Abstract
IntroductionThere is increasingly a double burden of under-nutrition and obesity in women of reproductive age. Preconception underweight or overweight, short stature and micronutrient deficiencies all contribute to excess maternal and fetal complications during pregnancy.MethodsA systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on maternal, newborn and child health (MNCH) outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture.ResultsMaternal pre-pregnancy weight is a significant factor in the preconception period with underweight contributing to a 32% higher risk of preterm birth, and obesity more than doubling the risk for preeclampsia, gestational diabetes. Overweight women are more likely to undergo a Cesarean delivery, and their newborns have higher chances of being born with a neural tube or congenital heart defect. Among nutrition-specific interventions, preconception folic acid supplementation has the strongest evidence of effect, preventing 69% of recurrent neural tube defects. Multiple micronutrient supplementation shows promise to reduce the rates of congenital anomalies and risk of preeclampsia. Although over 40% of women worldwide are anemic in the preconception period, only one study has shown a risk for low birth weight.ConclusionAll women, but especially those who become pregnant in adolescence or have closely-spaced pregnancies (inter-pregnancy interval less than six months), require nutritional assessment and appropriate intervention in the preconception period with an emphasis on optimizing maternal body mass index and micronutrient reserves. Increasing coverage of nutrition-specific and nutrition-sensitive strategies (such as food fortification; integration of nutrition initiatives with other maternal and child health interventions; and community based platforms) is necessary among adolescent girls and women of reproductive age. The effectiveness of interventions will need to be simultaneously monitored, and form the basis for the development of improved delivery strategies and new nutritional interventions.
Highlights
There is increasingly a double burden of under-nutrition and obesity in women of reproductive age
Despite research evidence linking iron deficiency with maternal mortality, around 40% of women are anemic globally [9]. Other micronutrients such as zinc and calcium have been found to improve maternal and newborn outcomes when supplementation is provided during pregnancy- it seems likely that ensuring adequate intake of these micronutrients earlier, which is during the preconception period, would be of added benefit for undernourished girls and women and in the case of unplanned pregnancies
The analyses showed that folic acid has a strong protective effect on preventing recurrent neural tube defects (NTDs) (RR 0.31, 95% confidence intervals (CI) 0.14-0.66) when it was restricted to randomized doubleblind placebo-controlled studies, this effect was no longer significant when two observational studies were included- (RR 0.43, 95% CI 0.13-1.40) (Figure 4)
Summary
There is increasingly a double burden of under-nutrition and obesity in women of reproductive age. Preconception underweight or overweight, short stature and micronutrient deficiencies all contribute to excess maternal and fetal complications during pregnancy. Despite research evidence linking iron deficiency with maternal mortality, around 40% of women are anemic globally [9]. Other micronutrients such as zinc and calcium have been found to improve maternal and newborn outcomes when supplementation is provided during pregnancy- it seems likely that ensuring adequate intake of these micronutrients earlier, which is during the preconception period, would be of added benefit for undernourished girls and women and in the case of unplanned pregnancies. Micronutrient supplementation or fortification is currently being used as strategies to improve nutrition even in resource-poor settings since many girls and women are chronically undernourished [42]
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