American Journal of Clinical Nutrition
Volume 105, Issue 6, 2017, Pages 1382-1390

Longer exposure to a new refugee food ration is associated with reduced prevalence of small for gestational age: Results from 2 cross-sectional surveys on the Thailand-Myanmar border (Article) (Open Access)

Carrara V.I.* , Stuetz W. , Lee S.J. , Sriprawat K. , Po B. , Hanboonkunupakarn B. , Nosten F.H. , McGready R.
  • a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
  • b Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
  • c Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
  • d Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
  • e Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
  • f Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
  • g Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand, Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
  • h Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand, Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

Abstract

Background: Despite the high risk of compromised nutrition, evidence of the effect of refugee rations on fetal growth is limited. A new ration containing micronutrient-fortified flour without increased caloric content of the general food basket was introduced to the Maela refugee camp in Thailand, July 2004. Objective: The effect of the length of gestational exposure of the new ration on fetal growth was compared with birth outcomes [small for gestational age (SGA), preterm birth (PTB)]. Design: In an observational study in 987 newborns from 1048 prospectively followed antenatal clinic (ANC) attendees enrolled in 2 cross-sectional surveys, exposure was categorized in 2004 according to gestation at the time of commencing the new ration and in 2006 as comprehensive (preconception and pregnancy). In both surveys, the pregnancy-specific ration and Vitamin supplements were routine. Results: In 2004, the proportions of SGA decreased with longer exposure to the new ration: no exposure during pregnancy (27.7%; n = 13 of 47) and exposure in the third (27.6%; n = 37 of 134), second (18.6%; n = 35 of 188), and first (19.4%; n = 6 of 31) trimesters, respectively (adjusted P-trend = 0.046). In 2006, the new ration was available to all women and there was no significant additional impact of the pregnancy-specific ration and Vitamin supplements. Between 2004 and 2006, SGA decreased from 28.9% (13 of 45) to 17.3% (69 of 398) (adjusted P = 0.050), a reduction of 40.1% (95% CI: 34.7%, 45.9%); there was also a decrease in the percentage of underweight women on admission to the ANC (38.2%; 95% CI: 31.4%, 45.5%). PTB rates were low and not significantly different with exposure to the new ration. Conclusions: In 2004, the earlier in gestation in which the new ration was available the greater the effect on fetal growth as shown by a reduced prevalence of SGA. In 2006, additional benefits to fetal growth from the pregnancy-specific ration and Vitamin supplements beyond those of the preconception ration were not observed. Good nutrition in pregnancy remains an important challenge for refugee populations. This trial was registered at http://drks-neu.uniklinik-freiburg.de/drksweb/as DRKS00007736. Am J Clin Nutr 2017;105:1382-90. © 2017 American Society for Nutrition.

Author Keywords

Pregnancy Small for gestational age Fetal growth Ration Preconception Birth length Head circumference Preterm birth Refugees Birth weight

Index Keywords

hospital admission prospective study refugee prenatal care drug effects thiamine Thailand follow up human Refugees Premature Birth Prenatal Nutritional Physiological Phenomena Fetal Development fortified food time factor diet Time Factors Food, Fortified Micronutrients trace element Cross-Sectional Studies Surveys and Questionnaires cross-sectional study Humans Infant, Newborn male female nutrition service newborn observational study questionnaire Myanmar pregnancy refugee camp prevalence vitamin fetus development Article underweight pregnancy outcome Maternal Exposure Infant, Small for Gestational Age adult major clinical study small for date infant vitamin supplementation folic acid prematurity newborn mortality iron Birth Weight Flour maternal nutrition third trimester pregnancy first trimester pregnancy gestational age second trimester pregnancy health survey
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85020501996&doi=10.3945%2fajcn.116.148262&partnerID=40&md5=aa9040de7ea48d401115cfcd1b9157b8
DOI: 10.3945/ajcn.116.148262
ISSN: 00029165
Cited by: 2
Original Language: English