What more can be done? Prioritizing the most promising antenatal interventions to improve birth weight

Annariina M. Koivu, Tampere University, Tampere, Finland
Tiia Haapaniemi, Tampere University, Tampere, Finland
Sufia Askari, Children's Investment Fund Foundation, London, United Kingdom
Nita Bhandari, Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
Robert E. Black, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
R Matthew Chico, London School of Hygiene & Tropical Medicine, London, UK
Kathryn G. Dewey, University of California, Davis, Davis, CA, USA
Christopher P. Christopher P Duggan, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
Nigel Klein, UCL Great Ormond Street Institute of Child Health, London, UK
Zulfiqar Ahmed Bhutta, Aga Khan University
Abdu Mohiddin, Aga Khan University


Background: Low birth weight (LBW) is associated with neonatal mortality and sequelae of lifelong health problems; prioritizing the most promising antenatal interventions may guide resource allocation and improve health outcomes.
Objective: We sought to identify the most promising interventions that are not yet included in the policy recommendations of the World Health Organization (WHO) but could complement antenatal care and reduce the prevalence of LBW and related adverse birth outcomes in low- and middle-income settings.
Methods: We utilized an adapted Child Health and Nutrition Research Initiative (CHNRI) prioritization method.
Results: In addition to procedures already recommended by WHO for the prevention of LBW, we identified six promising antenatal interventions that are not currently recommended by WHO with an indication for LBW prevention, namely: (1) provision of multiple micronutrients; (2) low-dose aspirin; (3) high-dose calcium; (4) prophylactic cervical cerclage; (5) psychosocial support for smoking cessation; and (6) other psychosocial support for targeted populations and settings. We also identified seven interventions for further implementation research and six interventions for efficacy research.
Conclusion: These promising interventions, coupled with increasing coverage of currently recommended antenatal care, could accelerate progress toward the global target of a 30% reduction in the number of LBW infants born in 2025 compared to 2006-10