Maternal-focused interventions to improve infant growth and nutritional status in low-middle income countries: A systematic review of reviews

PLoS One. 2021 Aug 18;16(8):e0256188. doi: 10.1371/journal.pone.0256188. eCollection 2021.

Abstract

Background: Small and nutritionally at-risk infants under 6 months (<6m) are a vulnerable group at increased risk of mortality, morbidity, poor growth and sub-optimal development. Current national and international (World Health Organization) management guidelines focus mainly on infants' needs, yet growing evidence suggests that maternal factors also influence infant outcomes. We aimed to inform future guidelines by exploring the impacts of maternal-focused interventions on infant feeding and growth.

Methods: We conducted a systematic review of reviews published since 2008 (PROSPERO, register number CRD 42019141724). We explored five databases and a wide variety of maternal-focused interventions based in low- and middle-income countries. Infant outcomes of interest included anthropometric status, birthweight, infant mortality, breastfeeding and complementary feeding practices. Given heterogenous interventions, we present a narrative synthesis of the extracted data.

Results: We included a total of 55 systematic reviews. Numerous maternal interventions were effective in improving infant growth or feeding outcomes. These included breastfeeding promotion, education, support and counselling interventions. Maternal mental health, while under-researched, showed potential to positively impact infant growth. There was also some evidence for a positive impact of: women's empowerment, m-health technologies, conditional cash transfers, water, sanitation and hygiene and agricultural interventions. Effectiveness was increased when implemented as part of a multi-sectoral program. Antenatal supplementation with macronutrient, multiple micronutrients, Vitamin D, zinc, iron folic acid and possibly calcium, iodine and B12 in deficient women, improved birth outcomes. In contrast, evidence for postnatal supplementation was limited as was evidence directly focusing on small and nutritionally at-risk infants; most reviews focused on the prevention of growth faltering.

Conclusion: Our findings suggest sufficient evidence to justify greater inclusion of mothers in more holistic packages of care for small and nutritionally at-risk infants aged <6m. Context specific approaches are likely needed to support mother-infant dyads and ensure infants survive and thrive.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Birth Weight
  • Breast Feeding
  • Counseling / organization & administration*
  • Dietary Supplements / analysis
  • Early Medical Intervention / methods*
  • Female
  • Folic Acid / administration & dosage
  • Humans
  • Infant
  • Infant Mortality
  • Infant Nutritional Physiological Phenomena / physiology
  • Infant, Low Birth Weight / growth & development*
  • Infant, Newborn
  • Micronutrients / administration & dosage
  • Micronutrients / deficiency
  • Mothers / psychology
  • Nutrients / administration & dosage
  • Nutrients / deficiency
  • Nutritional Status / physiology*
  • Practice Guidelines as Topic
  • Vitamins / administration & dosage

Substances

  • Micronutrients
  • Vitamins
  • Folic Acid

Grants and funding

Time contributed to authoring this paper was supported by the Eleanor Crook Foundation and Ireland’s Department for Foreign Affairs (Irish Aid) for EB, NL and MM. MK was supported by the Eleanor Crook Foundation. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The ideas, opinions and comments therein are entirely the responsibility of its author(s) and do not necessarily represent or reflect Irish Aid policy.