What more can be done? Prioritizing the most promising antenatal interventions to improve birth weight

Annariina M Koivu; Tiia Haapaniemi; Sufia Askari; Nita Bhandari; Robert E Black; R Matthew Chico; Kathryn G Dewey; Christopher P Duggan; Nigel Klein; Somesh Kumar; Joy E Lawn; Karim Manji; Pieta K Näsänen-Gilmore; Mihretab Salasibew; Katherine E A Semrau; Ulla Ashorn; Per Ashorn; LBW prevention prioritization working group

doi:10.1016/j.ajcnut.2022.10.022

What more can be done? Prioritizing the most promising antenatal interventions to improve birth weight

Am J Clin Nutr. 2023 Jun;117 Suppl 2(Suppl 2):S107-S117. doi: 10.1016/j.ajcnut.2022.10.022.

Authors

Annariina M Koivu¹, Tiia Haapaniemi², Sufia Askari³, Nita Bhandari⁴, Robert E Black⁵, R Matthew Chico⁶, Kathryn G Dewey⁷, Christopher P Duggan⁸, Nigel Klein⁹, Somesh Kumar¹⁰, Joy E Lawn¹¹, Karim Manji¹², Pieta K Näsänen-Gilmore², Mihretab Salasibew³, Katherine E A Semrau¹³, Ulla Ashorn², Per Ashorn¹⁴; LBW prevention prioritization working group

Collaborators

LBW prevention prioritization working group:
Toluwalase Awoyemi¹⁵, Adejumoke I Ayede¹⁶, Kalpana Bastola¹⁷, Zulfiqar A Bhutta¹⁸, Hannah Blencowe¹⁹, Parul Christian²⁰, Anna David²¹, Patricia Hunter²¹, Jaana Isojärvi¹⁷, Joanne Katz²⁰, Ayesha De Costa²², Daniel J Erchick²⁰, Sarah Gibson²³, Bronner P Goncalves²⁴, Michael G Gravett²⁵, Maryam Hadji¹⁷, Elizabeth Hazel²⁰, G Justus Hofmeyr²⁶, Naoko Kozuki²⁷, Anne Cc Lee²⁸, Hema Magge²⁹, Albert Manasyan³⁰, Abdulrahman Mohiddin³¹, Melissa Morrison³², Yvonne Muthiani¹⁷, Helen Nabwera³³, Annettee Nakimuli³⁴, Pius Okong³⁵, Andrew J Prendergast³⁶, Jonathon Simon³⁷, Marleen Temmerman³¹, Jian Yan²⁹

Affiliations

¹ Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. Electronic address: annariina.koivu@tuni.fi.
² Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
³ Children's Investment Fund Foundation, London, United Kingdom.
⁴ Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
⁵ Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
⁶ Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
⁷ Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA.
⁸ Center for Nutrition, Boston Children's Hospital/Harvard Medical School; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
⁹ UCL Great Ormond Street Institute of Child Health, London, UK.
¹⁰ Jhpiego, Baltimore, MD, USA.
¹¹ Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
¹² Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
¹³ Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
¹⁴ Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
¹⁵ University of Oxford, Oxford, UK.
¹⁶ College of Medicine University of Ibadan, Ibadan, Nigeria.
¹⁷ Tampere University, Tampere, Finland.
¹⁸ Aga Khan University, Centre for Global Child Health, Karachi, Pakistan and the Hospital for Sick Children, Toronto, Canada.
¹⁹ London School of Hygiene and Tropical Medicine, London, UK.
²⁰ Johns Hopkins University, Baltimore, USA.
²¹ University College London, London, UK.
²² World Health Organization, Geneva, Switzerland.
²³ Children's Investment Fund Foundation, London, UK.
²⁴ London School of Hygiene & Tropical Medicine, London, UK.
²⁵ University of Washington, Seattle, USA.
²⁶ Universities of Botswana, Witwatersrand, Fort Hare, Botswana.
²⁷ International Rescue Committee, Washington DC, USA.
²⁸ Brigham Women's Hospital, Harvard, Medical School, Boston, USA.
²⁹ Bill & Melinda Gates Foundation, Seattle, USA.
³⁰ University of Alabama at Birmingham, Birmingham, USA.
³¹ Aga Khan University, Karachi, Pakistan.
³² The ELMA Philanthropies Services, New York, USA.
³³ Liverpool School of Tropical Medicine, Liverpool, UK.
³⁴ Makerere University, Kampala, Uganda.
³⁵ Health Service Commission, Kampala, Uganda.
³⁶ Queen Mary University of London, London, UK.
³⁷ Independent consultant, Boston, USA.

Abstract

Background: Low birth weight (LBW) is associated with neonatal mortality and sequelae of lifelong health problems; prioritizing the most promising antenatal interventions may guide resource allocation and improve health outcomes.

Objective: We sought to identify the most promising interventions that are not yet included in the policy recommendations of the World Health Organization (WHO) but could complement antenatal care and reduce the prevalence of LBW and related adverse birth outcomes in low- and middle-income settings.

Methods: We utilized an adapted Child Health and Nutrition Research Initiative (CHNRI) prioritization method.

Results: In addition to procedures already recommended by WHO for the prevention of LBW, we identified six promising antenatal interventions that are not currently recommended by WHO with an indication for LBW prevention, namely: (1) provision of multiple micronutrients; (2) low-dose aspirin; (3) high-dose calcium; (4) prophylactic cervical cerclage; (5) psychosocial support for smoking cessation; and (6) other psychosocial support for targeted populations and settings. We also identified seven interventions for further implementation research and six interventions for efficacy research.

Conclusion: These promising interventions, coupled with increasing coverage of currently recommended antenatal care, could accelerate progress toward the global target of a 30% reduction in the number of LBW infants born in 2025 compared to 2006-10.

Keywords: Antenatal care (ANC); Child Health and Nutrition Research Initiative (CHNRI) method; Low birth weight (LBW); Low- and middle-income countries (LMICs); Preterm birth (PTB); Priority-setting.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Birth Weight
Child
Female
Humans
Infant
Infant, Low Birth Weight*
Infant, Newborn
Nutritional Status
Pregnancy
Pregnancy Complications*
Prenatal Care

Abstract

Publication types

MeSH terms

Grants and funding