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Review
, 11 Suppl 3 (Suppl 3), S3

Preconception Care: Nutritional Risks and Interventions

Review

Preconception Care: Nutritional Risks and Interventions

Sohni V Dean et al. Reprod Health.

Abstract

Introduction: There is increasingly a double burden of under-nutrition and obesity in women of reproductive age. Preconception underweight or overweight, short stature and micronutrient deficiencies all contribute to excess maternal and fetal complications during pregnancy.

Methods: A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on maternal, newborn and child health (MNCH) outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture.

Results: Maternal pre-pregnancy weight is a significant factor in the preconception period with underweight contributing to a 32% higher risk of preterm birth, and obesity more than doubling the risk for preeclampsia, gestational diabetes. Overweight women are more likely to undergo a Cesarean delivery, and their newborns have higher chances of being born with a neural tube or congenital heart defect. Among nutrition-specific interventions, preconception folic acid supplementation has the strongest evidence of effect, preventing 69% of recurrent neural tube defects. Multiple micronutrient supplementation shows promise to reduce the rates of congenital anomalies and risk of preeclampsia. Although over 40% of women worldwide are anemic in the preconception period, only one study has shown a risk for low birth weight.

Conclusion: All women, but especially those who become pregnant in adolescence or have closely-spaced pregnancies (inter-pregnancy interval less than six months), require nutritional assessment and appropriate intervention in the preconception period with an emphasis on optimizing maternal body mass index and micronutrient reserves. Increasing coverage of nutrition-specific and nutrition-sensitive strategies (such as food fortification; integration of nutrition initiatives with other maternal and child health interventions; and community based platforms) is necessary among adolescent girls and women of reproductive age. The effectiveness of interventions will need to be simultaneously monitored, and form the basis for the development of improved delivery strategies and new nutritional interventions.

Figures

Figure 1
Figure 1
Search flow diagram
Figure 2
Figure 2
Pre pregnancy underweight and risk for preterm birth: evidence from observational studies Citations to the included studies: Abenhaim 2007 [55], Chen 2009 [56], Driul 2008 [57], Johnson 2009 [58], Kosa 2010 [59], Murakami 2005 [60], Ronnenberg 2003 [61], Salihu 2009 [62], Wise 2010[63], Chen 2010 [64], Gilboa 2008 [65], Han 2010 [66].
Figure 3
Figure 3
Pre pregnancy overweight and risk for preeclampsia: evidence from observational studies Citations to the included studies: Abenhaim 2007 [55], Driul 2008 [57], Fortner 2009 [75], Murakami 2005 [60], Nohr 2008 [67], Cedergren 2004 [29], Chen 2010 [64], Doherty 2006 [11], Leeners 2006 [13], LaCoursiere 2005 [74], Phithakwatchara 2007 [85], Sebire 2001[1]
Figure 4
Figure 4
Folic acid supplementation and risk of recurrent neural tube defects: evidence from observational and experimental studies Citations to the included studies: Kirke 1992 [119], Laurence 1981 [120], MRC 1991 [118], Suarez 2000 [121], Vergel 1990 [122]
Figure 5
Figure 5
Folic acid supplementation and risk of congenital heart defects: evidence from observational and experimental studies Citations to the included studies: Botto 1996 [146], Czeizel 1996 [134], Czeizel 2004 [135], Kirke 1992 [119]
Figure 6
Figure 6
Multivitamin supplementation and risk of preeclampsia: evidence from observational studies Citations to the included studies: Bodnar 2006 [155], Catov 2009 [156]
Figure 7
Figure 7
multivitamin supplementation and risk of multiple congenital anomalies: evidence from observational studies Citations to the included studies: Bitsko 2007 [149], Czeizel 2003 [150], Khoury 1996 [151], Shaw 2000 [152]
Figure 8
Figure 8
multivitamin supplementation and risk of concurrent neural tube defects: evidence from observational studies Citations to the included studies: Bower 1992 [129], Chen 2008[133], Czeizel 1996 [134], Czeizel 2004 [135], Mulinare 1988 [136], Shaw 1995 [200], Werler 1993 [138]

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