Ceesay S M, Prentice A M, Cole T J, Foord F, Weaver L T, Poskitt E M, Whitehead R G
MRC Dunn Nutrition Unit, Keneba, Gambia, West Africa.
BMJ. 1997 Sep 27;315(7111):786-90. doi: 10.1136/bmj.315.7111.786.
To test the efficacy in terms of birth weight and infant survival of a diet supplement programme in pregnant African women through a primary healthcare system.
5 year controlled trial of all pregnant women in 28 villages randomised to daily supplementation with high energy groundnut biscuits (4.3 MJ/day) for about 20 weeks before delivery (intervention) or after delivery (control).
Rural Gambia.
Chronically undernourished women (twin bearers excluded), yielding 2047 singleton live births and 35 stillbirths.
Birth weight; prevalence of low birth weight (< 2500 g); head circumference; birth length; gestational age; prevalence of stillbirths; neonatal and postneonatal mortality.
Supplementation increased weight gain in pregnancy and significantly increased birth weight, particularly during the nutritionally debilitating hungry season (June to October). Weight gain increased by 201 g (P < 0.001) in the hungry season, by 94 g (P < 0.01) in the harvest season (November to May), and by 136 g (P < 0.001) over the whole year. The odds ratio for low birthweight babies in supplemented women was 0.61 (95% confidence interval 0.47 to 0.79, P < 0.001). Head circumference was significantly increased (P < 0.01), but by only 3.1 mm. Birth length and duration of gestation were not affected. Supplementation significantly reduced perinatal mortality: the odds ratio was 0.47 (0.23 to 0.99, P < 0.05) for stillbirths and 0.54 (0.35 to 0.85, P < 0.01) for all deaths in first week of life. Mortality after 7 days was unaffected.
Prenatal dietary supplementation reduced retardation in intrauterine growth when effectively targeted at genuinely at-risk mothers. This was associated with a substantial reduction in the prevalence of stillbirths and in early neonatal mortality. The intervention can be successfully delivered through a primary healthcare system.
通过初级卫生保健系统，测试一项针对非洲孕妇的饮食补充计划在出生体重和婴儿存活率方面的效果。
对28个村庄的所有孕妇进行为期5年的对照试验，随机分为在分娩前约20周（干预组）或分娩后（对照组）每日补充高能花生饼干（4.3兆焦耳/天）。
冈比亚农村。
长期营养不良的妇女（排除双胞胎孕妇），共分娩2047例单胎活产和35例死产。
出生体重；低出生体重（<2500克）的发生率；头围；出生身长；孕周；死产发生率；新生儿及新生儿后期死亡率。
补充营养增加了孕期体重增加，并显著增加了出生体重，尤其是在营养状况较差的饥饿季节（6月至10月）。饥饿季节体重增加201克（P<0.001），收获季节（11月至5月）增加94克（P<0.01），全年增加136克（P<0.001）。补充营养的妇女中低出生体重儿的比值比为0.61（95%置信区间0.47至0.79，P<0.001）。头围显著增加（P<0.01），但仅增加3.1毫米。出生身长和孕周不受影响。补充营养显著降低了围产期死亡率：死产的比值比为0.47（0.23至0.99，P<0.05），出生后第一周所有死亡的比值比为0.54（0.35至0.85，P<0.01）。7天后的死亡率不受影响。
当有效针对真正有风险的母亲时，产前饮食补充可减少宫内生长迟缓。这与死产发生率和早期新生儿死亡率的大幅降低有关。该干预措施可通过初级卫生保健系统成功实施。
