Effects of nutrition interventions during pregnancy on low birth weight: an overview of systematic reviews

Abstract

IntroductionLow birth weight (LBW, birth weight less than 2500 g) is associated with infant mortality and childhood morbidity. Poor maternal nutritional status is one of several contributing factors to LBW. We systematically reviewed the evidence for nutrition-specific (addressing the immediate determinants of nutrition) and nutrition-sensitive (addressing the underlying cause of undernutrition) interventions to reduce the risk of LBW and/or its components: preterm birth (PTB) and small-for-gestational age (SGA).MethodsWe conducted a comprehensive literature search in MEDLINE, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews (September 2015). Systematic reviews of randomised controlled trials focusing on nutritional interventions before and during pregnancy to reduce LBW and its components were eligible for inclusion into the overview review. We assessed the methodological quality of the included reviews using A Measurement Tool to Assess Reviews (AMSTAR), PROSPERO: CRD42015024814.ResultsWe included 23 systematic reviews which comprised 34 comparisons. Sixteen reviews were of high methodological quality, six of moderate and only one review of low quality. Six interventions were associated with a decreased risk of LBW: oral supplementation with (1) vitamin A, (2) low-dose calcium, (3) zinc, (4) multiple micronutrients (MMN), nutritional education and provision of preventive antimalarials. MMN and balanced protein/energy supplementation had a positive effect on SGA, while high protein supplementation increased the risk of SGA. High-dose calcium, zinc or long-chain n-3 fatty acid supplementation and nutritional education decreased the risk of PTB.ConclusionImproving women’s nutritional status positively affected LBW, SGA and PTB. Based on current evidence, especially MMN supplementation and preventive antimalarial drugs during pregnancy may be considered for policy and practice. However, for most interventions evidence was derived from a small number of trials and/or participants. There is a need to further explore the evidence of nutrition-specific and nutrition-sensitive interventions in order to reach the WHO’s goal of a 30% reduction in the global rate of LBW by 2025.

What birthweight percentile is associated with optimal perinatal mortality and childhood education outcomes?

“…Strategies with proven success at reducing the incidence of SGA and low birthweight include nutritional education, supplementation with vitamin A, low-dose calcium, zinc, and multiple micronutrients. 33 Balanced protein/energy supplementation reduced rates of SGA by 21% and stillbirth by 40%. 34 These recommendations should be made to women both before and during pregnancy and their benefit would be Numbers presented are nonstandardized regression coefficients ß (95% confidence intervals).…”

A Mediterranean Diet with an Enhanced Consumption of Extra Virgin Olive Oil and Pistachios Improves Pregnancy Outcomes in Women Without Gestational Diabetes Mellitus: A Sub-Analysis of the St. Carlos Gestational Diabetes Mellitus Prevention Study

“…Most studies evaluating the effect of maternal nutrition focus on its relationship with foetal growth [5,7,27,28]. Following a dietary pattern rich with a higher intake of fruits, vegetables, fish and poultry and lower intake of meat and fat of animal origin has been associated with lower small-for-gestational-age risk [5].…”

“…Maternal nutrition can potentially impact placental and foetal growth [5][6][7]. It can also have permanent negative consequences for the offspring.…”

A life history approach to prenatal supplementation: Building a bridge from biological anthropology to public health and nutrition

“…Prenatal supplementation with varying combinations of micronutrients, protein, energy, and lipids has been a tool in the global public health arsenal for addressing the adverse effects of undernutrition on women and infants since the 1960s (reviewed in da Silva Lopes et al, ; Haider & Bhutta, ; Haider et al, ; Imdad & Bhutta, ; Ota, Hori, Mori, Tobe‐Gai, & Farrar, ; Reiches, ). A history of prenatal supplementation as a strategy for addressing infant health is forthcoming (Reiches, ).…”