Maternal Characteristics Affect Fetal Growth Response in the Women First Preconception Nutrition Trial

Author:

Hambidge K Michael,Bann Carla M.,McClure Elizabeth M.,Westcott Jamie E.,Garcés Ana,Figueroa LesterORCID,Goudar Shivaprasad S.ORCID,Dhaded Sangappa M.,Pasha Omrana,Ali Sumera A.,Derman Richard J.,Goldenberg Robert L.,Koso-Thomas Marion,Somannavar Manjunath S.ORCID,Herekar Veena,Khan Umber,Krebs Nancy F.

Abstract

The objective of this secondary analysis was to identify maternal characteristics that modified the effect of maternal supplements on newborn size. Participants included 1465 maternal–newborn dyads in Guatemala, India, and Pakistan. Supplementation commenced before conception (Arm 1) or late 1st trimester (Arm 2); Arm 3 received usual care. Characteristics included body mass index (BMI), stature, anemia, age, education, socio-economic status (SES), parity, and newborn sex. Newborn outcomes were z-scores for length (LAZ), weight (WAZ), and weight to length ratio-for-age (WLRAZ). Mixed-effect regression models included treatment arm, effect modifier, and arm * effect modifier interaction as predictors, controlling for site, characteristics, and sex. Parity (para-0 vs. para ≥1), anemia (anemia/no anemia), and sex were significant effect modifiers. Effect size (95% CI) for Arm 1 vs. 3 was larger for para-0 vs. ≥1 for all outcomes (LAZ 0.56 (0.28, 0.84, p < 0.001); WAZ 0.45 (0.20, 0.07, p < 0.001); WLRAZ 0.52 (0.17, 0.88, p < 0.01) but only length for Arm 2 vs. 3. Corresponding effects for para ≥1 were >0.02. Arm 3 z-scores were all very low for para-0, but not para ≥1. Para-0 and anemia effect sizes for Arm 1 were > Arm 2 for WAZ and WLRAZ, but not LAZ. Arm 1 and 2 had higher WAZ for newborn boys vs. girls. Maternal nulliparity and anemia were associated with impaired fetal growth that was substantially improved by nutrition intervention, especially when commenced prior to conception.

Funder

Bill and Melinda Gates Foundation

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Publisher

MDPI AG

Subject

Food Science,Nutrition and Dietetics

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