TY - JOUR
T1 - Maternal characteristics affect fetal growth response in the women first preconception nutrition trial
AU - Michael Hambidge, K.
AU - Bann, Carla M.
AU - McClure, Elizabeth M.
AU - Westcott, Jamie E.
AU - Garcés, Ana
AU - Figueroa, Lester
AU - Goudar, Shivaprasad S.
AU - Dhaded, Sangappa M.
AU - Pasha, Omrana
AU - Ali, Sumera A.
AU - Derman, Richard J.
AU - Goldenberg, Robert L.
AU - Koso-Thomas, Marion
AU - Somannavar, Manjunath S.
AU - Herekar, Veena
AU - Khan, Umber
AU - Krebs, Nancy F.
N1 - Funding Information:
Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA; Jamie.Westcott@cuanschutz.edu (J.E.W.); Nancy.Krebs@cuanschutz.edu (N.F.K.) RTI International, Durham, NC 27709, USA; cmb@rti.org (C.M.B.); mcclure@RTI.org (E.M.M.) INCAP (Instituto de Nutrición de Centro América y Panamá), Guatemala City 01011, Guatemala; agarces@incap.int (A.G.); lfigueroa@incap.int (L.F.) KLE Academy of Higher Education and Research’s Jawaharlal Nehru Medical College, Belagavi, Karnataka 590010, India; sgoudar@jnmc.edu (S.S.G.); drdhadedsm@gmail.com (S.M.D.); manjunathsomannavar@gmail.com (M.S.S.); nandhari@gmail.com (V.H.) Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan; omrana.pasha@jhu.edu (O.P.); sumera.ali@aku.edu (S.A.A.); umber.s.khan@googlemail.com (U.K.) Department of Global Affairs, Thomas Jefferson University, Philadelphia, PA 19107, USA; richard.derman@jefferson.edu Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA; rlg88@cumc.columbia.edu NICHD/NIH, Bethesda, MD 20852, USA; kosomari@mail.nih.gov Correspondence: Michael.Hambidge@cuanschutz.edu; Tel.: +303-724-3261 Current Institution: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287 USA.
Funding Information:
Funding: This research was funded by The Bill and Melinda Gates Foundation OPP1055867 and the Eunice Kennedy Shriver NICHD and the Office of Dietary Supplements, NIH U10 HD 076474.
PY - 2019/10
Y1 - 2019/10
N2 - 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.
AB - 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.
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U2 - 10.3390/nu11102534
DO - 10.3390/nu11102534
M3 - Article
C2 - 31640153
AN - SCOPUS:85073756417
VL - 11
JO - Nutrients
JF - Nutrients
SN - 2072-6643
IS - 10
M1 - 2534
ER -