No abstract

Background: Early childhood growth failure including stunting is associated with suboptimal health and cognitive development outcomes. Despite progress, the prevalence of childhood stunting in India remains amongst the highest globally. Objective: We aimed to evaluate the impact of a systems strengthening interventional package, including body-mass-index measurement at pregnancy registration, monthly weight monitoring, on-the-spot supplementary nutrition, iron-folic acid supplementation, and targeted dietary counselling provided to women during their antenatal care on childhood stunting. Methods: This is a prospective follow-up comparison study. Women from three districts in West Bengal, India in their first trimester of pregnancy between May 2018 and May 2019 were enrolled into the study. Pregnancy, birth and infant characteristics were collected, and anthropometric indices measured. The relative risk of stunting in children in intervention and comparison groups were compared using generalized linear model to adjust for clustering effect. Results: A total of 809 mother-child dyads (406 intervention; 403 comparison) were followed between May 2018 and May 2021. The median age of women in the intervention and comparison group was 23 (IQR 20-25) and 25 (IQR 24-27) years respectively. Median gestational weight gain was higher amongst women in the intervention group (9 vs. 8 kilograms, p=0.04). Low-birth-weight prevalence was 29.3% (119/406) and 32.0% (129/403) in the intervention and comparison group respectively. At 12-35 months of age, children born to women in the intervention group had significantly reduced risk of stunting (RR=0.58, 95% CI 0.45-0.75, p<0.001). The odds of stunting amongst children born with low birthweight to women in the comparison group were statistically significant [OR 2.44 (1.44-4.14)], unlike those amongst children born to women in the intervention group [1.19 (0.58-2.46)]. Conclusions: These results indicate that strengthening of routine antenatal care including targeted nutritional counselling to expectant mothers can have distal beneficial effects on childhood stunting beyond the immediate post-natal period.

Background: The intervention is a part of a maternal and child nutrition project, operational in three districts of West Bengal, India. The current paper focuses on the identification of “nutrition risk pregnancies” at the community level and to determine the associations of the risk factors with birth outcomes like low-birth weight and pre-term birth.Methods: A cohort of 468 pregnant women attending antenatal clinics in their 1st trimester were identified from 74 sub-health centers from 3 diversified blocks of West Bengal, India. Five key intervention strategies were followed in order to achieve desired pregnancy weight gain birth outcomes, like low-birth weight, pre-term birth was analyzed in relation to “nutrition risk pregnancies”.Results: About 22.2% of the pregnant women in severe thin body mass index (BMI) categories gave birth to low-birth weight children and about 33.3% had pre-term deliveries compared to pregnant women with normal BMI with 16.8% and 18.8% low-birth and pre-term deliveries respectively. Among the nutrition risk factors, 1st weight at the time of pregnancy registration (95% CI, p=0.04), gestational weight gain (95% CI, p=0.002), were significantly associated with low-birth weight children. Gestational weight gain was also significantly associated with pre-term births (95% CI, p=0.009).Conclusions: Gestational weight gain beyond or less than recommended range may pre-dispose to low-birth weight and pre-term births. Since this factor could be managed through the existing, public health service delivery systems and family-based inputs, efforts should be geared towards identifying the risk factors and working towards appropriate weight gain.

Background: Despite progress, the prevalence of childhood undernutrition in India remains amongst the highest globally. Objective: We aimed to evaluate the impact of a functional integration interventional package during the antenatal period on childhood growth parameters. Methods: This is a post-interventional follow-up study of a maternal nutrition trial conducted between 2018–2019 among women in their first trimester of pregnancy from three districts in West Bengal, India. Those in the intervention group received a package that included body-mass-index measurement at pregnancy registration, monthly weight monitoring, targeted dietary counselling, supervised supplementary nutrition intake and iron-folic acid supplementation during daily anganwadi center visits. Age-matched pregnant women in the comparison group received standard-of-care. Maternal height and serial weights were recorded at antenatal visits, and birth and infant characteristics were noted. During the follow-up visit in 2021, child height and weight were measured. The relative risks of stunting, wasting and underweight were calculated using generalized linear models. Results: Eight-hundred-nine mother-child dyads (406 intervention; 403 comparison) were followed between May 2018 and May 2021. Median age of women in the intervention and comparison group was 23 (IQR 20–25) and 25 (IQR 24–27) years respectively. Median gestational-weight-gain was higher amongst intervention group women (9 vs. 8 kilograms, p = 0.04). Low-birth-weight prevalence was 29.3% (119/406) and 32.0% (129/403) in the intervention and comparison group. At 12–35 months of age, children born to women in the intervention group had significantly reduced risk of stunting (RR = 0.65, 95% CI 0.44–0.94), wasting (RR = 0.57, 95% CI 0.33–0.97) and underweight (RR = 0.61, 95% CI 0.42–0.88). Conclusions: These results indicate that functional integration and strengthening of routine antenatal care services including targeted nutritional counselling to expectant mothers can have distal beneficial effects on childhood undernutrition beyond the immediate post-natal period.