Document Type
Article
Publication Date
2-1-2019
Abstract
Background: Reported benefits of maternal nutrition supplements commenced during pregnancy in low-resource populations have typically been quite limited.
Objectives: This study tested the effects on newborn size, especially length, of commencing nutrition supplements for women in low-resource populations ≥3 mo before conception (Arm 1), compared with the same supplement commenced late in the first trimester of pregnancy (Arm 2) or not at all (control Arm 3).
Methods: Women First was a 3-arm individualized randomized controlled trial (RCT). The intervention was a lipid-based micronutrient supplement; a protein-energy supplement was also provided if maternal body mass index (kg/m2) was(DRC), Guatemala, India, and Pakistan. The primary outcome was length-for-age z score (LAZ), with all anthropometry obtainedDRC, outcomes were determined for all 4 sites from WHO newborn standards (non-gestational-age-adjusted, NGAA) as well as INTERGROWTH-21st fetal standards (3 sites, gestational age-adjusted, GAA).
Results: A total of 7387 nonpregnant women were randomly assigned, yielding 2451 births with NGAA primary outcomes and 1465 with GAA outcomes. Mean LAZ and other outcomes did not differ between Arm 1 and Arm 2 using either NGAA or GAA. Mean LAZ (NGAA) for Arm 1 was greater than for Arm 3 (effect size: +0.19; 95% CI: 0.08, 0.30, P = 0.0008). For GAA outcomes, rates of stunting and small-for-gestational-age were lower in Arm 1 than in Arm 3 (RR: 0.69; 95% CI: 0.49, 0.98, P = 0.0361 and RR: 0.78; 95% CI: 0.70, 0.88, P < 0.001, respectively). Rates of preterm birth did not differ among arms.
Conclusions: In low-resource populations, benefits on fetal growth-related birth outcomes were derived from nutrition supplements commenced before conception or late in the first trimester. This trial was registered at clinicaltrials.gov as NCT01883193.
Recommended Citation
Hambidge, K. Michael; Westcott, Jamie E.; Garcés, Ana; Figueroa, Lester; Goudar, Shivaprasad S.; Dhaded, Sangappa M.; Pasha, Omrana; Ali, Sumera A.; Tshefu, Antoinette; Lokangaka, Adrien; Derman, Richard J.; Goldenberg, Robert L.; Bose, Carl L.; Bauserman, Melissa; Koso-Thomas, Marion; Thorsten, Vanessa R.; Sridhar, Amaanti; Stolka, Kristen; Das, Abhik; McClure, Elizabeth M.; and Krebs, Nancy F., "A multicountry randomized controlled trial of comprehensive maternal nutrition supplementation initiated before conception: the Women First trial." (2019). Global Health Articles. Article 7.https://jdc.jefferson.edu/gha/7
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Language
English
Comments
This article has been peer reviewed. It is the author’s final published version in The American Journal of Clinical Nutrition, Volume 109, Issue 2, February 2019, Pages 457-469.
The published version is available at https://doi.org/10.1093/ajcn/nqy228. Copyright © Hambidge et al.