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Early Life Interventions During the First 1,000 Days of Life: Data Synthesis for Birth Outcomes and Child Linear Growth

32 Pages Posted: 3 Nov 2018

See all articles by Jay JH Park

Jay JH Park

MTEK Sciences

Mei Lan Fang

MTEK Sciences

Ofir Harar

MTEK Sciences

Louis Dron

MTEK Sciences

Reham Majzoub

McMaster University

Virginia Jeziorska

MTEK Sciences

Kristian Thorlund

MTEK Sciences

Edward J Mills

MTEK Sciences; McMaster University; Bill and Melinda Gates Foundation

Zulfiqar A Bhutta

University of Toronto - Centre for Global Child Health; Aga Khan University - Centre of Excellence in Women and Child Health

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Abstract

Background: The first 1,000 days of life encompasses three important life-stages: pregnancy, exclusive breastfeeding (EBF:0-6mo), and complementary feeding period (CFP:6-24mo). We evaluated the effectiveness of interventions under the domains of micronutrient and balanced energy protein and food supplements, deworming, maternal education, and water sanitation and hygiene (WASH), across the three life-stages.

Methods: We applied a Bayesian network analysis. We conducted comprehensive searches and network meta-analyses using RCTs of interventions provided to pregnant women, infants (0-6mo), and children (6-24mo) in LMICs. We compared effects on preterm birth and birthweight for pregnancy, LAZ for EBF, and HAZ for CFP, and probabilities of interventions being superior to standard-of-care (SOC) by at least a minimal clinically importance difference (MCID) for each life-stage.

Findings: We found several nutritional interventions that demonstrated effectiveness against SOC. For instance, compared to SOC, maternal supplements of multiple micronutrients (MMN) reduced the odds for preterm birth (OR=0·54; 95%CrI: 0·27, 0·97) and improved mean birthweight (Mean difference=0·36kg; 95%CrI: 0·12, 0·59kg), but not LAZ during EBF (Mean difference=−0·02; 95%CrI: −0·18, 0·14). Supplementing infants and children with MMN improved LAZ (Mean difference=0·20; 95% CrI: 0·03, 0·35) and HAZ (Mean difference=0·14; 95%CrI: 0·02, 0·25). We also found that pregnancy interventions generally had higher MCID probabilities than the interventions for the EBF/CFP.

Interpretation: Our analyses highlight the importance of intervening early, during pregnancy if possible. There is a need to combine compelling and evidence-based interventions from multiple domains and test for their effectiveness as a package.

Funding Statement: The Bill and Melinda Gates Foundation

Declaration of Interests: No authors have any competing interests.

Suggested Citation

Park, Jay JH and Fang, Mei Lan and Harar, Ofir and Dron, Louis and Majzoub, Reham and Jeziorska, Virginia and Thorlund, Kristian and Mills, Edward J and Bhutta, Zulfiqar A, Early Life Interventions During the First 1,000 Days of Life: Data Synthesis for Birth Outcomes and Child Linear Growth (October 29, 2018). Available at SSRN: https://ssrn.com/abstract=3276422 or http://dx.doi.org/10.2139/ssrn.3276422

Jay JH Park

MTEK Sciences

Vancouver
Canada

Mei Lan Fang

MTEK Sciences

Vancouver
Canada

Ofir Harar

MTEK Sciences

Vancouver
Canada

Louis Dron

MTEK Sciences

Vancouver
Canada

Reham Majzoub

McMaster University

1280 Main Street West
Hamilton, Ontario L8S 4M4
Canada

Virginia Jeziorska

MTEK Sciences

Vancouver
Canada

Kristian Thorlund

MTEK Sciences

Vancouver
Canada

Edward J Mills (Contact Author)

MTEK Sciences

Vancouver
Canada

McMaster University

1280 Main Street West
Hamilton, Ontario L8S 4M4
Canada

Bill and Melinda Gates Foundation

P.O. Box 23350
Seattle, WA 98102
United States

Zulfiqar A Bhutta

University of Toronto - Centre for Global Child Health ( email )

Toronto
Canada

Aga Khan University - Centre of Excellence in Women and Child Health ( email )

Pakistan

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