{
  "abstract": "Introduction The Women First (WF) Preconception Maternal Nutrition trial found greater benefits of small-quantity lipid-based nutrient supplements (SQ-LNS) for intrauterine growth among anaemic versus non-anaemic women at preconception. We investigated whether the benefits of SQ-LNS in improving markers of intrauterine growth occurred evenly across the mild to moderate spectrum of pre-pregnancy anaemia.Methods We analysed WF data (n=2443 maternal-newborn dyads) from Pakistan, India, Guatemala and the Democratic Republic of Congo. Women received SQ-LNS either ≥3 months preconception through pregnancy (Arm 1); starting in the late first trimester (Arm 2); or not at all (Arm 3: control), with all supplementations discontinued at delivery. The outcomes were infant weight, length and head circumference measured within 48 hours of birth, expressed as Z-scores. For each site, adjusted mean differences in the Z-scores were computed across six pre-pregnancy haemoglobin (Hb) categories (80–89, 90–99, 100–109, 110–119, 120–129, and ≥130 g/L) and pooled using meta-analysis.Results The effect of SQ-LNS on birth weight, length and head circumference varied by pre-pregnancy Hb categories. No significant differences in pooled mean Z-scores were observed for any Hb category >110 g/L, and no differences were found for Arm 1 vs Arm 2 across any Hb categories. For women with Hb 90–99 g/L pooled mean differences (95% CI) in the Z-scores for length (0.60 (0.03 to 1.23)), weight (0.50 (0.11 to 0.89)) and head circumference (0.26 (0.02 to 0.51)) were greatest for Arm 1 versus Arm 3. For women with Hb 100–109 g/L in Arm 1 versus Arm 3, pooled mean difference (95% CI) in birth weight Z-scores was significantly greater (0.33 (0.24 to 0.42)). Arm 2 vs Arm 3 women with Hb 90–99 g/L had greater birth weight Z-scores (0.14 (0.05 to 0.22)).Conclusion The findings highlight the importance of identifying women preconception for whom nutrition interventions may have the greatest impact on fetal growth.",
  "authors": [
    {
      "affiliations": [
        "Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Sumera Aziz Ali"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA",
        "Department of Obstetrics and Gynecology, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA"
      ],
      "name": "Ka Kahe"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA",
        "Columbia University Herbert Irving Comprehensive Cancer Center, New York, New York, USA"
      ],
      "name": "Jeanine M Genkinger"
    },
    {
      "affiliations": [
        "Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA",
        "Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"
      ],
      "name": "Linda Valeri"
    },
    {
      "affiliations": [
        "Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan"
      ],
      "name": "Sarah Saleem"
    },
    {
      "affiliations": [
        "Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan"
      ],
      "name": "Saleem Jessani"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA"
      ],
      "name": "Robert L Goldenberg"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Section of Nutrition, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA"
      ],
      "name": "Jamie Westcott"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Section of Nutrition, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA"
      ],
      "name": "Jennifer Kemp"
    },
    {
      "affiliations": [
        "Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala"
      ],
      "name": "Ana Garces"
    },
    {
      "affiliations": [
        "Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala"
      ],
      "name": "Lester Figueroa"
    },
    {
      "affiliations": [
        "Women's and Children’s Health Research Unit, KLE Academy of Higher Education & Research Deemed to be University - JNMC Campus, Belagavi, KA, India"
      ],
      "name": "Shivaprasad S Goudar"
    },
    {
      "affiliations": [
        "Women's and Children’s Health Research Unit, KLE Academy of Higher Education & Research Deemed to be University - JNMC Campus, Belagavi, KA, India"
      ],
      "name": "Sangappa M Dhaded"
    },
    {
      "affiliations": [
        "Thomas Jefferson University, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Richard Derman"
    },
    {
      "affiliations": [
        "University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)"
      ],
      "name": "Antoinette Tshefu Kitoto"
    },
    {
      "affiliations": [
        "University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)"
      ],
      "name": "Adrien Lokangaka"
    },
    {
      "affiliations": [
        "Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA"
      ],
      "name": "Melissa Bauserman"
    },
    {
      "affiliations": [
        "Research Triangle Institute, Research Triangle Park, North Carolina, USA"
      ],
      "name": "Elizabeth M McClure"
    },
    {
      "affiliations": [
        "National Institute of Child Health and Human Development, Bethesda, Maryland, USA"
      ],
      "name": "Marion Koso-Thomas"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA",
        "Vagelos College of Physicians and Surgeons, Columbia University Gertrude H Sergievsky Center, New York, New York, USA"
      ],
      "name": "Louise Kuhn"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Section of Nutrition, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA"
      ],
      "name": "Nancy F Krebs"
    },
    {
      "affiliations": [],
      "name": "Women First Preconception Nutrition Trial Group"
    }
  ],
  "title": "Women with moderate anaemia prior to conception benefited most from nutrition interventions: a secondary analysis of the Women First preconception maternal nutrition trial",
  "uid": "11c0ebcb-a3d3-5ba4-9caa-5820db26977a"
}