Nutritional and Anti-infective Interventions for Malnutrition in Pregnancy (Beleuman Welbodi)

NCT ID: NCT03079388

Last Updated: 2021-01-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1489 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-02-27

Study Completion Date

2020-02-24

Brief Summary

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Acute malnutrition in pregnancy is a risk factor for adverse outcomes in mothers and their unborn children. Undernutrition during pregnancy can result in maternal complications such as life-threatening hemorrhage and hypertensive disorders of pregnancy and infant complications such as intrauterine growth retardation, low birth weight, pre-term delivery and poor cognitive development. Poor women in the developing world are at heightened risk of malnutrition due to inadequate dietary intake and are subject to transmission of a number of infections including malaria, intestinal helminths, and genitourinary infections. Food interventions for malnutrition may be less effective under conditions with excessive inflammation and infection, and especially so during pregnancy. Without specifically addressing treatment for infections, undernourished mothers may be less responsive to nutritional interventions. The benefits of treating both malnutrition and common infections simultaneously remain largely unstudied. This study tests the hypothesis that malnourished pregnant women receiving 100 grams per day of a specially formulated ready-to-use supplementary food in addition to a combination of 5 anti-infective interventions will have greater weight gain in pregnancy and deliver larger, longer infants than women receiving the standard of care. The outcome of the pregnancy and maternal nutritional status will be followed until 6 months after delivery.

Detailed Description

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Conditions

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Pregnancy Malnutrition in Pregnancy Nutrition Disorders Stunting

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Ready-to-use supplementary food + anti-infective bundle

The women randomized to this arm will receive a ready-to-use-supplementary food (RUSF) designed specifically for pregnancy. The RUSF will provide a total of 520 kcal, 18 g protein, and 200% of recommended daily allowance (RDA) for most micronutrients during pregnancy. The supplement is also optimized to provide excellent protein quality and optimal polyunsaturated fatty acid composition. These women will receive 5 anti-infective interventions: 1) insecticide-treated mosquito net, 2) monthly intermittent preventive treatment of malaria during pregnancy (IPTp) 3) azithromycin at the second and third trimester 4) albendazole given in second trimester, and 5) bacterial vaginosis testing and treatment at enrollment and again at weeks 28-34

Group Type EXPERIMENTAL

Ready-to-use-supplementary food

Intervention Type DIETARY_SUPPLEMENT

Specially formulated supplementary food for pregnancy

Monthly intermittent preventive treatment of malaria during pregnancy (IPTp)

Intervention Type DRUG

Sulfadoxine-pyrimethamine (500 mg / 25 mg) given every 4 weeks, beginning at enrollment or at 13 weeks' gestation, whichever is later.

Insecticide-treated mosquito net

Intervention Type OTHER

An insecticide-treated mosquito net at the time of enrollment into the study.

Azithromycin

Intervention Type DRUG

Azithromycin 1 gram given once in second trimester and again during weeks 28-34 of gestation.

Albendazole

Intervention Type DRUG

Single dose albendazole 400mg given in the second trimester.

Bacterial vaginosis testing and treatment

Intervention Type COMBINATION_PRODUCT

Testing for bacterial vaginosis at enrollment and again at weeks 28-34 using a rapid diagnostic test for sialidase. Those with positive tests will receive extended release metronidazole 750mg daily for 7 days.

Corn-soy-blend

The women randomized to this arm will receive the standard of care for Sierra Leone. The treatment provided to women in this group includes 3.5 kg super cereal with 350 g vegetable oil every two weeks. This provides 250 mg portion/day of the super cereal and 25g oil/day for the mother. Women will receive the food for the duration of their pregnancy. These women will receive the current recommendations of the government of Sierra Leone, which includes standard intermittent preventive treatment of malaria during pregnancy (IPTp) of 2 doses of sulfadoxine/ pyrimethamine, iron and folic acid supplement with a goal of 90 pills/pregnancy, an insecticide-treated mosquito net, and albendazole for deworming in the second trimester.

Group Type ACTIVE_COMPARATOR

Corn-soy-blend

Intervention Type DIETARY_SUPPLEMENT

Standard of care for malnutrition in pregnancy in Sierra Leone

Standard intermittent preventive treatment of malaria during pregnancy (IPTp)

Intervention Type DRUG

Standard of care for Sierra Leone is 2 doses of sulfadoxine/ pyrimethamine (500mg/ 25mg).

Insecticide-treated mosquito net

Intervention Type OTHER

An insecticide-treated mosquito net at the time of enrollment into the study.

Albendazole

Intervention Type DRUG

Single dose albendazole 400mg given in the second trimester.

Interventions

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Ready-to-use-supplementary food

Specially formulated supplementary food for pregnancy

Intervention Type DIETARY_SUPPLEMENT

Corn-soy-blend

Standard of care for malnutrition in pregnancy in Sierra Leone

Intervention Type DIETARY_SUPPLEMENT

Monthly intermittent preventive treatment of malaria during pregnancy (IPTp)

Sulfadoxine-pyrimethamine (500 mg / 25 mg) given every 4 weeks, beginning at enrollment or at 13 weeks' gestation, whichever is later.

Intervention Type DRUG

Standard intermittent preventive treatment of malaria during pregnancy (IPTp)

Standard of care for Sierra Leone is 2 doses of sulfadoxine/ pyrimethamine (500mg/ 25mg).

Intervention Type DRUG

Insecticide-treated mosquito net

An insecticide-treated mosquito net at the time of enrollment into the study.

Intervention Type OTHER

Azithromycin

Azithromycin 1 gram given once in second trimester and again during weeks 28-34 of gestation.

Intervention Type DRUG

Albendazole

Single dose albendazole 400mg given in the second trimester.

Intervention Type DRUG

Bacterial vaginosis testing and treatment

Testing for bacterial vaginosis at enrollment and again at weeks 28-34 using a rapid diagnostic test for sialidase. Those with positive tests will receive extended release metronidazole 750mg daily for 7 days.

Intervention Type COMBINATION_PRODUCT

Other Intervention Names

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Sulfadoxine-pyrimethamine Sulfadoxine-pyrimethamine

Eligibility Criteria

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Inclusion Criteria

* Pregnant women and consenting to study participation
* Fundal height not greater than 32 cm
* Mid-upper arm circumference ≤23 cm
* Planning to reside in the study area during pregnancy and 6 months post partum
* Attending 1 of the 40 antenatal clinic sites

Exclusion Criteria

* \< 16 years of age without adult willing to consent
* Known pregnancy complications such as gestational diabetes, pre-eclampsia, hypertension
Minimum Eligible Age

14 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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The Children's Investment Fund Foundation

OTHER

Sponsor Role collaborator

Washington University School of Medicine

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mark J Manary, MD

Role: STUDY_CHAIR

Washington University School of Medicine

Locations

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1 Moriba Street

Pujehun, Pujehun District, Sierra Leone

Site Status

Countries

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Sierra Leone

References

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Hendrixson DT, Lasowski PN, Koroma AS, Manary MJ. Newborn Mid-Upper Arm Circumference Identifies Low-Birth Weight and Vulnerable Infants: A Secondary Analysis. Curr Dev Nutr. 2022 Sep 12;6(10):nzac138. doi: 10.1093/cdn/nzac138. eCollection 2022 Oct.

Reference Type DERIVED
PMID: 36475019 (View on PubMed)

Hendrixson DT, Smith K, Lasowski P, Callaghan-Gillespie M, Weber J, Papathakis P, Iversen PO, Koroma AS, Manary MJ. A novel intervention combining supplementary food and infection control measures to improve birth outcomes in undernourished pregnant women in Sierra Leone: A randomized, controlled clinical effectiveness trial. PLoS Med. 2021 Sep 28;18(9):e1003618. doi: 10.1371/journal.pmed.1003618. eCollection 2021 Sep.

Reference Type DERIVED
PMID: 34582451 (View on PubMed)

Hendrixson DT, Koroma AS, Callaghan-Gillespie M, Weber J, Papathakis P, Manary MJ. Use of a novel supplementary food and measures to control inflammation in malnourished pregnant women in Sierra Leone to improve birth outcomes: study protocol for a prospective, randomized, controlled clinical effectiveness trial. BMC Nutr. 2018 Apr 2;4:15. doi: 10.1186/s40795-018-0218-y. eCollection 2018.

Reference Type DERIVED
PMID: 32153879 (View on PubMed)

Other Identifiers

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201611119

Identifier Type: -

Identifier Source: org_study_id

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