scholarly journals The Effect of Maternal Multiple Micronutrient Supplementation on Female Early Infant Mortality Is Fully Mediated by Increased Gestation Duration and Intrauterine Growth

2019 ◽  
Vol 150 (2) ◽  
pp. 356-363 ◽  
Author(s):  
Mary K Quinn ◽  
Emily R Smith ◽  
Paige L Williams ◽  
Willy Urassa ◽  
Joy Shi ◽  
...  
Keyword(s):  
Birth Weight ◽  
Infant Mortality ◽  
Gestational Age ◽  
Controlled Trial ◽  
Joint Effect ◽  
P Value ◽  
Micronutrient Supplementation ◽  
Double Blind ◽  
Intrauterine Growth ◽  
Mortality Effect

ABSTRACT Background Maternal micronutrient supplementation in pregnancy (MMS) has been shown to improve birth weight among infants in low- and middle-income countries. Recent evidence suggests that the survival benefits of MMS are greater for female infants compared to male infants, but the mechanisms leading to differential effects remain unclear. Objective The objective of this study was to examine the potential mechanisms through which MMS acts on infant mortality among Tanzanian infants. Methods We used data collected from pregnant women and newborns in a randomized, double-blind, placebo-controlled trial of MMS conducted in Tanzania to examine mediators of the effect of MMS on 6-wk infant mortality (NCT00197548). Causal mediation analyses with the counterfactual approach were conducted to assess the contributions of MMS on survival via their effects on birth weight, gestational age, weight-for-gestational age, and the joint effect of gestational age and weight-for-gestational age. The weighting method allowed for interaction between gestational age and weight-for-gestational age. Results Among 7486 newborns, the effect of MMS on 6-wk survival was fully mediated (100%) through the joint effect of gestational age and weight-for-gestational age. MMS was also found to have a significant natural indirect effect through increased birth weight (P-value < 0.001) that explained 75% of the total effect on 6-wk mortality. When analyses were stratified by sex, changes in gestational age and weight-for-gestational age fully mediated the mortality effect among female infants (n = 3570), but these mediators only explained 34% of the effect among males (n = 3833). Conclusions The potential sex-specific effects of MMS on mortality may be a result of differences in mechanisms related to birth outcomes. In the context of the Tanzanian trial, the observed effect of MMS on 6-wk mortality for female infants was entirely mediated by increased gestation duration and improved intrauterine growth, while these mechanisms did not appear to be major contributors among male infants.

scholarly journals Mediators of the Effect of Multiple Micronutrient Supplementation in Pregnancy on Infant Mortality in Tanzania (P24-050-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Mary Quinn ◽  
Emily Smith ◽  
Paige Williams ◽  
Willy Urassa ◽  
Joy Shi ◽  
...  
Keyword(s):  
Infant Mortality ◽  
Gestational Age ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Joint Effect ◽  
Micronutrient Supplementation ◽  
Double Blind ◽  
Causal Mediation ◽  
Multiple Micronutrient ◽  
In Pregnancy

Abstract Objectives Maternal micronutrient supplementation (MMS) in pregnancy has been shown to improve birthweight among infants in low- and middle-income countries (LMIC). Recent evidence also suggests that the survival benefits of MMS are greater for female infants as compared to males, but the biological mechanisms leading to the differential effect remain unclear. The objective of this study was to conduct a causal mediation analysis to examine the mechanisms through which MMS may operate on infant mortality. Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2017;4: CD004905 Methods We utilized data from a randomized, double-blind, placebo-controlled trial of MMS conducted in Tanzania to examine mediators of the effect of MMS on six-week infant mortality. Causal mediation analyses were conducted for assessing the contributions of MMS on survival via their effects on birthweight, gestational age, weight-for-gestational age, and the joint effect of gestational age and weight-for-gestational age. Results Among 7486 participants (3762 randomized to MMS, 3724 randomized to placebo), we observed that the effect of MMS on survival was fully mediated through the joint effect of gestational age and weight-for-gestational age. Further, when analyses were stratified by sex, gestational age and weight-for-gestational age fully mediated the survival benefits for female infants while these factors accounted for only 34% of the effect among male infants. Conclusions We determined that increases in gestational age and birth weight fully mediate the beneficial effect of MMS on mortality among female infants; however, these mechanisms do not appear to be major contributors to a potential effect among males. Funding Sources This research was supported in part by the National Institutes of Health (NIH) predoctoral training grants, and was a secondary analysis of data from a study supported by a grant from the National Institute of Child Health and Human Development.

scholarly journals Fish Oil Supplementation in Pregnancy Increases Gestational Age, Size for Gestational Age, and Birth Weight in Infants: A Randomized Controlled Trial

2018 ◽  
Vol 149 (4) ◽  
pp. 628-634 ◽  
Author(s):  
Rebecca Kofod Vinding ◽  
Jakob Stokholm ◽  
Astrid Sevelsted ◽  
Bo L Chawes ◽  
Klaus Bønnelykke ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Birth Weight ◽  
Pregnant Women ◽  
Gestational Age ◽  
Controlled Trial ◽  
Growth Curves ◽  
Vitamin D Supplementation ◽  
Double Blind ◽  
Randomized Controlled ◽  
In Pregnancy

ABSTRACT Background Randomized trials have reported that supplementation with n–3 long-chain polyunsaturated fatty acids (LCPUFAs) in pregnancy can prolong pregnancy and thereby increase birth weight. Objective We aimed to examine the relations of n–3 LCPUFA supplementation in pregnancy with duration of pregnancy, birth weight, and size for gestational age (GA). Methods This was a double-blind randomized controlled trial conducted in 736 pregnant women and their offspring, from the Copenhagen Prospective Studies on Asthma in Childhood2010cohort. They were recruited between weeks 22 and 26 in pregnancy and randomly assigned to either of 2.4 g n–3 LCPUFA or control (olive oil) daily until 1 wk after birth. Exclusion criteria were endocrine, cardiovascular, or nephrologic disorders and vitamin D supplementation intake >600 IU/d. In this study we analyzed secondary outcomes, and further excluded twin pregnancies and extrauterine death. The primary outcome for the trial was persistent wheeze or asthma. Results The random assignment ran between 2008 and 2010. Six hundred and ninety-nine mother-infant pairs were included in the analysis. n–3 LCPUFA compared with control was associated with a 2-d prolongation of pregnancy [median (IQR): 282 (275–288) d compared with 280 (273–286) d, P = 0.02], a 97-g higher birth weight (mean ± SD: 3601 ± 534 g compared with 3504 ± 528 g, P = 0.02), and an increased size for GA according to the Norwegian population-based growth curves-Skjærven (mean ± SD: 49.9 ± 28.3 percentiles compared with 44.5 ± 27.6 percentiles, P = 0.01). Conclusion Supplementing pregnant women with n–3 LCPUFAs during the third trimester is associated with prolonged gestation and increased size for GA, leading to a higher birth weight in this randomized controlled trial. This trial was registered at clinicaltrials.gov as NCT00798226.

scholarly journals Efficacy of lidocaine-prilocaine combination cream in reducing pain caused by hepatitis B injection in neonates: a randomized control trial

2007 ◽  
Vol 47 (1) ◽  
pp. 12
Author(s):  
Nugroho Karyadiguna ◽  
Soetjiningsih Soetjiningsih ◽  
W. Retayasa ◽  
M. Kardana
Keyword(s):  
Birth Weight ◽  
Hepatitis B ◽  
Gestational Age ◽  
Controlled Trial ◽  
Chronological Age ◽  
Medical Procedures ◽  
Double Blind ◽  
Term Neonates ◽  
The Mean ◽  
Lidocaine Prilocaine

Background Many invasive medical procedures cause pain inneonates. Pain in this age group increases morbidity, impairsemotional bonding, and causes hyperalgesia. Combination oflidocaine and prilocaine cream is one of the topical analgesicsthat are easy to use and safe for neonates.Objective To assess the efficacy of lidocaine-prilocainecombination cream in reducing pain caused by intramuscularinjection of hepatitis B and to find out the correlation of sex,gestational age, birth weight, chronological age, and method ofdelivery with infant’s pain response.Methods A double blind randomized controlled trial wasconducted on term neonates. Subjects were selected consecutivelyand every subject was randomized to either receive lidocaine-prilocaine cream or placebo one hour prior to administration ofintramuscular hepatitis B vaccine. The administration wasrecorded by a handycam and the intensity of pain responses wasevaluated using DAN (Douleur Aigue Nouveau-ne) scale.Results Of 67 subjects, the mean of DAN scale was 7.60 (95%CI 7.27;7.95) in the lidocaine-prilocaine cream group and thiswas significantly lower (P<0.0001) than in placebo group, whichwas 8.82 (95% CI 8.56;9.09). ANCOVA showed that there wereno associations between sex, gestational age, birth weight,chronological age, and method of delivery with infant’s painresponse.Conclusion Lidocaine-prilocaine combination cream can reducethe pain caused by intramuscular injection of hepatitis B vaccineon term neonates.

scholarly journals Effect of multiple-micronutrient supplementation on maternal nutrient status, infant birth weight and gestational age at birth in a low-income, multi-ethnic population

2010 ◽  
Vol 104 (3) ◽  
pp. 437-445 ◽  
Author(s):  
Louise Brough ◽  
Gail A. Rees ◽  
Michael A. Crawford ◽  
R. Hugh Morton ◽  
Edgar K. Dorman
Keyword(s):  
Gestational Age ◽  
Low Income ◽  
Controlled Trial ◽  
Nutrient Status ◽  
First Trimester ◽  
Micronutrient Supplementation ◽  
Micronutrient Deficiencies ◽  
Double Blind ◽  
Multiple Micronutrient ◽  
Infant Birth

Poor nutrient intake during pregnancy can adversely affect both infant and maternal health. The aim was to investigate the efficacy of multiple-micronutrient supplementation during pregnancy in a socially deprived population in the developed world. We conducted a randomised, double-blind, placebo-controlled trial of multiple-micronutrient supplementation including 20 mg Fe and 400 μg folic acid, from the first trimester of pregnancy in 402 mothers, in East London, UK. Nutrient status was measured at recruitment, and at 26 and 34 weeks of gestation. Infants were weighed at birth. At recruitment the prevalence of anaemia was 13 %, vitamin D insufficiency 72 %, thiamin deficiency 12 % and folate deficiency 5 %, with no differences between groups. Only 39 % of women completed the study; rates of non-compliance were similar in both groups. Intention-to-treat analysis showed that participants receiving treatment had higher mean Hb at 26 weeks of gestation (110 (sd10)v.108 (sd10) g/l;P = 0·041) and 34 weeks of gestation (113 (sd12)v.109 (sd10) g/l;P = 0·003) and packed cell volume concentrations at 26 weeks of gestation (0·330 (sd0·025)v.0·323 (sd0·026) l/l;P = 0·011) and 34 weeks of gestation (0·338 (sd0·029)v.0·330 (sd0·028) l/l;P = 0·014) compared with controls. Analysis of compliant women showed supplemented women had higher median concentrations of serum ferritin, erythrocyte folate and 25-hydroxyvitamin D later in gestation than controls. In the compliant subset (n149), placebo mothers had more small-for-gestational age (SGA) infants (eight SGAv.thirteen;P = 0·042) than treatment mothers. Baseline micronutrient deficiencies were common; the multiple-micronutrient supplement was well-tolerated and improved nutrient status. Multiple-micronutrient supplements from early pregnancy may be beneficial and larger studies are required to assess impact on birth outcomes and infant development.

scholarly journals The Analysis of Factors Related to the Incidence Of Low Birth Weight In dr. Ben Mboi Ruteng Hospital, Manggarai Regency

2021 ◽  
Vol 10 (1) ◽  
pp. 37-42
Author(s):  
Reineldis Elsidianastika Trisnawati Neldis
Keyword(s):  
Birth Weight ◽  
Infant Mortality ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Maternal Age ◽  
Neonatal Period ◽  
Statistical Tests ◽  
P Value ◽  
Cross Sectional ◽  
Significance Level

ABSTRACT LBW is considered the leading cause of infant mortality, especially in the first month of life. The incidence of LBW in Indonesia has a prevalence of 10.2% and most of the LBW infants who died during the neonatal period. According to the health profile of the East Nusa Tenggara Province, the number of infant mortality cases in NTT Province in 2018 was 1,265 cases, the factors causing infant mortality in this case were dominated by LBW and Asphyxia. Based on data obtained from dr. Ben Mboi Ruteng Hospital, LBW cases in 2019 totaled 640 cases. LBW is one of the risk factors that have a contribution to infant mortality during the neonatal period. Until now, LBW is still a problem that causes morbidity and mortality in newborns. The purpose of this study was to analyze the factors associated with the incidence of low birth weight babies (LBW) in dr.Ben Mboi Ruteng Hospital. This type of research is a quantitative study with a cross sectional research design. The population in the study was 2.480 mothers giving birth and the sample size obtained was 96 respondents with a sampling technique, namely purposive sampling. The results of statistical tests using Chi Square with a significance level of 0,05 indicate that maternal age has a p-value of 0,004 (p<0,05), gestational age has a p-value of 0,004 (p<0,05) and parity has a p-value value 0,704 (p>0,05. The conclusion of this study is that there is a significant relationship between maternal age and gestational age with the incidence of LBW and there is no relationship between parity and the incidence of LBW in dr. Ben Mboi Ruteng Hospital.  Keywords: age, parity, gestational age, LBW

scholarly journals Prenatal Maternal Docosahexaenoic Acid (DHA) Supplementation and Newborn Anthropometry in India: Findings from DHANI

2021 ◽  
Author(s):  
Shweta Khandelwal ◽  
Dimple Kondal ◽  
Monica Chaudhry ◽  
Kamal Patil ◽  
MK Swamy ◽  
...  
Keyword(s):  
Birth Weight ◽  
Docosahexaenoic Acid ◽  
Gestational Age ◽  
Head Circumference ◽  
Corn Oil ◽  
Controlled Trial ◽  
Omega 3 ◽  
Double Blind ◽  
Gestational Age At Delivery ◽  
Newborn Anthropometry

Long-chain omega-3 fatty acid status during pregnancy may influence newborn anthropometry and duration of gestation. Evidence from high-quality trials from LMICs is limited. We conducted a double-blind, randomized, placebo-controlled trial among 957 pregnant women (singleton gestation, 14-20 weeks&rsquo; gestation at enrollment) in India to test the effectiveness of 400 mg/d algal docosahexaenoic acid (DHA) compared to placebo provided from enrollment through delivery. Among 3379 women who were screened, 1171 were found eligible; 957 enrolled and were randomized. The intervention was two microencapsulated algal DHA (200 X 2= 400 mg/d) or two microencapsulated soy and corn oil placebo tablets to be consumed daily from enrollment (20 weeks) through delivery. The primary outcome was newborn anthropometry (birth weight, length, head circumference). Secondary outcomes were gestational age and 1 and 5 min Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score. The groups (DHA; n=478 and placebo; n=479) were well balanced at baseline. There were 902 live births. Compliance with the intervention was similar across groups (DHA: 88.5%; placebo: 87.1%). There were no significant differences between DHA and placebo group for birth weight (2750.6 &plusmn; 421.5 vs. 2768.2 &plusmn; 436.6 g, p=0.54), length (47.3 &plusmn; 2.0 vs. 47.5 &plusmn;2.0 cm, p=0.13) or head circumference (33.7 &plusmn; 1.4 vs 33.8 &plusmn; 1.4 cm, p=0.15). The mean gestational age at delivery was similar between groups (DHA: 38.8 &plusmn; 1.7 placebo: 38.8 &plusmn; 1.7 wk, p= 0.54) as were APGAR scores at 1 and 5 min. Supplementing mothers through pregnancy with 400mg/d DHA did not impact the offspring birthweight, length or head circumference.

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