scholarly journals Re: First-trimester risk assessment based on ultrasound and cell-free DNA vs combined screening: a randomized controlled trial. K. O. Kagan, R. Sroka, J. Sonek, H. Abele, K. Lüthgens, M. Schmid, P. Wagner, S. Brucker, D. Wallwiener and M. Hoopmann. Ultras

2018 ◽  
Vol 51 (4) ◽  
pp. 436-436
Author(s):  
L. Hui
Keyword(s):  
Risk Assessment ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
First Trimester ◽  
Cell Free Dna ◽  
Randomized Controlled ◽  
Free Dna

scholarly journals A multicountry randomized controlled trial of comprehensive maternal nutrition supplementation initiated before conception: the Women First trial

2019 ◽  
Vol 109 (2) ◽  
pp. 457-469 ◽  
Author(s):  
K Michael Hambidge ◽  
Jamie E Westcott ◽  
Ana Garcés ◽  
Lester Figueroa ◽  
Shivaprasad S Goudar ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Gestational Age ◽  
Maternal Nutrition ◽  
Controlled Trial ◽  
First Trimester ◽  
Maternal Body Mass Index ◽  
Low Resource ◽  
Randomized Controlled ◽  
Nutrition Supplementation ◽  
Republic Of The Congo

ABSTRACT Background Reported benefits of maternal nutrition supplements commenced during pregnancy in low-resource populations have typically been quite limited. Objectives This study tested the effects on newborn size, especially length, of commencing nutrition supplements for women in low-resource populations ≥3 mo before conception (Arm 1), compared with the same supplement commenced late in the first trimester of pregnancy (Arm 2) or not at all (control Arm 3). Methods Women First was a 3-arm individualized randomized controlled trial (RCT). The intervention was a lipid-based micronutrient supplement; a protein-energy supplement was also provided if maternal body mass index (kg/m2) was <20 or gestational weight gain was less than recommendations. Study sites were in rural locations of the Democratic Republic of the Congo (DRC), Guatemala, India, and Pakistan. The primary outcome was length-for-age z score (LAZ), with all anthropometry obtained <48 h post delivery. Because gestational ages were unavailable in DRC, outcomes were determined for all 4 sites from WHO newborn standards (non-gestational-age-adjusted, NGAA) as well as INTERGROWTH-21st fetal standards (3 sites, gestational age-adjusted, GAA). Results A total of 7387 nonpregnant women were randomly assigned, yielding 2451 births with NGAA primary outcomes and 1465 with GAA outcomes. Mean LAZ and other outcomes did not differ between Arm 1 and Arm 2 using either NGAA or GAA. Mean LAZ (NGAA) for Arm 1 was greater than for Arm 3 (effect size: +0.19; 95% CI: 0.08, 0.30, P = 0.0008). For GAA outcomes, rates of stunting and small-for-gestational-age were lower in Arm 1 than in Arm 3 (RR: 0.69; 95% CI: 0.49, 0.98, P = 0.0361 and RR: 0.78; 95% CI: 0.70, 0.88, P < 0.001, respectively). Rates of preterm birth did not differ among arms. Conclusions In low-resource populations, benefits on fetal growth–related birth outcomes were derived from nutrition supplements commenced before conception or late in the first trimester. This trial was registered at clinicaltrials.gov as NCT01883193.

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