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. Barker; Alan A. Jackson; Barrie M. Margetts; Caroline H.D. Fall

doi:10.3945/ajcn.114.084921

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. Barker

Alan A. Jackson, Barrie M. Margetts, Caroline H.D. Fall

Research output: Contribution to journal › Article › peer-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 language	English
Pages (from-to)	1257-1268
Number of pages	12
Journal	American Journal of Clinical Nutrition
Volume	100
Issue number	5
DOIs	https://doi.org/10.3945/ajcn.114.084921
Publication status	Published - 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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Potdar, R., 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. D. (2014). 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). American Journal of Clinical Nutrition, 100(5), 1257-1268. https://doi.org/10.3945/ajcn.114.084921

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title = "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)",

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 ",

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",

author = "Ramesh Potdar and Sahariah, \{Sirazul Ameen\} and Meera Gandhi and Kehoe, \{Sarah H.\} and Nick Brown and Harshad Sane and Monika Dayama and Swati Jha and Ashwin Lawande and Coakley, \{Patsy J.\} and Ella Marley-Zagar and Harsha Chopra and Devi Shivshankaran and Purvi Chheda-Gala and Priyadarshini Muley-Lotankar and G. Subbulakshmi and Wills, \{Andrew K.\} and Cox, \{Vanessa A.\} and Vijaya Taskar and Barker, \{David J.P.\} and Jackson, \{Alan A.\} and Margetts, \{Barrie M.\} and Fall, \{Caroline H.D.\}",

year = "2014",

month = sep,

day = "17",

doi = "10.3945/ajcn.114.084921",

language = "English",

volume = "100",

pages = "1257--1268",

journal = "American Journal of Clinical Nutrition",

issn = "0002-9165",

publisher = "Oxford University Press (OUP)",

number = "5",

}

Potdar, R, Sahariah, SA, Gandhi, M, Kehoe, SH, Brown, N, Sane, H, Dayama, M, Jha, S, Lawande, A, Coakley, PJ, Marley-Zagar, E, Chopra, H, Shivshankaran, D, Chheda-Gala, P, Muley-Lotankar, P, Subbulakshmi, G, Wills, AK, Cox, VA, Taskar, V, Barker, DJP, Jackson, AA, Margetts, BM & Fall, CHD 2014, '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)', American Journal of Clinical Nutrition, vol. 100, no. 5, pp. 1257-1268. https://doi.org/10.3945/ajcn.114.084921

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). / Potdar, Ramesh; Sahariah, Sirazul Ameen; Gandhi, Meera et al.
In: American Journal of Clinical Nutrition, Vol. 100, No. 5, 17.09.2014, p. 1257-1268.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Improving women's diet quality pre-conceptionally and during gestation

T2 - effects on birth weight and prevalence of low birth weight; a randomized controlled efficacy trial in India (Mumbai Maternal Nutrition Project)

AU - Potdar, Ramesh

AU - Sahariah, Sirazul Ameen

AU - Gandhi, Meera

AU - Kehoe, Sarah H.

AU - Brown, Nick

AU - Sane, Harshad

AU - Dayama, Monika

AU - Jha, Swati

AU - Lawande, Ashwin

AU - Coakley, Patsy J.

AU - Marley-Zagar, Ella

AU - Chopra, Harsha

AU - Shivshankaran, Devi

AU - Chheda-Gala, Purvi

AU - Muley-Lotankar, Priyadarshini

AU - Subbulakshmi, G.

AU - Wills, Andrew K.

AU - Cox, Vanessa A.

AU - Taskar, Vijaya

AU - Barker, David J.P.

AU - Jackson, Alan A.

AU - Margetts, Barrie M.

AU - Fall, Caroline H.D.

PY - 2014/9/17

Y1 - 2014/9/17

N2 - 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

AB - 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

KW - pregnancy

KW - body mass index procedure

KW - diet

KW - birth weight

KW - fruit

KW - India

KW - low birth weight infant

KW - newborn

KW - micronutirients

KW - milk

KW - mothers

KW - prenatal nutrition

KW - per protocol analysis

KW - green leafy vegetables

KW - maternal nutrition

KW - snacks intention to treat analysis

U2 - 10.3945/ajcn.114.084921

DO - 10.3945/ajcn.114.084921

M3 - Article

SN - 0002-9165

VL - 100

SP - 1257

EP - 1268

JO - American Journal of Clinical Nutrition

JF - American Journal of Clinical Nutrition

IS - 5

ER -

Potdar R, Sahariah SA, Gandhi M, Kehoe SH, Brown N, Sane H et al. 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). American Journal of Clinical Nutrition. 2014 Sept 17;100(5):1257-1268. doi: 10.3945/ajcn.114.084921