Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review

• 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: periconception; folic acid; iron folic acid; delaying pregnancy; inter pregnancy interval; family planning; maternal health; neonatal health
• Online Access: https://www.mdpi.com/2072-6643/12/3/606

<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; I² = 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; I² = 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, I² = 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.