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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Main Authors: Zohra S Lassi, Sophie GE Kedzior, Wajeeha Tariq, Yamna Jadoon, Jai K Das, Zulfiqar A Bhutta
Format: Article
Language:English
Published: MDPI AG 2020-02-01
Series:Nutrients
Subjects:
Online Access:https://www.mdpi.com/2072-6643/12/3/606
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spelling doaj-d5936d2cec3f423e9ecd9d53466bb0c32020-11-25T01:19:53ZengMDPI 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&#8722;2.05; two studies, <i>n</i> = 911; I<sup>2</sup> = 0%) and (RR = 2.25, 95% CI = 1.29&#8722;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&#8722;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&#8722;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
collection DOAJ
language English
format Article
sources DOAJ
author Zohra S Lassi
Sophie GE Kedzior
Wajeeha Tariq
Yamna Jadoon
Jai K Das
Zulfiqar A Bhutta
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
author_facet Zohra S Lassi
Sophie GE Kedzior
Wajeeha Tariq
Yamna Jadoon
Jai K Das
Zulfiqar A Bhutta
author_sort Zohra S Lassi
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_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_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_sort effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low- and middle-income countries: a systematic review
publisher MDPI AG
series Nutrients
issn 2072-6643
publishDate 2020-02-01
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&#8722;2.05; two studies, <i>n</i> = 911; I<sup>2</sup> = 0%) and (RR = 2.25, 95% CI = 1.29&#8722;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&#8722;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&#8722;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.
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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