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. 2020 Feb 26;12(3):606.
doi: 10.3390/nu12030606.

Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review

Zohra S Lassi  1 , Sophie Ge Kedzior  1 , Wajeeha Tariq  2 , Yamna Jadoon  2 , Jai K Das  2 , Zulfiqar A Bhutta  2   3
Affiliations

Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review

Zohra S Lassi et al. Nutrients. .

Abstract

Pregnancy in adolescence and malnutrition are common challenges in low- and middle-income countries (LMICs), and are associated with many complications and comorbidities. The preconception period is an ideal period for intervention as a preventative tactic for teenage pregnancy, and to increase micronutrient supplementation prior to conception. Over twenty databases and websites were searched and 45 randomized controlled trials (RCTs) or quasi-experimental interventions with intent to delay the age at first pregnancy (n = 26), to optimize inter-pregnancy intervals (n = 4), and supplementation of folic acid (n = 5) or a combination of iron and folic acid (n = 10) during the periconception period were included. The review found that educational interventions to delay the age at first pregnancy and optimizing inter-pregnancy intervals significantly improved the uptake of contraception use (RR = 1.71, 95% CI = 1.42-2.05; two studies, n = 911; I2 = 0%) and (RR = 2.25, 95% CI = 1.29-3.93; one study, n = 338), respectively. For periconceptional folic acid supplementation, the incidence of neural tube defects were reduced (RR = 0.53; 95% CI = 0.41-0.77; two studies, n = 248,056; I2 = 0%), and iron-folic acid supplementation improved the rates of anemia (RR = 0.66, 95% CI = 0.53-0.81; six studies; n = 3430, I2 = 88%), particularly when supplemented weekly and in a school setting. Notwithstanding the findings, more robust RCTs are required from LMICs to further support the evidence.

Keywords: delaying pregnancy; family planning; folic acid; inter pregnancy interval; iron folic acid; maternal health; neonatal health; periconception.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Intervention types with associated outcomes.
Figure 2
Figure 2
Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA) flow diagram.
Figure 3
Figure 3
Risk of bias assessment comprised of Cochrane and EPOC criteria. Green: low risk; Red: high risk; Yellow: unclear; NA: not applicable to risk of bias due to study type. (a). delaying early pregnancy intervention, (b). prolonging inter-pregnancy intervals; (c): peri-conceptional iron-folic acid supplementation; (d). peri-conceptional folic acid supplementation.
Figure 3
Figure 3
Risk of bias assessment comprised of Cochrane and EPOC criteria. Green: low risk; Red: high risk; Yellow: unclear; NA: not applicable to risk of bias due to study type. (a). delaying early pregnancy intervention, (b). prolonging inter-pregnancy intervals; (c): peri-conceptional iron-folic acid supplementation; (d). peri-conceptional folic acid supplementation.
Figure 3
Figure 3
Risk of bias assessment comprised of Cochrane and EPOC criteria. Green: low risk; Red: high risk; Yellow: unclear; NA: not applicable to risk of bias due to study type. (a). delaying early pregnancy intervention, (b). prolonging inter-pregnancy intervals; (c): peri-conceptional iron-folic acid supplementation; (d). peri-conceptional folic acid supplementation.
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