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Supplementary feeding and infection control in pregnant adolescents in Sierra Leone

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This is a summary of the following paper: Koroma A, Ellie M, Bangura K et al (2023) Supplementary feeding and infection control in pregnant adolescents – A secondary analysis of a randomised trial among malnourished women in Sierra Leone. Maternal & Child Nutrition, 19, e13456. https://doi.org/10.1111/mcn.13456

Undernutrition in pregnancy during adolescence carries a high risk of maternal morbidity and poor birth outcomes. This study performed a secondary data analysis to test the hypothesis that, during pregnancy, undernourished adolescents would benefit more than adults from an intervention consisting of a daily ration of supplementary food and anti-infective treatments. 

The original randomised controlled trial was conducted in Sierra Leone and enrolled 236 younger adolescents (aged under 18 years), 454 older adolescents (aged 18–19 years) and 741 adults (aged 20 years or above), all with a mid-upper arm circumference of 23cm or more. Both control and intervention groups received treatment, albeit under different regimens. The intervention arm received antibiotic and antimalarial treatment at multiple stages of pregnancy, plus a daily ration of ready-to-use supplemental food throughout (18g protein and a broad range of micronutrients). The control arm received daily corn-soy blended flour, palm oil and a sharing ration in line with World Food Programme standards (17.5g protein), plus iron and folic acid during the second and third trimesters.

When evaluating outcomes, irrespective of the intervention group, younger adolescents had a similar rate of weight change compared to adult mothers. Younger adolescent mothers had newborns with lower birth weight, length and mid-upper arm circumference, as well as higher proportions of blow birth weight and stunted newborns compared to adult mothers.

Overall, while the intervention proved effective when all ages were pooled together, there were significant differences in effect between each maternal age group. These results were not as expected. Younger adolescent mothers benefited less from the combined intervention than adult mothers regarding the rate of weight gain during pregnancy and infant birth weight, length and rate of low birth weight. Younger adolescents also benefited less than older adolescents, although differences did not reach statistical significance.

The findings reinforce what has been seen in other studies: that younger adolescent mothers tend to give birth to babies with lower birth weight, length and mid-upper arm circumference than adult mothers. These findings do not, however, indicate that supplementary food is not beneficial when treating undernourished adolescents, as the analysis was not structured as supplementary food versus no supplementary food, so the results should be viewed with care.

There were limitations to the study. As a post hoc analysis (conducted after the dataset was already viewed), the incidence of multiple testing increased the chance of false positive results. Strengths included a large sample size and a robust design of the original trial. Further investigation is required to determine if the findings are comparable in different environments, as this was conducted in a rural West African context.

The findings may suggest that there are unaddressed barriers to nutrient transfer, improved length of gestation and/or other factors essential for foetal development. Holistic care – including nutritional, anti-infective and mental health care, as well as social support – may be necessary to attain optimal birth outcomes, especially in the most vulnerable young adolescents.

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Supplementary feeding and infection control in pregnant adolescents in Sierra Leone. Field Exchange 69, May 2023. p31. www.ennonline.net/fex/69/supplementary-feeding-and-infection-control-in-pregnant-adolescents-in-sierra-leone

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