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孕前、孕期和幼儿期提供综合干预显著改善婴儿出生结局及生长发育结果
作者:小柯机器人 发布时间:2022/10/31 10:35:54

印度新德里卫生研究与发展中心Nita Bhandari团队研究了在孕前、孕期和幼儿期提供的一揽子健康、营养、心理社会支持和讲卫生运动干预措施对出生结局和24月龄线性生长的影响。相关论文发表在2022年10月26日出版的《英国医学杂志》上。

为了确定与常规护理相比,单独在孕前、孕期和幼儿期以及整个孕前、孕期和幼儿期综合和同时提供健康、营养、水、卫生(WaSH)以及社会心理护理干预措施对婴儿出生结局和24月龄线性生长的影响,研究组在印度德里的中低收入社区进行了一项个体随机析因试验。

研究组共招募了13500名女性,将其随机分为孕前干预组(n=6722)或常规护理组(n=6778)。其中2652名和2269名孕妇再次随机接受孕期和早期儿童干预或常规护理。出生结局分析包括1290例孕前、孕期和早期儿童干预(A组),1276例孕前干预(B组),1093例孕期和早期婴儿干预(C组),以及1093例对照护理(D组)的活产。截至2021年6月30日,年龄为24个月的儿童被纳入24月龄结果分析(A组453人,B组439人,C组293人,D组271人)。

干预措施为在孕前、孕期和幼儿期提供健康、营养、心理社会护理和支持以及WaSH干预措施。主要结局是低出生体重、小于胎龄儿、早产和平均出生体重。24月龄的结局是平均身高-年龄z评分和发育迟缓比例。研究组进行了三个预先指定的比较:孕前干预组(A+B)与无孕前干预组(C+D);孕期和早期儿童干预组(A+C)与孕期和早期儿童常规护理组(B+D)以及孕前、孕期和早期干预组(A)与对照组(D)。

孕前干预组(506/2235)的低出生体重儿比例低于无孕前干预组(502/1889;发病率比为0.85,绝对风险降低3.80%)。孕期干预组(502/2096)的低出生体重儿比例低于非孕期干预组(506/2028),但置信区间的上限跨越零效应(0.87;1.71%)。与对照组(267/934;0.76,5.59%)相比,在孕前和孕期接受干预的组(267/1141)对低出生体重儿比例影响更大。

与未接受这些干预的组(136/710;0.51)相比,孕期和幼儿期干预组(79/746)与对照组相比(51/271)在24个月大时发育迟缓比例明显降低(0.49,7.98%)。与无孕前干预组(83/564)相比,孕前干预组(132/892)在24个月时未观察到发育迟缓的影响。

研究结果表明,在孕前、孕期和幼儿期提供的一揽子干预方案大大降低了低出生体重和24个月时发育迟缓的风险。仅孕期和幼儿期干预对出生结局和24个月结局的影响较小但有统计学意义。孕前干预对出生结局有重要影响,但对24个月的结局没有影响。

附:英文原文

Title: Impact of a package of health, nutrition, psychosocial support, and WaSH interventions delivered during preconception, pregnancy, and early childhood periods on birth outcomes and on linear growth at 24 months of age: factorial, individually randomised controlled trial

Author: Sunita Taneja, Ranadip Chowdhury, Neeta Dhabhai, Ravi Prakash Upadhyay, Sarmila Mazumder, Sitanshi Sharma, Kiran Bhatia, Harish Chellani, Rupali Dewan, Pratima Mittal, MK Bhan, Rajiv Bahl, Nita Bhandari

Issue&Volume: 2022/10/26

Abstract:

Objective To determine the effect of integrated and concurrent delivery of health, nutrition, water, sanitation and hygiene (WaSH), and psychosocial care interventions during the preconception period alone, during pregnancy and early childhood, and throughout preconception, pregnancy, and early childhood on birth outcomes and linear growth at 24 months of age compared with routine care.

Design Individually randomised factorial trial.

Setting Low and middle income neighbourhoods of Delhi, India.

Participants 13500 women were randomised to receive preconception interventions (n=6722) or routine care (n=6778). 2652 and 2269 pregnant women were randomised again to receive pregnancy and early childhood interventions or routine care. The analysis of birth outcomes included 1290 live births for the preconception, pregnancy, and early childhood interventions (group A), 1276 for the preconception intervention (group B), 1093 for the pregnancy and early childhood interventions (group C), and 1093 for the control (group D). Children aged 24 months by 30 June 2021 were included in the 24 month outcome analysis (453 in group A, 439 in B, 293 in C, and 271 in D).

Interventions Health, nutrition, psychosocial care and support, and WaSH interventions were delivered during preconception, pregnancy, and early childhood periods.

Main outcome measures The primary outcomes were low birth weight, small for gestational age, preterm, and mean birth weight. At 24 months, the outcomes were mean length-for-age z scores and proportion stunted. Three prespecified comparisons were made: preconception intervention groups (A+B) versus no preconception intervention groups (C+D); pregnancy and early childhood intervention groups (A+C) versus routine care during pregnancy and early childhood (B+D) and preconception, pregnancy, and early childhood interventions groups (A) versus control group (D).

Results The proportion with low birth weight was lower in the preconception intervention groups (506/2235) than in the no preconception intervention groups (502/1889; incidence rate ratio 0.85, 98.3% confidence interval 0.75 to 0.97; absolute risk reduction 3.80%, 98.3% confidence interval 6.99% to 0.60%). The proportion with low birth weight was lower in the pregnancy intervention groups (502/2096) than in the no pregnancy intervention groups (506/2028) but the upper limit of the confidence interval crossed null effect (0.87, 0.76 to 1.01; 1.71%, 4.96% to 1.54%). There was a larger effect on proportion with low birth weight in the group that received interventions in the preconception and pregnancy periods (267/1141) compared with the control group (267/934; 0.76, 0.62 to 0.91; 5.59%, 10.32% to 0.85%). The proportion stunted at 24 months of age was substantially lower in the pregnancy and early childhood intervention groups (79/746) compared with the groups that did not receive these interventions (136/710; 0.51, 0.38 to 0.70; 8.32%, 12.31% to 4.32%), and in the group that received preconception, pregnancy, and early childhood interventions (47/453) compared with the control group (51/271; 0.49, 0.32 to 0.75; 7.98%, 14.24% to 1.71%). No effect on stunting at 24 months was observed in the preconception intervention groups (132/892) compared with the no preconception intervention groups (83/564).

Conclusions An intervention package delivered during preconception, pregnancy, and early childhood substantially reduced low birth weight and stunting at 24 months. Pregnancy and early childhood interventions alone had lower but important effects on birth outcomes and 24 month outcomes. Preconception interventions alone had an important effect on birth outcomes but not on 24 month outcomes.

DOI: 10.1136/bmj-2022-072046

Source: https://www.bmj.com/content/379/bmj-2022-072046

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj