Supplementary feeding and infection control in pregnant adolescents - A secondary analysis of a randomized trial among malnourished women in Sierra Leone

Authors: KOROMA, AMINATA - Ministry Of Health & Sanitation; ELLIE, MARIAMA - University Of Oslo; BANGURA, KADIATU - Ministry Of Health & Sanitation; IVERSEN, PER - University Of Oslo; HENDRIXSON, DAVID - University Of Washington Medical School; STEPHENSON, KEVIN - Washington University School Of Medicine; MANARY, MARK - Washington University School Of Medicine

Submitted to: Maternal and Child Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/24/2022
Publication Date: 11/9/2022
Citation: Koroma, A.S., Ellie, M., Bangura, K., Iversen, P.O., Hendrixson, D.T., Stephenson, K., Manary, M.J. 2022. Supplementary feeding and infection control in pregnant adolescents - A secondary analysis of a randomized trial among malnourished women in Sierra Leone. Maternal and Child Nutrition. 19(1). Article e13456. https://doi.org/10.1111/mcn.13456.
DOI: https://doi.org/10.1111/mcn.13456

Interpretive Summary: Malnutrition during pregnancy for young mothers (10-19 years) presents a higher risk for maternal death and poor birth outcomes, especially in low-resource settings. This is a secondary analysis of a clinical trial for pregnant girls and women in Sierra Leone, which studied the impact of supplementary food and anti-infective treatments. We found that infants born of young mothers benefited less from the supplementary food and anti-infective treatments. Further work is needed to identify interventions that benefit undernourished pregnant adolescents and their newborns.

Technical Abstract: Undernutrition during pregnancy in adolescence confers a high risk of maternal morbidity and adverse birth outcomes, particularly in low-resource settings. In a secondary analysis, we hypothesized that younger undernourished pregnant adolescents (<18 years) would benefit more than undernourished pregnant adults (>20 years) from the intervention of supplementary food and anti-infective treatments. The original trial in Sierra Leone enrolled 236 younger adolescents (<18 years), 454 older adolescents (aged 18–19 years), and 741 adults (=20 years), all with a mid-upper arm circumference < or =23 cm. Younger adolescents had lower final fundal height as well as smaller newborns (-0.3 kg; 95% confidence interval [CI], -0.3, -0.2; p < 0.001) and shorter newborns (-1.1 cm; 95% CI, -1.5, -0.7; p < 0.001) than adults. The intervention's effect varied significantly between maternal age groups: adults benefited more than younger adolescents with respect to newborn birth weight (difference in difference, 166 g; 95% CI, 26, 306; interaction p = 0.02), birth length (difference in difference, 7.4 mm; 95% CI, 0.1, 14.8; interaction p = 0.047), and risk for low birth weight (<2.5 kg) (interaction p = 0.019). The differences in response persisted despite adjustments for maternal anthropometry, the number of prior pregnancies, and human immunodeficiency virus status. Older adolescents similarly benefited more than younger adolescents, though differences did not reach statistical significance. In conclusion, newborns born to younger adolescent mothers had worse outcomes than those born to adult mothers, and adults and their newborns benefited more from the intervention than younger adolescents.