Effects of nutrition interventions during pregnancy on low birth weight: an overview of systematic reviews
What this study found
Overall, improving women’s nutritional status during pregnancy was associated with lower risk of low birth weight, small-for-gestational-age birth, and preterm birth, with the strongest and most consistent support for multiple micronutrient supplementation and preventive antimalarial drugs. Specific effects varied by intervention: vitamin A added to iron plus folate reduced low birth weight by 33%, high-dose calcium (≥1 g/day) reduced preterm birth by 24%, multiple micronutrients reduced low birth weight by 11-14% and SGA by 10-17%, zinc in adolescent pregnancy reduced low birth weight by…
- Study & population
- Overview of systematic reviews of randomized, quasi-randomized, and cluster-randomized trials in pregnant women, mostly with singleton pregnancies, from low-, middle-, and high-income settings.
- Intervention
- Across the underlying reviews, active regimens included single vitamins and minerals (vitamin A, C, E, folic acid, calcium, iron, iodine, magnesium, zinc), multiple micronutrients, balanced energy/protein supplements, and marine oil or long-chain n-3 fatty acid supplementation during pregnancy.
- Key limitation
- Many interventions were supported by only a small number of trials, and the evidence varied widely in dose, formulation, population risk, and setting.
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Open PDFOriginal abstract
Introduction Low birth weight (LBW, birth weight less than 2500 g) is associated with infant mortality and childhood morbidity. Poor maternal nutritional status is one of several contributing factors to LBW. We systematically reviewed the evidence for nutrition-specific (addressing the immediate determinants of nutrition) and nutrition-sensitive (addressing the underlying cause of undernutrition) interventions to reduce the risk of LBW and/or its components: preterm birth (PTB) and small-for-gestational age (SGA). Methods We conducted a comprehensive literature search in MEDLINE, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews (September 2015). Systematic reviews of randomised controlled trials focusing on nutritional interventions before and during pregnancy to reduce LBW and its components were eligible for inclusion into the overview review. We assessed the methodological quality of the included reviews using A Measurement Tool to Assess Reviews (AMSTAR), PROSPERO: CRD42015024814. Results We included 23 systematic reviews which comprised 34 comparisons. Sixteen reviews were of high methodological quality, six of moderate and only one review of low quality. Six interventions were associated with a decreased risk of LBW: oral supplementation with (1) vitamin A, (2) low-dose calcium, (3) zinc, (4) multiple micronutrients (MMN), nutritional education and provision of preventive antimalarials. MMN and balanced protein/energy supplementation had a positive effect on SGA, while high protein supplementation increased the risk of SGA. High-dose calcium, zinc or long-chain n-3 fatty acid supplementation and nutritional education decreased the risk of PTB. Conclusion Improving women’s nutritional status positively affected LBW, SGA and PTB. Based on current evidence, especially MMN supplementation and preventive antimalarial drugs during pregnancy may be considered for policy and practice. However, for most interventions evidence was derived from a small number of trials and/or participants. There is a need to further explore the evidence of nutrition-specific and nutrition-sensitive interventions in order to reach the WHO’s goal of a 30% reduction in the global rate of LBW by 2025.