International Food Policy Research Institute, Washington, DC, USA.
FHI Solutions, Washington, DC, USA.
J Nutr. 2021 Aug 7;151(8):2282-2295. doi: 10.1093/jn/nxab131.
Maternal nutrition interventions are inadequately integrated into antenatal care (ANC). Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization through government ANC services.
We compared nutrition-intensified ANC (I-ANC) with standard ANC (S-ANC) on coverage of nutrition interventions and maternal nutrition practices.
We used a cluster-randomized design with cross-sectional baseline (2017) and endline (2019) surveys (n ∼660 pregnant and 1800 recently delivered women per survey) and a repeated-measures longitudinal study in 2018-2019 (n = 400). We derived difference-in-difference effect estimates (DIDs) for diet diversity, consumption of micronutrient supplements, weight monitoring, and early breastfeeding practices.
Despite substantial secular improvements in service coverage from India's national nutrition program, women in the I-ANC arm received more home visits [DID: 7-14 percentage points (pp)] and counseling on core nutrition messages (DID: 10-23 pp) than in the S-ANC arm. One-third of women got ≥3 home visits and one-fourth received ≥4 ANC check-ups in the I-ANC arm. Improvements were greater in the I-ANC arm than in the S-ANC arm for any receipt and consumption of iron-folic acid (DID: 7.5 pp and 9.5 pp, respectively) and calcium supplements (DID: 14.1 pp and 11.5 pp, respectively). Exclusive breastfeeding improved (DID: 7.5 pp) but early initiation of breastfeeding did not. Maternal food group consumption (∼4 food groups) and probability of adequacy of micronutrients (∼20%) remained low in both arms. Repeated-measures longitudinal analyses showed similar results, with additional impact on consumption of vitamin A-rich foods (10 pp, 11 g/d), other vegetables and fruits (22-29 g/d), and gestational weight gain (0.4 kg).
Intensifying nutrition in government ANC services improved maternal nutrition practices even with strong secular trends in service coverage. Dietary diversity, supplement consumption, and breastfeeding practices remained suboptimal. Achieving greater behavior changes will require strengthening the delivery and use of maternal nutrition services integrated into ANC services in the health system. This trial was registered at clinicaltrials.gov as NCT03378141.
孕产妇营养干预措施在产前保健 (ANC) 中未得到充分整合。Alive & Thrive 旨在通过政府 ANC 服务加强微量营养素补充的提供，并加强人际咨询和社区动员。
我们比较了强化 ANC (I-ANC) 与标准 ANC (S-ANC) 在营养干预措施和孕产妇营养实践方面的覆盖情况。
我们使用了一个群组随机设计，包括 2017 年的横断面基线调查和 2019 年的终点调查（每个调查约 660 名孕妇和 1800 名最近分娩的妇女），以及 2018-2019 年的重复测量纵向研究（n=400）。我们得出了饮食多样性、微量营养素补充剂消费、体重监测和早期母乳喂养实践的差异-差异效应估计值 (DID)。
尽管印度国家营养计划的服务覆盖面有了实质性的提高，但在 I-ANC 组中，妇女接受了更多的家访[差异-差异：7-14 个百分点 (pp)]和核心营养信息的咨询（差异-差异：10-23 pp），比在 S-ANC 组中更多。三分之一的妇女在 I-ANC 组中接受了≥3 次家访，四分之一的妇女接受了≥4 次 ANC 检查。在 I-ANC 组中，任何铁叶酸和钙补充剂的接受和消费都有更大的改善（差异-差异：7.5 pp 和 9.5 pp）。纯母乳喂养有所改善（差异-差异：7.5 pp），但母乳喂养的开始时间没有变化。在两个组中，孕产妇食物组的消费（约 4 种食物组）和微量营养素充足的可能性（约 20%）仍然较低。重复测量的纵向分析显示出类似的结果，对维生素 A 丰富的食物（10 pp，11 g/d）、其他蔬菜和水果（22-29 g/d）和妊娠体重增加（0.4 kg）的消费也有额外的影响。
即使在 ANC 服务覆盖范围有强劲的长期趋势的情况下，在政府 ANC 服务中强化营养也改善了孕产妇的营养实践。饮食多样性、补充剂消费和母乳喂养行为仍然不理想。要实现更大的行为改变，需要加强整合到 ANC 服务中的孕产妇营养服务的提供和利用。这项试验在 clinicaltrials.gov 上注册为 NCT03378141。
