Potdar Ramesh D, Sahariah Sirazul A, Gandhi Meera, Kehoe Sarah H, Brown Nick, Sane Harshad, Dayama Monika, Jha Swati, Lawande Ashwin, Coakley Patsy J, Marley-Zagar Ella, Chopra Harsha, Shivshankaran Devi, Chheda-Gala Purvi, Muley-Lotankar Priyadarshini, Subbulakshmi G, Wills Andrew K, Cox Vanessa A, Taskar Vijaya, Barker David J P, Jackson Alan A, Margetts Barrie M, Fall Caroline H D
From the Centre for the Study of Social Change, Mumbai, India (RDP, SAS, MG, HS, MD, SJ, AL, HC, DS, PC-G, PM-L, and GS); the Medical Research Council Lifecourse Epidemiology Unit (SHK, NB, PJC, EM-Z, AKW, VAC, DJPB, and CHDF), the National Institute for Health Research Southampton Biomedical Research Centre (AAJ), and Public Health Nutrition, Faculty of Medicine (BMM), University of Southampton, Southampton, United Kingdom; and Streehitakarini, Mumbai, India (VT).
Am J Clin Nutr. 2014 Nov;100(5):1257-68. doi: 10.3945/ajcn.114.084921. Epub 2014 Sep 17.
Low birth weight (LBW) is an important public health problem in undernourished populations.
We tested whether improving women's dietary micronutrient quality before conception and throughout pregnancy increases birth weight in a high-risk Indian population.
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 ≥ 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% of WHO Reference Nutrient Intakes of β-carotene, riboflavin, folate, vitamin B-12, calcium, and iron (controls: 0-7%). The primary outcome was birth weight.
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% CI: -15, 68 g; P = 0.22). There was an interaction (P < 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 (<18.6), middle (18.6-21.8), and highest (>21.8) thirds of BMI, respectively]. In 1094 newborns whose mothers started supplementation ≥ 90 d before pregnancy (per-protocol analysis), birth weight was higher in the treatment group (+48 g; 95% CI: 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% CI: 0.66, 1.05; P = 0.10; per-protocol OR = 0.76; 95% CI: 0.59, 0.98; P = 0.03) but no effect on gestational age in either analysis.
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 ≥ 3 mo before conception and was not underweight. This trial was registered at www.controlled-trials.com/isrctn/ as ISRCTN62811278.
低出生体重是营养不良人群中一个重要的公共卫生问题。
我们测试了在高危印度人群中，孕前及孕期全程改善女性饮食中微量营养素质量是否会增加出生体重。
本研究为非盲、个体随机对照试验。干预措施为从孕前≥90天直至分娩，除日常饮食外，每天食用一份由绿叶蔬菜、水果和牛奶制成的零食（治疗组）或低微量营养素蔬菜（土豆和洋葱）（对照组）。治疗组零食含有0.69兆焦能量（对照组：0.37兆焦）以及世界卫生组织参考营养素摄入量中10%-23%的β-胡萝卜素、核黄素、叶酸、维生素B-12、钙和铁（对照组：0%-7%）。主要结局指标为出生体重。
在6513名随机分组的女性中，2291名女性怀孕，1962名女性分娩出活产单胎新生儿，对1360名新生儿进行了测量。在意向性分析中，治疗组出生体重无总体增加（增加26克；95%置信区间：-15,68克；P = 0.22）。分配组与孕前期母体体重指数（BMI；单位：kg/m²）之间存在交互作用（P < 0.001）[出生体重效应：BMI最低（<18.6）、中间（18.6 - 21.8）和最高（>21.8）三分位数组分别为-23克、+34克和+96克]。在1094名母亲在孕前≥90天开始补充营养的新生儿中（符合方案分析），治疗组出生体重较高（增加48克；95%置信区间：1,96克；P = 0.046）。同样，效应随母体BMI增加（-8克、+79克和+113克；P交互作用 = 0.001）。低出生体重的结果相似（意向性分析比值比：0.83；95%置信区间：0.66,1.05；P = 0.10；符合方案分析比值比 = 0.76；95%置信区间：0.59,0.98；P = 0.03），但两种分析对孕周均无影响。
孕前及孕期全程每天食用一份提供额外绿叶蔬菜、水果和牛奶的零食对出生体重无总体影响。符合方案分析和亚组分析表明，如果母亲在孕前≥3个月开始补充营养且体重正常，出生体重可能会增加。本试验在www.controlled-trials.com/isrctn/上注册，注册号为ISRCTN62811278。
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