

Rabbani

et al. 2021

Campbell Systematic Reviews

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Background: Optimal nutrition plays a crucial role in pregnancy. Poor maternal nutrition and maternal obesity has risk factors for serious fetal complications and neonatal outcomes, including intrauterine growth restriction, congenital abnormalities, stillbirth, low birth weight (LBW), preterm birth, fetal macrosomia, increased risk of neonatal infections, neonatal hypothermia, and neonatal death. The prevalence of maternal malnutrition is higher in low-and middle-income countries (LMICs) (10-19%) when compared with highincome countries, with variation by region and by country. Several behavioral interventions, including dietary control and exercise, have been found to reduce the risk of these adverse outcomes. However, none has reviewed dietary interventions to prevent maternal obesity in pregnant women.Objectives: The review aims to assess the effectiveness of balanced energy protein (BEP) supplementation, food distribution programs (FDPs), and dietary interventions to prevent maternal obesity during pregnancy on birth, child health, and developmental outcomes.Search Methods: We searched Cochrane Controlled Trials Register (CENTRAL), MEDLINE, Embase, CINAHL, and 12 other databases, and trials registers for ongoing studies up until April 2019. We also searched for gray literature from different sources and for citations on Google Scholar and Web of Sciences. We also checked the reference lists of included studies and relevant reviews and contacted the authors of studies for any ongoing and unpublished studies. The search was followed by title/abstract screening, full-text screening and data extraction. Selection Criteria: We included randomized control trials, and quasi experimental trials to evaluate the impact of nutritional interventions (BEP, FDP, and dietary interventions to prevent maternal obesity) compared to control or standard of care, among healthy pregnant women of any age living in LMICs.

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PROTOCOL: Effects of nutritional interventions during pregnancy on birth, child health, and development outcomes: A systematic review of evidence from low‐ and middle‐income countries

Abstract: BACKGROUND 1.1 | The problem, condition or issue Optimal nutrition plays a crucial role before, during and after pregnancy

Cited by 2 publications

References 36 publications

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

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

Effects of nutritional interventions during pregnancy on birth, child health and development outcomes: A systematic review of evidence from low‐ and middle‐income countries

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