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

Abstract

BACKGROUND: Low birth weight (LBW) is an important public health problem in undernourished populations.<br/><br/>OBJECTIVE: We tested whether improving women's dietary micronutrient quality before conception and throughout pregnancy increases birth weight in a high-risk Indian population.<br/><br/>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 &gt; 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.<br/><br/>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 &lt; 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 (&lt;18.6), middle (18.6-21.8), and highest (&gt;21.8) thirds of BMI, respectively]. In 1094 newborns whose mothers started supplementation &gt; 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.<br/><br/>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 &gt;3 mo before conception and was not underweight. This trial was registered at www.controlled-trials.com/isrctn/ as ISRCTN62811278<br/>

Topics

• impedance spectroscopy
• iron
• Calcium