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

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

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.

Keywords: maternal nutrition; newborn anthropometry; nulliparous; preconception.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Adjusted mean (95% confidence interval) length-for-age z-scores (LAZ) of neonatal outcomes by treatment arm and parity. Horizontal line at LAZ −1 depicts a length deficit that has predicted a high risk of stunting at two years. Circles indicate parity = 0; Triangles indicate parity ≥1.
Figure 2
Figure 2
Adjusted mean (95% confidence interval) weight-for-age z-scores (WAZ) of neonatal outcomes by treatment arm and parity. Horizontal line at WAZ −1.28 corresponds to the 10th% WAZ (small-for-gestational age). Circles indicate parity = 0; Triangles indicate parity ≥1.
Figure 3
Figure 3
Adjusted mean (95% confidence interval) weight to length ratio-for-age z-scores (WLRAZ) of neonatal outcomes by treatment arm and parity. Horizontal line at WLRAZ −2 depicts weight to length deficit for diagnosis of wasting. Circles indicate parity = 0; Triangles indicate parity ≥1.

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