Maggie Mphande (Mphil) maggie.mphande@studmed.uio.no Effectiveness of diet counselling during pregnancy on birth outcomes Maggie Mphande (Mphil) maggie.mphande@studmed.uio.no

Methodology Data collected from 195 mother-baby pairs (end point) 2 study sites – 1 primary health facility and 1 health center Anthropometric measurements were taken using WHO standard procedures; birth weight length abdominal and head circumference Training was given to all data collectors

Birth weight procedure Two birth weight measurements were taken The first measurement was taken immediately (within 1 hour) after birth The second measurement was taken after 24 hours ‘Seca 376 infant weighing scale’ was used with baby undressed

Birth length Measured using a stadiometer with a fixed vertical backboard and an adjustable head piece Two people involved Measured twice just like birth weight (1 hour after birth and 24 hours after birth)

Head circumference Measured using paper tape measure Placed the head circumference tape around the child’s head so that the tape lies: across the frontal bones of the skull; slightly above the eyebrows; perpendicular to the long axis of the face; above the ears; and over the occipital prominence at the back of the head.

Abdominal circumference Measured using paper tape measure Upper hip bone was located and the top of the right iliac crest Measuring tape was placed in a horizontal plane around the abdomen at the level of the iliac crest Then ensure that the tape is snug, but does not compress the skin, and is parallel to the floor.

Mean neonatal size at birth (preliminary results) Birth outcomes Intervention N = 96 Control N = 88 Unadj. P-value Birth weight (g) 3009.1 ± 459.8 2953.9 ± 483.0 0.43 Birth length (cm) 47.6 ± 3.0 47.4 ± 3.0 0.60 Head circumference (cm) 34.0 ± 1.8 0.93 Abdominal circumference 30.5 ± 2.6 29.1 ± 3.2 0.002 Low birth weight: n (%) 12 (12.5) 14 (15.9) 0.53 AC of neonates in the intervention arm were significantly larger than in the control There was a trend towards a bigger size of neonates (bwt, L & HC ) in the intervention arm, even though not statistically significant 12.5% of the neonates in the Intervention weighed < 2500 g compared to 15.9% in the control arm

Prevalence of low birth weight Weight at birth of less than 2,500 grams (5.5 pounds) Very LBW is less than 1,500 g Of the 25 neonates with LBW, 13 were in the Control arm 1 baby had very LBW (Control)

Effect of intervention on neonatal size at birth There were no variations in BW, length, HC and AC between the clusters (villages) [ICC < 0.01%] Being in the intervention arm showed trends towards increasing birth size, length and head circumference (even though this was not significant) Birth outcomes β (95 % CI) P-value Ref: Control arm Birth weight 55.7 (-81.7, 193.1) 0.43 Birth length 0.10 (-1.16, 1.36) 0.88 Head circumference 0.02 (-0.48, 0.52) 0.93 Abdominal circumference 1.60 (0.53, 2.67) 0.003

Factors associated with BW On average, babies born to over weight women weighed 147.8 g more than babies born to women with normal birth weight [147.8 (7.7, 303.4)] (P = 0.05) For each year increase in age, BW increased by 15.6 g [15.6 (5.0, 26.2)] (P = 0.04) Female babies weighed 144.7 g lesser than male babies [-144.7 (-280.9, -8.6)] (P = 0.04)

Abdominal circumference Birth length Head circumference Abdominal circumference β (95 % CI) P-value SES 0.11 (0.002, 0.23) 0.05 BMI (over-w) 1.38 (0.48, 2.28) 0.003 0.70 (0.13, 1.26) 0.02 Maternal age 15.6 (5.11, 26.11) 0.004 HH size 0.82 (0.34, 1.31) 0.001 SBP -0.04 (-0.07, -0.004) 0.03

Conclusions Preliminary findings showed that diet counselling was associated with AC However there was a trend towards larger birth lengths, HC and BW in the intervention arm The prevalence of LBW was lower among women who were counselled We found stronger associations between SES, BMI, maternal age with BW Significant associations were also found between BMI, HH size with HC