Abstract
Improving micronutrient intakes of under‐nourished mothers in low‐ and middle‐income countries increases birth weight, but there is little data on the nature and timing during gestation of any effects on fetal growth. Ultrasound measures of fetal size were used to determine whether and when a food‐based supplement affected fetal growth. Non‐pregnant women living in Mumbai slums, India (N = 6,513), were randomly assigned to receive either a daily micronutrient‐rich snack containing green leafy vegetables, fruit, and milk (treatment) or a snack made from lower‐micronutrient vegetables (control) in addition to their usual diet from before pregnancy until delivery. From 2,291 pregnancies, the analysis sample comprised 1,677 fetuses (1,335 fetuses of women supplemented for ≥3 months before conception). First‐trimester (median: 10 weeks, interquartile range: 9–12 weeks) fetal crown‐rump length was measured. Fetal head circumference, biparietal diameter, femur length, and abdominal circumference were measured during the second (19, 19–20 weeks) and third trimesters (29, 28–30 weeks). The intervention had no effect on fetal size or growth at any stage of pregnancy. In the second trimester, there were interactions between parity and allocation group for biparietal diameter (p = .02) and femur length (p = .04) with both being smaller among fetuses of primiparous women and larger among those of multiparous women, in the treatment group compared with the controls. Overall, a micronutrient‐rich supplement did not increase standard ultrasound measures of fetal size and growth at any stage of pregnancy. Additional ultrasound measures of fetal soft tissues (fat and muscle) may be informative.
Highlights
Low birth weight (LBW) is an important public health problem in low‐ and middle‐income countries (UNICEF & WHO, 2004)
As in the larger group of women, there was a significant interaction between allocation group and parity (Figure 4) for femur length (FL) at visit 2 (p = .03); the interaction was not significant for biparietal diameter (BPD)
The intervention did not have a significant effect on growth of head circumference (HC), abdominal circumference (AC), and FL
Summary
Low birth weight (LBW) is an important public health problem in low‐ and middle‐income countries (UNICEF & WHO, 2004). LBW commonly results from intrauterine growth restriction and is associated with increased neonatal mortality and morbidity, slower postnatal growth, poorer cognitive development, and a higher risk of chronic non‐ communicable diseases in later life (Barker, 1998; Victora et al, 2008). Poor maternal nutritional status contributes to the prevalence of LBW (Osrin & De L Costello, 2000). Many studies have investigated the effect on birth outcomes of supplementing mothers with multiple micronutrients during pregnancy (Haider & Bhutta, 2015; Kawai, Spiegelman, Shankar, & Fawzi, 2011). Meta‐analyses suggest that this reduces the prevalence of LBW (Fall, Fisher, Osmond, & Margetts, 2009; Shah, Ohlsson, & Knowledge Synthesis Group on Determinants of Low Birth Weight and Preterm Births, 2009).
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