Article Text
Abstract
Introduction Low 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).
Methods We 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.
Results We 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.
Conclusion Improving 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.
- low birthweight
- preterm birth
- small-for-gestational age
- child health
- nutrition
- pregnancy
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Footnotes
Handling editor Prashant Jha
Contributors KdSL and EO were responsible for the study conception and design. KdSL (all), AD (half) and OOB (half) screened studies for eligibility. KdSL and PS extracted data from reviews and assessed methodological quality. KdSL wrote the paper. All authors made critical revisions to the manuscript, read and approved the final version.
Funding Nutrition International and the Evidence and Programme Guidance, Department of Nutrition for Health and Development, WHO provided partial internal or external funding for this work. WHO acknowledges the financial support of Bill & Melinda Gates Foundation to build the evidence base on systematic reviews on the effects of nutrition actions for health and development. The source of funding had no role in study design, data collection and interpretation and writing of the overview review. The corresponding author EO had full access to all data and had final responsibility for the decision to submit this review for publication.
Disclaimer The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.
Competing interests JPP-R, EO, LMD-R and RM are authors and/or co-authors of included Cochrane reviews. They were not involved in the screening process or selection of reviews for inclusion. All other authors declare that they have no conflicts of interests.
Provenance and peer review Not commissioned; externally peer reviewed.