Interventions to improve birth outcomes of pregnant women living in low- and middle-income countries
Citation: Park JJH, Harari O, Siden E, et al. Interventions to improve birth outcomes of pregnant women living in low- and middle-income countries: a systematic review and network meta-analysis. Gates Open Research. 2020;3:1657.
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding sources: Bill and Melinda Gates Foundation.
What is this? Despite significant progress in maternal, newborn and child health, adverse birth outcomes, including preterm birth and low birthweight, remain challenging particularly for low- and middle-income countries (LMICs).
The authors of this systematic review and network meta-analysis searched for randomized trials focused on micronutrient supplements, balanced energy protein supplements, deworming, maternal education and hygiene (WASH) for pregnant women in LMICs. They restricted their searches to articles published in English and did the search in September 2019. They included 101 randomised trials (206,531 participants).
What works? Micronutrient supplements including calcium and 1500 kcal/day of local food reduced the risk of preterm birth.
Supplementation of folic acid, iron, zinc and multiple micronutrients reduced the risk of preterm birth.
Multiple micronutrients including folic acid, iron or both and considering balanced energy food supplements, unfortified lipid-based nutrient supplements of 20 grams (LNS20) improved mean birthweight.
High caloric local food intervention (1500 kcal/day) reduced the risk of low birthweight.
Calcium, multiple micronutrients, LNS20, and fortified LNS20 reduced the risk of low birthweight.
What doesn’t work? Balanced energy food supplements (other than 1500 kcal/day of local food, maternal education and deworming interventions) showed no reduction in the risk of preterm birth.
Deworming and maternal education showed no improvements in mean birthweight.
A single dose of deworming during pregnancy did not show a decrease in low birthweight compared to standard care.
What is uncertain? The impact of WASH interventions on preterm birth and birthweight outcomes could not be ascertained.
Implications: The authors stated that maternal, newborn and child health programs should consider adopting and adapting effective interventions as a mechanism to achieve global nutrition targets and that interventions should be combined as packages and evaluated.
Other considerations: The authors of the review discussed their findings in the context of socioeconomic status and place of residence (LMICs).
This summary was prepared by Tuba Yavuz, checked by Sydney Johnson, and finalized by Mike Clarke.