scholarly journals Human Capital and Wage Income Gains of Scaling-Up Maternal Prenatal Nutrition Interventions in Low- and Middle-Income Countries

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 887-887
Author(s):  
Nandita Perumal ◽  
Mia Blakstad ◽  
Goodarz Danaei ◽  
Gunther Fink ◽  
Mark Lambiris ◽  
...  
Keyword(s):  
Human Capital ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Maternal Nutrition ◽  
Scaling Up ◽  
Nutrition Intervention ◽  
Nutrition Interventions ◽  
Middle Income ◽  
Prenatal Nutrition ◽  
Middle Income Countries

Abstract Objectives Scaling-up nutrition interventions during pregnancy may provide human capital gains by lowering the risk of adverse birth outcomes associated with reduced long-term socioeconomic outcomes. We estimated gains in years of schooling and lifetime wages of scaling up prenatal maternal nutrition interventions for a 137 low- and middle-income countries. Methods Through a comprehensive review of the literature, we identified four prenatal maternal nutrition interventions with convincing-level of evidence for improving birth outcomes: prenatal multiple micronutrient supplements (MMS), calcium supplements, iron-folic acid supplements (IFA), and balanced protein energy supplements (BEP) among underweight pregnant women (BMI < 18.5 kg/m2). Effect sizes for intervention impact were derived from systematic reviews and random-effects meta-analysis. We focused on low birthweight (LBW) and preterm birth (PTB) as primary birth outcomes. We used the 2015 LBW and PTB prevalence estimates to calculate country-specific absolute reductions attributable to scaling-up a given prenatal nutrition invention. We then used an effect size based on a de novo review of the economics literature to quantify gains in schooling and lifetime wages due to reductions in LBW/PTB under two hypothetical scale-up scenarios of 50% and 90% coverage. Results For each country, returns on schooling and lifetime wages were estimated for scaling-up each prenatal nutrition intervention. For example, in Bangladesh, scaling-up IFA supplements from current coverage of 26% to 90% was estimated to reduce LBW prevalence by 3.2% contributing to a predicted increase of 0.11 million school years and US$153 million in wages per birth cohort. Similarly, scaling-up MMS, calcium supplements, and BEP to 90% coverage was predicted to increase schooling by 0.25, 0.17, and 0.07 million years, and wages by US$338, US$223, and US$97 million, respectively, per birth cohort. Global, regional, and national-level estimates for schooling and wage gains for each nutrition intervention will be presented. Conclusions Our findings indicate that scaling-up prenatal maternal nutrition interventions will contribute to substantial population-level increases in human capital, particularly in countries with a high burden of low birthweight or preterm birth. Funding Sources Bill and Melinda Gates Foundation.

scholarly journals Interventions to improve birth outcomes of pregnant women living in low- and middle-income countries: a systematic review and network meta-analysis

2020 ◽  
Vol 3 ◽  
pp. 1657
Author(s):  
Jay J. H. Park ◽  
Ofir Harari ◽  
Ellie Siden ◽  
Michael Zoratti ◽  
Louis Dron ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Adverse Birth Outcomes ◽  
Middle Income ◽  
Middle Income Countries

Background: Improving the health of pregnant women is important to prevent adverse birth outcomes, such as preterm birth and low birthweight. We evaluated the comparative effectiveness of interventions under the domains of micronutrient, balanced energy protein, deworming, maternal education, and water sanitation and hygiene (WASH) for their effects on these adverse birth outcomes. Methods: For this network meta-analysis, we searched for randomized clinical trials (RCTs) of interventions provided to pregnant women in low- and middle-income countries (LMICs). We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We extracted data from eligible studies for study characteristics, interventions, participants’ characteristics at baseline, and birth outcomes. We compared effects on preterm birth (<37 gestational week), low birthweight (LBW; <2500 g), and birthweight (continuous) using studies conducted in LMICs. Results: Our network meta-analyses were based on 101 RCTs (132 papers) pertaining to 206,531 participants. Several micronutrients and balanced energy food supplement interventions demonstrated effectiveness over standard-of-care. For instance, versus standard-of-care, micronutrient supplements for pregnant women, such as iron and calcium, decreased risks of preterm birth (iron: RR=0.70, 95% credible interval [Crl] 0.47, 1.01; calcium: RR=0.76, 95%Crl 0.56, 0.99). Daily intake of 1500kcal of local food decreased the risks of preterm birth (RR=0.36, 95%Crl 0.16, 0.77) and LBW (RR=0.17, 95%Crl 0.09, 0.29), respectively when compared to standard-of-care. Educational and deworming interventions did not show improvements in birth outcomes, and no WASH intervention trials reported on these adverse birth outcomes. Conclusion: We found several pregnancy interventions that improve birth outcomes. However, most clinical trials have only evaluated interventions under a single domain (e.g. micronutrients) even though the causes of adverse birth outcomes are multi-faceted. There is a need to combine interventions that of different domains as packages and test for their effectiveness. Registration: PROSPERO CRD42018110446; registered on 17 October 2018.

scholarly journals Interventions to improve birth outcomes of pregnant women living in low- and middle-income countries: a systematic review and network meta-analysis

2019 ◽  
Vol 3 ◽  
pp. 1657 ◽  
Author(s):  
Jay J. H. Park ◽  
Ofir Harari ◽  
Ellie Siden ◽  
Michael Zoratti ◽  
Louis Dron ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Adverse Birth Outcomes ◽  
Middle Income ◽  
Middle Income Countries

Background: Improving the health of pregnant women is important to prevent adverse birth outcomes, such as preterm birth and low birthweight. We evaluated the comparative effectiveness of interventions under the domains of micronutrient, balanced energy protein, deworming, maternal education, and water sanitation and hygiene (WASH) for their effects on these adverse birth outcomes. Methods: For this network meta-analysis, we searched for randomized clinical trials (RCTs) of interventions provided to pregnant women in low- and middle-income countries (LMICs). We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We extracted data from eligible studies for study characteristics, interventions, participants’ characteristics at baseline, and birth outcomes. We compared effects on preterm birth (<37 gestational week), low birthweight (LBW; <2500 g), and birthweight (continuous) using studies conducted in LMICs. Results: Our network meta-analyses were based on 101 RCTs (132 papers) pertaining to 206,531 participants. Several micronutrients and balanced energy food supplement interventions demonstrated effectiveness over standard-of-care. For instance, versus standard-of-care, micronutrient supplements for pregnant women, such as iron and calcium, decreased risks of preterm birth (iron: RR=0.70, 95% credible interval [Crl] 0.47, 1.01; calcium: RR=0.76, 95%Crl 0.56, 0.99). Daily intake of 1500kcal of local food decreased the risks of preterm birth (RR=0.36, 95%Crl 0.16, 0.77) and LBW (RR=0.17, 95%Crl 0.09, 0.29), respectively when compared to standard-of-care. Educational and deworming interventions did not show improvements in birth outcomes, and no WASH intervention trials reported on these adverse birth outcomes. Conclusion: We found several pregnancy interventions that improve birth outcomes. However, most clinical trials have only evaluated interventions under a single domain (e.g. micronutrients) even though the causes of adverse birth outcomes are multi-faceted. There is a need to combine interventions that of different domains as packages and test for their effectiveness. Registration: PROSPERO CRD42018110446; registered on 17 October 2018.

Differential Effects of Maternal Diets on Birth Outcomes and Metabolic Parameters in Rats After Ethanol Consumption during Pregnancy

2020 ◽  
pp. 1-25
Author(s):  
Yidi Wang ◽  
Bradley A. Feltham ◽  
Michael N. A. Eskin ◽  
Miyoung Suh
Keyword(s):  
Total Cholesterol ◽  
Birth Outcomes ◽  
Maternal Nutrition ◽  
Maternal Diet ◽  
Hdl Cholesterol ◽  
Nutrition Intervention ◽  
Metabolic Parameters ◽  
Nutrition Status ◽  
Sprague Dawley ◽  
Metabolic Outcomes

Abstract Maternal nutrition status plays an important role in the development of fetal alcohol spectrum disorders (FASD), but its direct evidence is lacking. This study compared a standard chow with a semi-purified energy dense (E-dense) diet on birth and metabolic outcomes in rats after ethanol (EtOH) consumption during pregnancy. Pregnant Sprague-Dawley rats were randomized into four groups: chow (n=6), chow+EtOH (20% v/v) (n=7), E-dense (n=6), and E-dense+EtOH (n=8). Birth outcomes including litter size, body and organ weights were collected. Metabolic parameters were measured in dams and pups at postnatal day (PD) 7. Maternal EtOH consumption decreased body weights (p <0.0001) and litter sizes (p <0.05) in chow-fed dams. At PD7, pups born to dams fed E-dense diet had higher body (p <0.002) and liver weights (p <0.0001). These pups also had higher plasma total cholesterol (p <0.0001), triacyclglycerol (p <0.003) and alanine aminotransferase (p <0.03) compared to those from chow-fed dams. Dams fed E-dense diet had higher plasma total- (p <0.0001) and HDL-cholesterol (p <0.0001) and lower glucose (p <0.0001). EtOH increased total cholesterol (p <0.03) and glucose (p <0.05) only in dams fed the E-dense diet. Maternal exposure to E-dense diet attenuated prenatal EtOH-induced weight loss and produced different metabolic outcomes in both dams and pups. While the long-lasting effects of these outcomes are unknown, this study highlights the importance of maternal diet quality for maternal health and infant growth, and suggests that maternal nutrition intervention may be a potential target for alleviating FASD.

Do Cash Transfers Improve Birth Outcomes? Evidence from Matched Vital Statistics, and Program and Social Security Data

2016 ◽  
Vol 8 (2) ◽  
pp. 1-43 ◽  
Author(s):  
Verónica Amarante ◽  
Marco Manacorda ◽  
Edward Miguel ◽  
Andrea Vigorito
Keyword(s):  
Social Security ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Maternal Nutrition ◽  
Vital Statistics ◽  
Cash Transfers ◽  
Gestational Length ◽  
Assistance Program ◽  
Intrauterine Growth ◽  
Key Driver

There is limited empirical evidence on whether cash transfers to poor pregnant women improve children's birth outcomes and potentially help weaken the cycle of intergenerational poverty. Using a unique array of program and social security administrative micro-data matched to longitudinal vital statistics in Uruguay, we estimate that participation in a generous social assistance program led to a sizable reduction in the incidence of low birthweight. The effect is due to faster intrauterine growth rather than longer gestational length. Our findings are consistent with improved maternal nutrition during pregnancy being a key driver of improved birthweight. (JEL I14, I32, I38, J13, J16, O15)

scholarly journals Evidence-based interventions to reduce mortality among preterm and low-birthweight neonates in low-income and middle-income countries: a systematic review and meta-analysis

2021 ◽  
Vol 6 (2) ◽  
pp. e003618
Author(s):  
Mirjam Y Kleinhout ◽  
Merel M Stevens ◽  
Kwabena Aqyapong Osman ◽  
Kwame Adu-Bonsaffoh ◽  
Floris Groenendaal ◽  
...  
Keyword(s):  
Low Income ◽  
Low Birthweight ◽  
Meta Analysis ◽  
Neonatal Resuscitation ◽  
Newborn Care ◽  
Evidence Based ◽  
Antenatal Corticosteroids ◽  
Essential Newborn Care ◽  
Middle Income ◽  
Middle Income Countries

BackgroundPreterm birth is the leading cause of under-five-mortality worldwide, with the highest burden in low-income and middle-income countries (LMICs). The aim of this study was to synthesise evidence-based interventions for preterm and low birthweight (LBW) neonates in LMICs, their associated neonatal mortality rate (NMR), and barriers and facilitators to their implementation. This study updates all existing evidence on this topic and reviews evidence on interventions that have not been previously considered in current WHO recommendations.MethodsSix electronic databases were searched until 3 March 2020 for randomised controlled trials reporting NMR of preterm and/or LBW newborns following any intervention in LMICs. Risk ratios for mortality outcomes were pooled where appropriate using a random effects model (PROSPERO registration number: CRD42019139267).Results1236 studies were identified, of which 49 were narratively synthesised and 9 contributed to the meta-analysis. The studies included 39 interventions in 21 countries with 46 993 participants. High-quality evidence suggested significant reduction of NMR following antenatal corticosteroids (Pakistan risk ratio (RR) 0.89; 95% CI 0.80 to 0.99|Guatemala 0.74; 0.68 to 0.81), single cord (0.65; 0.50 to 0.86) and skin cleansing with chlorhexidine (0.72; 0.55 to 0.95), early BCG vaccine (0.64; 0.48 to 0.86; I2 0%), community kangaroo mother care (OR 0.73; 0.55 to 0.97; I2 0%) and home-based newborn care (preterm 0.25; 0.14 to 0.48|LBW 0.42; 0.27 to 0.65). No effects on perinatal (essential newborn care 1.02; 0.91 to 1.14|neonatal resuscitation 0.95; 0.84 to 1.07) or 7-day NMR (essential newborn care 1.03; 0.83 to 1.27|neonatal resuscitation 0.92; 0.77 to 1.09) were observed after training birth attendants.ConclusionThe findings of this study encourage the implementation of additional, evidence-based interventions in the current (WHO) guidelines and to be selective in usage of antenatal corticosteroids, to reduce mortality among preterm and LBW neonates in LMICs. Given the global commitment to end all preventable neonatal deaths by 2030, continuous evaluation and improvement of the current guidelines should be a priority on the agenda.

scholarly journals Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 491 ◽  
Author(s):  
Christina Oh ◽  
Emily C. Keats ◽  
Zulfiqar A. Bhutta
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Child Health ◽  
Low Birthweight ◽  
Grey Literature ◽  
Micronutrient Supplementation ◽  
Maternal Anemia ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Almost two billion people are deficient in key vitamins and minerals, mostly women and children in low- and middle-income countries (LMICs). Deficiencies worsen during pregnancy due to increased energy and nutritional demands, causing adverse outcomes in mother and child, but could be mitigated by interventions like micronutrient supplementation. To our knowledge, this is the first systematic review that aimed to compile evidence from both efficacy and effectiveness trials, evaluating different supplementation interventions on maternal, birth, child health, and developmental outcomes. We evaluated randomized controlled trials and quasi-experimental studies published since 1995 in peer-reviewed and grey literature that assessed the effects of calcium, vitamin A, iron, vitamin D, and zinc supplementation compared to placebo/no treatment; iron-folic (IFA) supplementation compared to folic acid only; multiple micronutrient (MMN) supplementation compared to IFA; and lipid-based nutrient supplementation (LNS) compared to MMN supplementation. Seventy-two studies, which collectively involved 314 papers (451,723 women), were included. Meta-analyses showed improvement in several key birth outcomes, such as preterm birth, small-for-gestational age (SGA) and low birthweight with MMN supplementation, compared to IFA. MMN also improved child outcomes, including diarrhea incidence and retinol concentration, which are findings not previously reported. Across all comparisons, micronutrient supplementation had little to no effect on mortality (maternal, neonatal, perinatal, and infant) outcomes, which is consistent with other systematic reviews. IFA supplementation showed notable improvement in maternal anemia and the reduction in low birthweight, whereas LNS supplementation had no apparent effect on outcomes; further research that compares LNS and MMN supplementation could help understand differences with these commodities. For single micronutrient supplementation, improvements were noted in only a few outcomes, mainly pre-eclampsia/eclampsia (calcium), maternal anemia (iron), preterm births (vitamin D), and maternal serum zinc concentration (zinc). These findings highlight that micronutrient-specific supplementation should be tailored to specific groups or needs for maximum benefit. In addition, they further contribute to the ongoing discourse of choosing antenatal MMN over IFA as the standard of care in LMICs.

Sign in / Sign up

Export Citation Format

Share Document