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
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...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-12-01
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| Series: | Campbell Systematic Reviews |
| Online Access: | https://doi.org/10.1002/cl2.1361 |
| _version_ | 1797374856294039552 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Omar Dewidar |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T19:11:49Z |
| format | Article |
| id | doaj.art-9f52ca3d22e640cf99d5c5d0d65bb345 |
| institution | Directory Open Access Journal |
| issn | 1891-1803 |
| language | English |
| last_indexed | 2024-03-08T19:11:49Z |
| publishDate | 2023-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Campbell Systematic Reviews |
| spelling | doaj.art-9f52ca3d22e640cf99d5c5d0d65bb3452023-12-27T11:00:42ZengWileyCampbell Systematic Reviews1891-18032023-12-01194n/an/a10.1002/cl2.1361Effectiveness of nutrition counseling for pregnant women in low‐ and middle‐income countries to improve maternal and infant behavioral, nutritional, and health outcomes: A systematic reviewOmar Dewidar0Jessica John1Aqeel Baqar2Mohamad Tarek Madani3Ammar Saad4Alison Riddle5Erika Ota6Jacqueline K. Kung'u7Mandana Arabi8Manoj Kumar Raut9Seth S. Klobodu10Sarah Rowe11Jennifer Hatchard12Jennifer Busch‐Hallen13Chowdhury Jalal14Sara Wuehler15Vivian Welch16Bruyere Research Institute University of Ottawa Ottawa Ontario CanadaEat, Drink and Be Healthy Tunapuna Trinidad and TobagoSchool of Epidemiology and Public Health University of Ottawa Ottawa Ontario CanadaBruyere Research Institute University of Ottawa Ottawa Ontario CanadaSchool of Epidemiology and Public Health University of Ottawa Ottawa Ontario CanadaBruyere Research Institute University of Ottawa Ottawa Ontario CanadaGlobal School of Nursing Science, Global Health Nursing St. Luke's International University Chuo‐ku JapanNutrition International—Africa Regional Office Nairobi Nairobi KenyaNutrition International New York New York USANutrition International New Delhi IndiaDepartment of Nutrition and Food Science California State University, Chico Chico California USANutrition International Ottawa Ontario CanadaNutrition International Ottawa Ontario CanadaNutrition International Ottawa Ontario CanadaGlobal Technical Services, Nutrition International Ottawa Ontario CanadaNutrition International Ottawa Ontario CanadaBruyere Research Institute University of Ottawa Ottawa Ontario CanadaAbstract 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.https://doi.org/10.1002/cl2.1361 |
| spellingShingle | 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 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 Campbell Systematic Reviews |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | https://doi.org/10.1002/cl2.1361 |
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