Improving women's diet quality pre-conceptionally 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 Potdar, Sirazul Ameen 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 J.P. BarkerAlan A. Jackson, Barrie M. Margetts, Caroline H.D. Fall

    Research output: Contribution to journalArticlepeer-review

    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-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 -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 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 0.66, 1.05; P = 0.10; per-protocol OR = 0.76; 95 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)1257-1268
    Number of pages12
    JournalAmerican Journal of Clinical Nutrition
    Volume100
    Issue number5
    DOIs
    Publication statusPublished - 17 Sept 2014

    Keywords

    • pregnancy
    • body mass index procedure
    • diet
    • birth weight
    • fruit
    • India
    • low birth weight infant
    • newborn
    • micronutirients
    • milk
    • mothers
    • prenatal nutrition
    • per protocol analysis
    • green leafy vegetables
    • maternal nutrition
    • snacks intention to treat analysis

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