Drivers of malnutrition among late adolescent and young women in rural Pakistan: a cross-sectional assessment of the MaPPS trial

BackgroundNutritional status critically contributes to maternal and child morbidities and mortality. Undernutrition during pregnancy and preconception is linked to adverse pregnancy and birth outcomes and has downstream effects on the growth and development of children. The gut microbiome has a profound influence on the nutritional status of the host. Dysbiosis has emerged as a major factor in the development of malnutrition. This phenomenon is understudied in settings with a high prevalence of undernutrition, and further investigation is warranted to better understand such interactions.MethodsThe study is a prospective, longitudinal observational study to investigate the impact and relationship between prokaryotic and eukaryotic microbes in the gut and their association with maternal health and birth outcomes among young women, 17-24 years of age in Matiari District, Pakistan. We aim to enroll 400 pregnant women with low and normal BMIs at the time of recruitment (<16 weeks of gestation). Data collection includes demographics, morbidities, medication use, empowerment, dietary recall, and anthropometrics. Stool and blood specimens are collected at several time points for different laboratory assays.DiscussionLimited studies have examined the role of the microbiome in maternal health and birth outcomes where the prevalence of undernutrition is high. Here we aim to investigate the interplay of maternal and child undernutrition with the composition (diversity) and functionality of the gut microbiome and capture how it is influenced by environmental and genetic factors. Findings are expected to provide valuable insights into the understanding of undernutrition.Study registrationThe study is registered withClinicalTrials.govIdentifier:NCT05108675.

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Elucidating the dynamics and impact of the gut microbiome on maternal nutritional status during pregnancy, effect on pregnancy outcomes and infant health in rural Pakistan: study protocol for a prospective, longitudinal observational study

Wasan,

Baxter,

Spiegel-Feld

et al. 2024

BMJ Open

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IntroductionUndernutrition during pregnancy is linked to adverse pregnancy and birth outcomes and has downstream effects on the growth and development of children. The gut microbiome has a profound influence on the nutritional status of the host. This phenomenon is understudied in settings with a high prevalence of undernutrition, and further investigation is warranted to better understand such interactions.Methods and analysisThis is a prospective, longitudinal observational study to investigate the relationship between prokaryotic and eukaryotic microbes in the gut and their association with maternal body mass index (BMI), gestational weight gain, and birth and infant outcomes among young mothers (17–24 years) in Matiari District, Pakistan. We aim to enrol 400 pregnant women with low and normal BMIs at the time of recruitment (<16 weeks of gestation). To determine the weight gain during pregnancy, maternal weight is measured in the first and third trimesters. Gut microbiome dynamics (bacterial and eukaryotic) will be assessed using 16S and 18S rDNA surveys applied to the maternal stool samples. Birth outcomes include birth weight, small for gestational age, large for gestational age, preterm birth and mortality. Infant growth and nutritional parameters include WHO z-scores for weight, length and head circumference at birth through infancy. To determine the impact of the maternal microbiome, including exposure to pathogens and parasites on the development of the infant microbiome, we will analyse maternal and infant microbiome composition, micronutrients in serum using metallomics (eg, zinc, magnesium and selenium) and macronutrients in the stool. Metatranscriptomics metabolomics and markers of inflammation will be selectively deployed on stool samples to see the variations in dietary intake and maternal nutritional status. We will also use animal models to explore the bacterial and eukaryotic components of the microbiome.Ethics and disseminationThe study is approved by the National Bioethics Committee (NBC) in Pakistan, the Ethics Review Committee (ERC) at Aga Khan University and the Research Ethics Board (REB) at the Hospital for Sick Children, and findings will be published in peer-reviewed journals.Trial registration numberNCT05108675.

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Drivers of malnutrition among late adolescent and young women in rural Pakistan: a cross-sectional assessment of the MaPPS trial

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References 43 publications

Determinants of nutrition security status of women in rural households in Northwest Ethiopia

Determinants of nutrition security status of women in rural households in Northwest Ethiopia

Elucidating the Dynamics and Impact of the Gut Microbiome on Maternal Nutritional Status During Pregnancy in Rural Pakistan: Study Protocol for a Prospective, Longitudinal Observational Study

Elucidating the dynamics and impact of the gut microbiome on maternal nutritional status during pregnancy, effect on pregnancy outcomes and infant health in rural Pakistan: study protocol for a prospective, longitudinal observational study

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