title: Effect of a micronutrient-rich snack taken preconceptionally and throughout pregnancy on ultrasound measures of fetal growth: The Mumbai Maternal Nutrition Project (MMNP).
abstract: Improving micronutrient intakes of under-nourished mothers in low- and middle-income countries increases birth weight, but there is little data on the nature and timing during gestation of any effects on fetal growth. Ultrasound measures of fetal size were used to determine whether and when a food-based supplement affected fetal growth. Non-pregnant women living in Mumbai slums, India (N = 6,513), were randomly assigned to receive either a daily micronutrient-rich snack containing green leafy vegetables, fruit, and milk (treatment) or a snack made from lower-micronutrient vegetables (control) in addition to their usual diet from before pregnancy until delivery. From 2,291 pregnancies, the analysis sample comprised 1,677 fetuses (1,335 fetuses of women supplemented for ≥3 months before conception). First-trimester (median: 10 weeks, interquartile range: 9-12 weeks) fetal crown-rump length was measured. Fetal head circumference, biparietal diameter, femur length, and abdominal circumference were measured during the second (19, 19-20 weeks) and third trimesters (29, 28-30 weeks). The intervention had no effect on fetal size or growth at any stage of pregnancy. In the second trimester, there were interactions between parity and allocation group for biparietal diameter (p = .02) and femur length (p = .04) with both being smaller among fetuses of primiparous women and larger among those of multiparous women, in the treatment group compared with the controls. Overall, a micronutrient-rich supplement did not increase standard ultrasound measures of fetal size and growth at any stage of pregnancy. Additional ultrasound measures of fetal soft tissues (fat and muscle) may be informative.
authors.affiliation: Dr Joshi Imaging Clinic, Mumbai, India.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Lawande
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
authors.forename: Chiara
authors.identifier: 0000-0001-5117-9985
authors.initials: C
authors.lastname: Di Gravio
authors.affiliation: Centre for the Study of Social Change, Mumbai, India.
authors.forename: Ramesh D
authors.initials: RD
authors.lastname: Potdar
authors.affiliation: Centre for the Study of Social Change, Mumbai, India.
authors.forename: Sirazul A
authors.initials: SA
authors.lastname: Sahariah
authors.affiliation: Centre for the Study of Social Change, Mumbai, India.
authors.forename: Meera
authors.initials: M
authors.lastname: Gandhi
authors.affiliation: Centre for the Study of Social Change, Mumbai, India.
authors.forename: Harsha
authors.initials: H
authors.lastname: Chopra
authors.affiliation: Centre for the Study of Social Change, Mumbai, India.
authors.forename: Harshad
authors.initials: H
authors.lastname: Sane
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Kehoe
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
authors.forename: Ella
authors.initials: E
authors.lastname: Marley-Zagar
authors.affiliation: Public Health Nutrition, University of Southampton, Southampton, UK.
authors.forename: Barrie M
authors.initials: BM
authors.lastname: Margetts
authors.affiliation: NIHR Southampton Biomedical Research Centre, Southampton, UK.
authors.forename: Alan A
authors.initials: AA
authors.lastname: Jackson
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
authors.forename: Caroline H D
authors.initials: CHD
authors.lastname: Fall
mesh_terms: D000328:Adult; D000818:Animals; D000886:Anthropometry; D018568:Crown-Rump Length; D004032:Diet; D019587:Dietary Supplements; D005260:Female; D047109:Fetal Development; D005333:Fetus / Q000000981:diagnostic imaging; D005638:Fruit; D005865:Gestational Age; D006801:Humans; D007194:India; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000008:administration & dosage*; D008892:Milk; D009752:Nutritional Status; D011204:Poverty Areas; D016742:Preconception Care / Q000379:methods; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D062410:Snacks; D016216:Ultrasonography, Prenatal; D014675:Vegetables
chemical_list: D018977:Micronutrients
keywords: India; fetal growth; food-based supplement; pregnancy; randomised controlled trial; ultrasound