Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review
<b> </b>Pregnancy in adolescence and malnutrition are common challenges in low- and middle-income countries (LMICs), and are associated with many complications and comorbidities. The preconception period is an ideal period for intervention as a preventative tactic for teenage pregnancy,...
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MDPI AG
2020-02-01
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author | Zohra S Lassi Sophie GE Kedzior Wajeeha Tariq Yamna Jadoon Jai K Das Zulfiqar A Bhutta |
author_facet | Zohra S Lassi Sophie GE Kedzior Wajeeha Tariq Yamna Jadoon Jai K Das Zulfiqar A Bhutta |
author_sort | Zohra S Lassi |
collection | DOAJ |
description | <b> </b>Pregnancy in adolescence and malnutrition are common challenges in low- and middle-income countries (LMICs), and are associated with many complications and comorbidities. The preconception period is an ideal period for intervention as a preventative tactic for teenage pregnancy, and to increase micronutrient supplementation prior to conception. Over twenty databases and websites were searched and 45 randomized controlled trials (RCTs) or quasi-experimental interventions with intent to delay the age at first pregnancy (<i>n</i><i> </i>= 26), to optimize inter-pregnancy intervals (<i>n</i> = 4), and supplementation of folic acid (<i>n</i> = 5) or a combination of iron and folic acid (<i>n</i> = 10) during the periconception period were included. The review found that educational interventions to delay the age at first pregnancy and optimizing inter-pregnancy intervals significantly improved the uptake of contraception use (RR = 1.71, 95% CI = 1.42−2.05; two studies, <i>n</i> = 911; I<sup>2</sup> = 0%) and (RR = 2.25, 95% CI = 1.29−3.93; one study, <i>n</i> = 338), respectively. For periconceptional folic acid supplementation, the incidence of neural tube defects were reduced (RR = 0.53; 95% CI = 0.41−0.77; two studies, <i>n</i> = 248,056; I<sup>2</sup> = 0%), and iron-folic acid supplementation improved the rates of anemia (RR = 0.66, 95% CI = 0.53−0.81; six studies; <i>n</i> = 3430, I<sup>2</sup> = 88%), particularly when supplemented weekly and in a school setting. Notwithstanding the findings, more robust RCTs are required from LMICs to further support the evidence. |
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spelling | doaj.art-d5936d2cec3f423e9ecd9d53466bb0c32022-12-22T03:05:41ZengMDPI AGNutrients2072-66432020-02-0112360610.3390/nu12030606nu12030606Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic ReviewZohra S Lassi0Sophie GE Kedzior1Wajeeha Tariq2Yamna Jadoon3Jai K Das4Zulfiqar A Bhutta5Robinson Research Institute, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide 5005, AustraliaRobinson Research Institute, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide 5005, AustraliaDepartment of Pediatrics, the Aga Khan University, Karachi 74800, PakistanDepartment of Pediatrics, the Aga Khan University, Karachi 74800, PakistanDepartment of Pediatrics, the Aga Khan University, Karachi 74800, PakistanDepartment of Pediatrics, the Aga Khan University, Karachi 74800, Pakistan<b> </b>Pregnancy in adolescence and malnutrition are common challenges in low- and middle-income countries (LMICs), and are associated with many complications and comorbidities. The preconception period is an ideal period for intervention as a preventative tactic for teenage pregnancy, and to increase micronutrient supplementation prior to conception. Over twenty databases and websites were searched and 45 randomized controlled trials (RCTs) or quasi-experimental interventions with intent to delay the age at first pregnancy (<i>n</i><i> </i>= 26), to optimize inter-pregnancy intervals (<i>n</i> = 4), and supplementation of folic acid (<i>n</i> = 5) or a combination of iron and folic acid (<i>n</i> = 10) during the periconception period were included. The review found that educational interventions to delay the age at first pregnancy and optimizing inter-pregnancy intervals significantly improved the uptake of contraception use (RR = 1.71, 95% CI = 1.42−2.05; two studies, <i>n</i> = 911; I<sup>2</sup> = 0%) and (RR = 2.25, 95% CI = 1.29−3.93; one study, <i>n</i> = 338), respectively. For periconceptional folic acid supplementation, the incidence of neural tube defects were reduced (RR = 0.53; 95% CI = 0.41−0.77; two studies, <i>n</i> = 248,056; I<sup>2</sup> = 0%), and iron-folic acid supplementation improved the rates of anemia (RR = 0.66, 95% CI = 0.53−0.81; six studies; <i>n</i> = 3430, I<sup>2</sup> = 88%), particularly when supplemented weekly and in a school setting. Notwithstanding the findings, more robust RCTs are required from LMICs to further support the evidence.https://www.mdpi.com/2072-6643/12/3/606periconceptionfolic acidiron folic aciddelaying pregnancyinter pregnancy intervalfamily planningmaternal healthneonatal health |
spellingShingle | Zohra S Lassi Sophie GE Kedzior Wajeeha Tariq Yamna Jadoon Jai K Das Zulfiqar A Bhutta Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review Nutrients periconception folic acid iron folic acid delaying pregnancy inter pregnancy interval family planning maternal health neonatal health |
title | Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review |
title_full | Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review |
title_fullStr | Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review |
title_full_unstemmed | Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review |
title_short | Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review |
title_sort | effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low and middle income countries a systematic review |
topic | periconception folic acid iron folic acid delaying pregnancy inter pregnancy interval family planning maternal health neonatal health |
url | https://www.mdpi.com/2072-6643/12/3/606 |
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