Effectiveness of nutrition counseling for pregnant women in low- and middle-income countries to improve maternal and infant behavioral, nutritional, and health outcomes: A systematic review

IF 4 Q1 SOCIAL SCIENCES, INTERDISCIPLINARY

Campbell Systematic Reviews Pub Date : 2023-11-29 DOI:10.1002/cl2.1361

Omar Dewidar, Jessica John, Aqeel Baqar, Mohamad Tarek Madani, Ammar Saad, Alison Riddle, Erika Ota, Jacqueline K. Kung'u, Mandana Arabi, Manoj Kumar Raut, Seth S. Klobodu, Sarah Rowe, Jennifer Hatchard, Jennifer Busch-Hallen, Chowdhury Jalal, Sara Wuehler, Vivian Welch

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Abstract

Background

Nutritional counseling, which includes two-way interactive education, has been hypothesized to improve the health and nutritional status of pregnant women, but little is known about the impact such practice of care might have on maternal and infant health and behavioral outcomes of pregnant women living in low income, low-middle income, and upper-middle-income countries (LMIC)s.

Objectives

We conducted a systematic review to appraise the effectiveness and impact on health equity of two-way nutritional counseling practices in LMICs on maternal and infant behavioral, nutritional, and health outcomes.

Search Methods

We conducted electronic searches for relevant studies on Medline, Embase, CINAHL, PsychInfo, and the Cochrane CENTRAL for randomized and non-randomized trials on the effectiveness of two-way interactive nutritional counseling among pregnant women from the date of database inception up to June 22, 2021. In addition, we searched references of included studies in systematic reviews, gray literature resources, and unpublished studies or reports that satisfied our eligibility criteria using a focused Google search.

Selection Criteria

We included randomized and non-randomized controlled studies (NRS), controlled before and after, and interrupted time series that assessed the effectiveness of two-way interactive nutrition counseling targeting pregnant women in LMICs.

Data Collection and Analysis

Data extraction and risk of bias were conducted in duplicate. The risk of bias (ROB) for randomized trials (RCT) was assessed according to the Cochrane Handbook of Systematic Reviews, and ROB for NRS was assessed using the Newcastle-Ottawa scale (NOS). RCT and NRS were meta-analyzed separately.

Main Results

Our search identified 6418 records and 52 studies met our inclusion criteria, but only 28 were used in the quantitative analysis. Twenty-eight studies were conducted in Asia, the most in Iran. Eight studies were conducted in Africa. Two-way interactive nutritional counseling during pregnancy may improve dietary caloric intake (mean difference [MD]: 81.65 calories, 95% confidence interval [CI], 15.37–147.93, three RCTs; I² = 42%; moderate certainty of evidence using GRADE assessment), may reduce hemorrhage (relative risk [RR]: 0.63; 95% CI, 0.25–1.54, two RCTs; I² = 40%; very low certainty of evidence using GRADE assessment), may improve protein (MD: 10.44 g, 95% CI, 1.83–19.05, two RCTs; I² = 95%; high certainty of evidence using GRADE assessment), fat intake (MD: 3.42 g, 95% CI, −0.20 to 7.04, two RCTs; I² = 0%; high certainty of evidence using GRADE assessment), and may improve gestational weight gain within recommendations (RR: 1.84; 95% CI, 1.10–3.09, three RCTs; I² = 69%). Nutrition counseling probably leads to the initiation of breastfeeding immediately after birth (RR: 1.72; 95% CI, 1.42–2.09, one RCT). There was little to no effect on reducing anemia (RR: 0.77; 95% CI, 0.50–1.20, three RCTs; I² = 67%; very low certainty of evidence using GRADE assessment) risk of stillbirths (RR: 0.81; 95% CI, 0.52–1.27, three RCTs; I² = 0%; moderate certainty of evidence using GRADE assessment) and risk of cesarean section delivery (RR: 0.96; 95% CI, 0.76–1.20, four RCTs; I² = 36%; moderate certainty of evidence using GRADE assessment).

Authors’ Conclusions

Our review highlights improvements in maternal behavioral and health outcomes through interactive nutrition counseling during pregnancy. However, we are uncertain about the effects of nutrition counseling due to the low certainty of evidence and a low number of studies for some key outcomes. Moreover, the effects on health equity remain unknown. More methodologically rigorous trials that focus on a precise selection of outcomes driven by the theory of change of nutrition counseling to improve maternal and infant behavioral and health outcomes and consider equity are required.

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低收入和中等收入国家孕妇营养咨询对改善母婴行为、营养和健康结果的有效性:一项系统综述。

背景:营养咨询，包括双向互动教育，已经被假设可以改善孕妇的健康和营养状况，但对于这种护理实践可能对生活在低收入、中低收入和中高收入国家(LMIC)的孕妇的母婴健康和行为结果的影响知之甚少。目的:我们进行了一项系统综述，以评估中低收入国家双向营养咨询实践对母婴行为、营养和健康结果的有效性和对健康公平性的影响。检索方法:我们在Medline、Embase、CINAHL、PsychInfo和Cochrane CENTRAL上进行了相关研究的电子检索，从数据库建立之日起至2021年6月22日，对孕妇进行双向互动营养咨询的有效性进行了随机和非随机试验。此外，我们检索了系统综述中纳入研究的参考文献、灰色文献资源和未发表的研究或报告，这些研究或报告符合我们的资格标准。选择标准:我们纳入了随机和非随机对照研究(NRS)，前后对照，以及中断时间序列，以评估针对中低收入国家孕妇的双向互动营养咨询的有效性。数据收集和分析:数据提取和偏倚风险一式两份。随机试验(RCT)的偏倚风险(ROB)根据Cochrane系统评价手册进行评估，NRS的ROB采用Newcastle-Ottawa量表(NOS)进行评估。RCT和NRS分别进行meta分析。主要结果:我们检索到6418条记录，52项研究符合我们的纳入标准，但只有28项用于定量分析。在亚洲进行了28项研究，其中伊朗最多。在非洲进行了八项研究。孕期双向互动营养咨询可改善膳食热量摄入(平均差[MD]: 81.65卡路里，95%可信区间[CI]， 15.37-147.93, 3项随机对照试验;i2 = 42%;使用GRADE评估证据的中度确定性)，可能减少出血(相对风险[RR]: 0.63;95% CI, 0.25-1.54, 2个随机对照试验;i2 = 40%;使用GRADE评估的证据确定性非常低)，可能改善蛋白质(MD: 10.44 g, 95% CI, 1.83-19.05, 2个随机对照试验;i2 = 95%;使用GRADE评估证据的高确定性)，脂肪摄入(MD: 3.42 g, 95% CI， -0.20至7.04,2个随机对照试验;I 2 = 0%;使用GRADE评估证据的高确定性)，并可能在推荐范围内改善妊娠体重增加(RR: 1.84;95% CI, 1.10-3.09, 3个rct;i2 = 69%)。营养咨询可能导致出生后立即开始母乳喂养(RR: 1.72;95% CI, 1.42-2.09, 1项RCT)。对减少贫血几乎没有影响(RR: 0.77;95% CI, 0.50-1.20, 3个rct;I 2 = 67%;使用GRADE评估的证据确定性极低)死产风险(RR: 0.81;95% CI, 0.52-1.27, 3个rct;I 2 = 0%;使用GRADE评估证据的中等确定性)和剖宫产的风险(RR: 0.96;95% CI, 0.76-1.20, 4个rct;I 2 = 36%;使用GRADE评估证据的中等确定性)。作者的结论:我们的综述强调了通过孕期互动营养咨询对产妇行为和健康结果的改善。然而，由于证据的不确定性和一些关键结果的研究数量较少，我们不确定营养咨询的效果。此外，对卫生公平的影响仍然未知。需要更多方法上严谨的试验，这些试验侧重于由营养咨询变化理论驱动的精确选择结果，以改善孕产妇和婴儿的行为和健康结果，并考虑公平性。

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