Habtu Michael, Agena Alemayehu Gebremariam, Umugwaneza Maryse, Mochama Monica, Munyanshongore Cyprien
College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda.
Department of Public Health, School of Health Sciences, Mount Kenya University, Kigali, Rwanda.
Front Nutr. 2022 Jul 22;9:874714. doi: 10.3389/fnut.2022.874714. eCollection 2022.
Inadequate maternal nutrition before and during pregnancy is a principal risk factor for poor fetal development, resulting in low birth weight (LBW) and subsequently, poor child growth. Most studies focus on the impact of nutritional interventions after birth while only a few interventions consider integrated nutrition service packages. Therefore, there is limited evidence on whether integrated maternal nutrition interventions have a positive effect on birthweight. Thus, a post-program quasi-experimental study was carried out to determine the effectiveness of the integrated maternal nutrition intervention package on low birth weight in Rwanda. A total of 551 mother-baby pairs from the intervention and 545 controls were included in the analysis. Data regarding socio-demographic, maternal anthropometric parameters, and dietary diversity were collected using a structured questionnaire. Birth weight was assessed right after delivery, within 24 h. Logistic regression, linear regression, and path analysis were fitted to determine the effectiveness of the intervention on birth weight. The study found that the intervention reduced LBW by 66.99% ( < 0.001) and increased average birth weight by 219 g ( < 0.001). Logistic regression identified reduced risk of LBW among the intervention group (AOR = 0.23; 95%CI = 0.12-0.43; < 0.001). It was also observed that the direct effect of the intervention on birth weight was 0.17 (β = 0.17; < 0.001) and the main indirect mediator was maternal MUAC (β = 0.05; < 0.001). Moreover, maternal passive smoking exposure and MUAC < 23 cm were found as risk factors for LBW. This study has demonstrated that an integrated maternal nutritional intervention package can significantly reduce LBW in low-income settings and should, therefore, be considered to improve birth weight.
孕期及孕前孕产妇营养不足是胎儿发育不良的主要风险因素，会导致低出生体重，进而影响儿童后期生长。大多数研究关注出生后营养干预的影响，而只有少数干预措施考虑了综合营养服务包。因此，关于孕产妇综合营养干预对出生体重是否有积极影响的证据有限。因此，开展了一项项目后准实验研究，以确定孕产妇综合营养干预包对卢旺达低出生体重的有效性。分析纳入了来自干预组的551对母婴和545对对照组母婴。使用结构化问卷收集了社会人口学、孕产妇人体测量参数和饮食多样性的数据。在分娩后24小时内立即评估出生体重。采用逻辑回归、线性回归和路径分析来确定干预对出生体重的有效性。研究发现，干预使低出生体重降低了66.99%（P<0.001），平均出生体重增加了219克（P<0.001）。逻辑回归确定干预组低出生体重风险降低（优势比=0.23；95%置信区间=0.12 - 0.43；P<0.001）。还观察到干预对出生体重的直接效应为0.17（β = 0.17；P<0.001），主要间接中介因素是孕产妇的上臂中段周长（β = 0.05；P<0.001）。此外，发现孕产妇被动吸烟暴露和上臂中段周长<23厘米是低出生体重的风险因素。这项研究表明，孕产妇综合营养干预包可以显著降低低收入环境中的低出生体重，因此应考虑采用以提高出生体重。
