根据具体情况为孕妇提供基于食物的营养教育和咨询，以改善分娩结果：马拉维农村群组随机对照试验

IF 3.8 Q2 NUTRITION & DIETETICS

Current Developments in Nutrition Pub Date : 2024-11-07 DOI:10.1016/j.cdnut.2024.104506

Penjani Rhoda Kamudoni , Lillian Kaunda , Marion Tharrey , Maggie Mphande , Shyreen Chithambo , Elaine Ferguson , Zumin Shi , Ibrahimu Mdala , Kenneth Maleta , Alister Munthali , Gerd Holmboe-Ottesen , Per Ole Iversen

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引用次数: 0

摘要

背景在马拉维等低收入国家，孕产妇膳食摄入不足仍是一项公共卫生挑战，并可能导致不良分娩结局。方法我们在马拉维南部开展了一项双臂（1:1）群组随机对照试验，招募妊娠期为 12-18 周的孕妇。20 个村庄（群组）被随机分配到干预组或对照组。营养教育和咨询（NEC）干预包括教育课程，随后是烹饪示范和咨询课程。我们鼓励妇女使用当地营养丰富的食物，以提高膳食的充足性和多样性。我们采用线性规划来确定可增加微量营养素摄入量的食物组合。对照组接受标准的产前健康教育。我们发现，干预组和对照组在出生后 1 小时或 24 小时内记录的平均出生体重没有明显差异。与对照组相比，干预组婴儿的出生身长（P = 0.043）和腹围（P = 0.007）更大，而其他出生结果没有显著差异。值得注意的是，量化分析显示，NEC 干预有利于身高低于参与样本平均身高（156 厘米）的母亲的出生体重（P-交互作用 = 0.043）。我们注意到，NEC 干预有利于身高低于样本平均身高的母亲的出生体重。我们的研究结果证明，有必要进一步研究在孕早期和更大范围内提供量身定制的 NEC。该试验已在 clinicaltrials.gov 登记为 NCT03136393。

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Context-Tailored Food-Based Nutrition Education and Counseling for Pregnant Women to Improve Birth Outcomes: A Cluster-Randomized Controlled Trial in Rural Malawi

Background

Inadequate maternal dietary intakes remain a public health challenge in low-income countries like Malawi and can cause adverse birth outcomes.

Objectives

To improve maternal dietary intakes and thus reduce the prevalence of adverse birth outcomes in rural Malawi.

Methods

We performed a 2-armed (1:1) cluster-randomized controlled trial in Southern Malawi, enrolling pregnant women at gestational age 12–18 wk. Twenty villages (clusters) were randomly assigned to an intervention or a control group. A nutrition education and counseling (NEC) intervention consisted of education sessions followed by cooking demonstrations and counseling sessions. The women were encouraged to use locally available nutrient-dense foods to enhance dietary adequacy and -diversity. We applied linear programming to identify food combinations that could increase micronutrient intakes. The control group received standard antenatal health education.

Results

Among the 311 women recruited, 187 (60%) completed the trial. We found no significant difference in mean birth weights recorded within 1 or 24 h of birth between the intervention and control groups. Intervention infants had greater birth length (P = 0.043) and abdominal circumference (P = 0.007) compared to controls, whereas other birth outcomes did not differ significantly. Notably, a quantile analysis revealed that the NEC intervention favored birth weight among mothers with a height below the mean height of the participant sample (156 cm) (P-interaction = 0.043).

Conclusions

Tailoring NEC in food-insecure communities did not result in a significant difference in birth weight among infants of the participating mothers, but mean birth length and abdominal circumference were greater in the intervention group compared to controls. We noted that the NEC intervention favored birth weight among mothers with a lower height than the mean sample height. Our results warrant further investigation into offering tailored NEC early in pregnancy and on a larger scale.

This trial was registered at clinicaltrials.gov as NCT03136393.

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