Maternal nutrition intervention and maternal complications in 4 districts of Bangladesh: a nested cross-sectional study
This article was published in The Plos Medicine [© 2019 Todd et al. This is an open access article distributed under the terms of the Creative Commons Attribution License] and the definite version is available at: https://doi.org/10.1371/journal.pmed.1002927. The Journal's website is at: https...
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PLOS Medicine
2022
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| 在线阅读: | http://hdl.handle.net/10361/16518 https://doi.org/10.1371/journal.pmed.1002927 |
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10361-16518 |
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Brac University |
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Institutional Repository |
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en_US |
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Maternal nutrition intervention Maternal complications |
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Maternal nutrition intervention Maternal complications Todd, Catherine S. Chowdhury, Zakaria Mahmud, Zeba Islam, Nazia Shabnam, Sadia Parvin, Musarrat Bernholc, Alissa Martinez, Andres Aktar, Bachera Afsana, Kaosar Sanghvi, Tina Maternal nutrition intervention and maternal complications in 4 districts of Bangladesh: a nested cross-sectional study |
| description |
This article was published in The Plos Medicine [© 2019 Todd et al. This is an open
access article distributed under the terms of the Creative Commons Attribution License] and the definite version is available at: https://doi.org/10.1371/journal.pmed.1002927. The Journal's website is at: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002927 |
| author2 |
Brac James P. Grant School of Public Health |
| author_facet |
Brac James P. Grant School of Public Health Todd, Catherine S. Chowdhury, Zakaria Mahmud, Zeba Islam, Nazia Shabnam, Sadia Parvin, Musarrat Bernholc, Alissa Martinez, Andres Aktar, Bachera Afsana, Kaosar Sanghvi, Tina |
| format |
Journal article |
| author |
Todd, Catherine S. Chowdhury, Zakaria Mahmud, Zeba Islam, Nazia Shabnam, Sadia Parvin, Musarrat Bernholc, Alissa Martinez, Andres Aktar, Bachera Afsana, Kaosar Sanghvi, Tina |
| author_sort |
Todd, Catherine S. |
| title |
Maternal nutrition intervention and maternal complications in 4 districts of Bangladesh: a nested cross-sectional study |
| title_short |
Maternal nutrition intervention and maternal complications in 4 districts of Bangladesh: a nested cross-sectional study |
| title_full |
Maternal nutrition intervention and maternal complications in 4 districts of Bangladesh: a nested cross-sectional study |
| title_fullStr |
Maternal nutrition intervention and maternal complications in 4 districts of Bangladesh: a nested cross-sectional study |
| title_full_unstemmed |
Maternal nutrition intervention and maternal complications in 4 districts of Bangladesh: a nested cross-sectional study |
| title_sort |
maternal nutrition intervention and maternal complications in 4 districts of bangladesh: a nested cross-sectional study |
| publisher |
PLOS Medicine |
| publishDate |
2022 |
| url |
http://hdl.handle.net/10361/16518 https://doi.org/10.1371/journal.pmed.1002927 |
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10361-165182023-04-12T08:43:13Z Maternal nutrition intervention and maternal complications in 4 districts of Bangladesh: a nested cross-sectional study Todd, Catherine S. Chowdhury, Zakaria Mahmud, Zeba Islam, Nazia Shabnam, Sadia Parvin, Musarrat Bernholc, Alissa Martinez, Andres Aktar, Bachera Afsana, Kaosar Sanghvi, Tina Brac James P. Grant School of Public Health Maternal nutrition intervention Maternal complications This article was published in The Plos Medicine [© 2019 Todd et al. This is an open access article distributed under the terms of the Creative Commons Attribution License] and the definite version is available at: https://doi.org/10.1371/journal.pmed.1002927. The Journal's website is at: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002927 Background Maternal morbidity is common in Bangladesh, where the maternal mortality rate has plateaued over the last 6 years. Maternal undernutrition and micronutrient deficiencies contribute to morbidity, but few interventions have measured maternal outcomes. We compared reported prevalence of antepartum, intrapartum, and postpartum complications among recently delivered women between maternal nutrition intervention and control areas in Bangladesh. Methods and findings We conducted a cross-sectional assessment nested within a population-based cluster-randomized trial comparing a nutrition counseling and micronutrient supplement intervention integrated within a structured home-based maternal, newborn, and child health (MNCH) program to the MNCH program alone in 10 sub-districts each across 4 Bangladesh districts. Eligible consenting women, delivering within 42–60 days of enrollment and identified by community-level health workers, completed an interviewer-administered questionnaire detailing the index pregnancy and delivery and allowed review of their home-based care register. We compared pooled and specific reported antepartum, intrapartum, and postpartum complications between study groups using hierarchical logistic regression. There were 594 women in the intervention group and 506 in the control group; overall, mean age was 24 years, 31% were primiparas, and 39% reported facility-based delivery, with no significant difference by study group. There were no significant differences between the intervention and control groups in household-level characteristics, including reported mean monthly income (intervention, 6,552 taka, versus control, 6,017 taka; p = 0.48), having electricity (69.6% versus 71.4%, p = 0.84), and television ownership (41.1% versus 38.7%, p = 0.81). Women in the intervention group had higher recorded iron and folic acid and calcium supplement consumption and mean dietary diversity scores, but reported anemia rates were similar between the 2 groups (5.7%, intervention; 6.5%, control; p = 0.83). Reported antepartum (69.4%, intervention; 79.2%, control; p = 0.12) and intrapartum (41.4%, intervention; 48.5%, control; p = 0.18) complication rates were high and not significantly different between groups. Reported postpartum complications were significantly lower among women in the intervention group than the control group (33.5% versus 48.2%, p = 0.02), and this difference persisted in adjusted analysis (adjusted odds ratio [AOR] = 0.51, 95% CI 0.32–0.82; p < 0.001). For specific conditions, odds of retained placenta (AOR = 0.35, 95% CI 0.19–0.67; p = 0.001), postpartum bleeding (AOR = 0.37, 95% CI 0.15–0.92; p = 0.033), and postpartum fever/infection (AOR = 0.27, 95% CI 0.11–0.65; p = 0.001) were significantly lower in the intervention group in adjusted analysis. There were no significant differences in reported hospitalization for antepartum (49.8% versus 45.1%, p = 0.37), intrapartum (69.9% versus 59.8%, p = 0.18), or postpartum (36.1% versus 29.9%, p = 0.49) complications between the intervention and control groups. The main limitations of this study are outcome measures based on participant report, non-probabilistic selection of community-level workers’ catchment areas for sampling, some missing data for variables derived from secondary sources (e.g., dietary diversity score), and possible recall bias for reported dietary intake and supplement use. Conclusions Reported overall postpartum and specific intrapartum and postpartum complications were significantly lower for women in intervention areas than control areas, despite similar rates of facility-based delivery and hospitalization for reported complications, in this exploratory analysis. Maternal nutrition interventions providing intensive counseling and micronutrient supplements may reduce some pregnancy complications or impact women’s ability to accurately recognize complications, but more rigorous evaluation is needed for these outcomes. Published 2022-04-05T04:17:07Z 2022-04-05T04:17:07Z 2019 2019-10-04 Journal article Todd, C. S., Chowdhury, Z., Mahmud, Z., Islam, N., Shabnam, S., Parvin, M., Bernholc, A., Martinez, A., Aktar, B., Afsana, K., & Sanghvi, T. (2019). Maternal nutrition intervention and maternal complications in 4 districts of Bangladesh: A nested cross-sectional study. PLoS medicine, 16(10), e1002927. https://doi.org/10.1371/journal.pmed.1002927 http://hdl.handle.net/10361/16518 https://doi.org/10.1371/journal.pmed.1002927 en_US https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002927 Plos Medicine application/pdf PLOS Medicine |