Improving women's diet quality preconceptionally and during gestation: effects on birth weight and prevalence of low birth weight-a randomized controlled efficacy trial in India (Mumbai Maternal Nutrition Project)

Ramesh D Potdar, Sirazul A Sahariah, Meera Gandhi, Sarah H Kehoe, Nick Brown, Harshad Sane, Monika Dayama, Swati Jha, Ashwin Lawande, Patsy J Coakley, Ella Marley-Zagar, Harsha Chopra, Devi Shivshankaran, Purvi Chheda-Gala, Priyadarshini Muley-Lotankar, G Subbulakshmi, Andrew K Wills, Vanessa A Cox, Vijaya Taskar, David Jp BarkerAlan A Jackson, Barrie M Margetts, Caroline Hd Fall

Research output: Contribution to journalArticle (Academic Journal)

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Abstract

BACKGROUND: Low birth weight (LBW) is an important public health problem in undernourished populations.

OBJECTIVE: We tested whether improving women's dietary micronutrient quality before conception and throughout pregnancy increases birth weight in a high-risk Indian population.

DESIGN: The study was a nonblinded, individually randomized controlled trial. The intervention was a daily snack made from green leafy vegetables, fruit, and milk (treatment group) or low-micronutrient vegetables (potato and onion) (control group) from ≥90 d before pregnancy until delivery in addition to the usual diet. Treatment snacks contained 0.69 MJ of energy (controls: 0.37 MJ) and 10-23% of WHO Reference Nutrient Intakes of β-carotene, riboflavin, folate, vitamin B-12, calcium, and iron (controls: 0-7%). The primary outcome was birth weight.

RESULTS: Of 6513 women randomly assigned, 2291 women became pregnant, 1962 women delivered live singleton newborns, and 1360 newborns were measured. In an intention-to-treat analysis, there was no overall increase in birth weight in the treatment group (+26 g; 95% CI: -15, 68 g; P = 0.22). There was an interaction (P < 0.001) between the allocation group and maternal prepregnant body mass index (BMI; in kg/m(2)) [birth-weight effect: -23, +34, and +96 g in lowest (<18.6), middle (18.6-21.8), and highest (>21.8) thirds of BMI, respectively]. In 1094 newborns whose mothers started supplementation ≥90 d before pregnancy (per-protocol analysis), birth weight was higher in the treatment group (+48 g; 95% CI: 1, 96 g; P = 0.046). Again, the effect increased with maternal BMI (-8, +79, and +113 g; P-interaction = 0.001). There were similar results for LBW (intention-to-treat OR: 0.83; 95% CI: 0.66, 1.05; P = 0.10; per-protocol OR = 0.76; 95% CI: 0.59, 0.98; P = 0.03) but no effect on gestational age in either analysis.

CONCLUSIONS: A daily snack providing additional green leafy vegetables, fruit, and milk before conception and throughout pregnancy had no overall effect on birth weight. Per-protocol and subgroup analyses indicated a possible increase in birth weight if the mother was supplemented ≥3 mo before conception and was not underweight. This trial was registered at www.controlled-trials.com/isrctn/ as ISRCTN62811278.

Original languageEnglish
Pages (from-to)1257-68
Number of pages12
JournalAmerican Journal of Clinical Nutrition
Volume100
Issue number5
DOIs
Publication statusPublished - Nov 2014

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    Potdar, R. D., Sahariah, S. A., Gandhi, M., Kehoe, S. H., Brown, N., Sane, H., Dayama, M., Jha, S., Lawande, A., Coakley, P. J., Marley-Zagar, E., Chopra, H., Shivshankaran, D., Chheda-Gala, P., Muley-Lotankar, P., Subbulakshmi, G., Wills, A. K., Cox, V. A., Taskar, V., ... Fall, C. H. (2014). Improving women's diet quality preconceptionally and during gestation: effects on birth weight and prevalence of low birth weight-a randomized controlled efficacy trial in India (Mumbai Maternal Nutrition Project). American Journal of Clinical Nutrition, 100(5), 1257-68. https://doi.org/10.3945/ajcn.114.084921