A modular systematic review of antenatal interventions to address undernutrition during pregnancy in the prevention of low birth weight

Patricia J Hunter; Yvonne Muthiani; Pieta K Näsänen-Gilmore; Annariina M Koivu; Pia Pörtfors; Kalpana Bastola; Raija Vimpeli; Juho Luoma; Ulla Ashorn; Per Ashorn

doi:10.1016/j.ajcnut.2023.01.024

A modular systematic review of antenatal interventions to address undernutrition during pregnancy in the prevention of low birth weight

Am J Clin Nutr. 2023 Jun:117 Suppl 2:S134-S147. doi: 10.1016/j.ajcnut.2023.01.024.

Authors

Affiliations

¹ University College London Great Ormond Street Institute of Child Health, London, UK. Electronic address: patricia.hunter@ucl.ac.uk.
² Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
³ Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Institute for Health and Welfare, FI-00271, Helsinki, Finland.
⁴ Finnish Institute for Health and Welfare, FI-00271, Helsinki, Finland.
⁵ Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland.

PMID: 37331760
DOI: 10.1016/j.ajcnut.2023.01.024

Abstract

Background: Poor nutrition during pregnancy can lead to adverse birth outcomes including low birth weight (LBW).

Objective: This modular systematic review aimed to provide evidence for the effects of seven antenatal nutritional interventions on the risks of LBW, preterm birth (PTB), small-for-gestational-age (SGA) and stillbirth (SB).

Methods: We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and CINAHL Complete between April and June 2020, with a further update in September 2022 (Embase only). We included randomized controlled trials (RCTs) and reviews of RCTs to estimate the effect sizes of the selected interventions on the four birth outcomes.

Results: Evidence suggests that balanced protein and energy (BPE) supplementation for pregnant women with undernutrition can reduce the risk of LBW, SGA and SB. Evidence from low and lower middle-income countries (MIC) suggests that multiple micronutrient (MMN) supplementation can reduce the risk of LBW and SGA in comparison with iron or iron and folic acid supplementation and lipid-based nutrient supplements (LNS) with any quantity of energy can reduce the risk of LBW in comparison with MMN supplementation. Evidence from high and upper MIC suggests that supplementation with omega-3 fatty acids (O3FA) can reduce the risk and supplementation with high-dose calcium might possibly reduce the risk of LBW and PTB. Antenatal dietary education programs might possibly reduce the risk of LBW in comparison with standard-of-care. No RCTs were identified for monitoring weight gain followed by interventions to support weight gain in women who are underweight.

Conclusions: Provision of BPE, MMN and LNS to pregnant women in populations with undernutrition can reduce the risk of LBW and related outcomes. The benefits of O3FA and calcium supplementation to this population require further investigation. Targeting interventions to pregnant women who are not gaining weight has not been tested with RCTs.

Keywords: antenatal care; low birth weight; nutrition; pregnancy; preterm birth; small-for-gestational-age; stillbirth; undernutrition.

Publication types

Systematic Review

MeSH terms

Birth Weight
Calcium
Dietary Supplements
Female
Humans
Infant, Low Birth Weight
Infant, Newborn
Iron
Malnutrition* / prevention & control
Pregnancy
Pregnancy Outcome
Premature Birth* / epidemiology
Premature Birth* / prevention & control
Weight Gain

Substances

Calcium
Iron