A double-blind randomized controlled trial of maternal postpartum deworming to improve infant weight gain in the Peruvian Amazon

Background : Nutritional interventions targeting the critical growth and development period before two years of age can have the greatest impact on health trajectories over the life course. Compelling evidence has demonstrated that interventions investing in maternal health in the first 1000 days of life are beneficial for both mothers and their children. One such potential intervention is deworming integrated into maternal postpartum care in areas where soil-transmitted helminth (STH) infections are endemic. Methodology/Principal Findings : From February to August 2014, 1010 mother-infant pairs were recruited into a trial aimed at assessing the effectiveness of maternal postpartum deworming on infant and maternal health outcomes. Following delivery, mothers were randomly assigned to receive either single-dose 400 mg albendazole or placebo. Participants were followed-up at 1 and 6 months postpartum. There was no statistically significant difference in mean weight gain between infants in the experimental and control groups (mean difference: -0.02; 95% CI: -0.1, 0.08) at 6 months of age. Further, deworming had no effect on measured infant morbidity indicators. However, ad hoc analyses restricted to mothers who tested positive for STHs at baseline suggest that infants of mothers in the experimental group had greater mean length gain in cm (mean difference: 0.8; 95% CI: 0.1, 1.4) and length-for-age z-score (mean difference: 0.5; 95% CI: 0.2, 0.8) at 6 months of age. Conclusions/Significance : In a study population composed of both STH-infected and uninfected mothers, maternal postpartum deworming was insufficient to impact infant growth and morbidity indicators up to 6 months postpartum. Among STH-infected mothers, however, important improvements in infant length gain and length-for-age were observed. The benefits of maternal postpartum deworming should be further investigated in study populations having higher overall prevalences and intensities of STH infections and, in particular, where whipworm and hookworm infections are of public health concern

Effect of a two-component intervention to change hospital practice from early to delayed umbilical cord clamping in the Peruvian Amazon Efecto de una intervención de dos componentes para modificar la práctica hospitalaria de pinzamiento del cordón umbilical de precoz a tardío en la Amazonia peruana

OBJECTIVE: To investigate the effect of a two-component intervention to change hospital practice with regard to the timing of umbilical cord clamping. METHODS: A pre-/post-study design was used to measure the effect of a two-component intervention on mean time to clamp the umbilical cord. The study took place at Hospital Iquitos "César Garayar García" in Iquitos, Peru. A total of 224 women were recruited from the hospital labor room: 112 pre-intervention, from 18 May-3 June 2009, and 112 post-intervention, from 6-20 July 2009. The intervention consisted of 1) a "best practice" three-day training workshop on birthing, and 2) a hospital directive. All deliveries were observed and the time between delivery of the first shoulder and clamping of the umbilical cord was measured with a digital stopwatch. RESULTS: The mean time between delivery and cord clamping before the intervention was 56.8 seconds (95% confidence interval [CI]: 51.0, 62.7). This increased to 169.8 seconds (95% CI: 153.8, 185.8) following the intervention. The difference in mean time to clamp remained significant in multivariate analyses (&#946;adjusted = 113.2 seconds, 95% CI: 96.6, 129.9). CONCLUSIONS: Hospital policy and practice can be successfully changed from early to delayed umbilical cord clamping using a simple, two-component intervention.<br>OBJETIVO: Investigar el efecto de una intervención de dos componentes para modificar la práctica hospitalaria respecto del momento en que se practica el pinzamiento del cordón umbilical. MÉTODOS: Se empleó un estudio con diseño antes-después para medir el efecto de una intervención de dos componentes sobre el tiempo medio de pinzamiento del cordón umbilical. El estudio se llevó a cabo en el Hospital Iquitos "César Garayar Gar-cía" en Iquitos (Perú). Se incluyeron en total 224 mujeres atendidas en la sala de trabajo de parto del hospital: 112 antes de la intervención, entre el 18 de mayo y el 3 de junio del 2009, y 112 después de la intervención, entre el 6 y el 20 de julio del 2009. La intervención consistió en: 1) un taller de capacitación sobre las "mejores prácticas" en la atención del parto, de 3 días de duración y 2) una directiva del hospital. Se observaron todos los partos y se midió el tiempo entre la salida del hombro anterior y el pinzamiento del cordón umbilical con un cronómetro digital. RESULTADOS: El tiempo medio entre el parto y el pinzamiento del cordón antes de la intervención fue de 56,8 segundos (intervalo de confianza [IC] de 95%: 51,0-62,7), y aumentó a 169,8 segundos (IC 95%: 153,8-185,8) después de la intervención. La diferencia en el tiempo medio hasta el pinzamiento siguió siendo significativa en los análisis multivariados (&#946;ajustado = 113,2 segundos, IC 95%: 96,6-129,9). CONCLUSIONES: Es posible cambiar las normas y las prácticas hospitalarias de pinzamiento del cordón umbilical de precoz a tardío mediante una intervención sencilla de dos componentes

A Double-Blind Randomized Controlled Trial of Maternal Postpartum Deworming to Improve Infant Weight Gain in the Peruvian Amazon.

BackgroundNutritional interventions targeting the critical growth and development period before two years of age can have the greatest impact on health trajectories over the life course. Compelling evidence has demonstrated that interventions investing in maternal health in the first 1000 days of life are beneficial for both mothers and their children. One such potential intervention is deworming integrated into maternal postpartum care in areas where soil-transmitted helminth (STH) infections are endemic.Methodology/principal findingsFrom February to August 2014, 1010 mother-infant pairs were recruited into a trial aimed at assessing the effectiveness of maternal postpartum deworming on infant and maternal health outcomes. Following delivery, mothers were randomly assigned to receive either single-dose 400 mg albendazole or placebo. Participants were followed-up at 1 and 6 months postpartum. There was no statistically significant difference in mean weight gain between infants in the experimental and control groups (mean difference: -0.02; 95% CI: -0.1, 0.08) at 6 months of age. Further, deworming had no effect on measured infant morbidity indicators. However, ad hoc analyses restricted to mothers who tested positive for STHs at baseline suggest that infants of mothers in the experimental group had greater mean length gain in cm (mean difference: 0.8; 95% CI: 0.1, 1.4) and length-for-age z-score (mean difference: 0.5; 95% CI: 0.2, 0.8) at 6 months of age.Conclusions/significanceIn a study population composed of both STH-infected and uninfected mothers, maternal postpartum deworming was insufficient to impact infant growth and morbidity indicators up to 6 months postpartum. Among STH-infected mothers, however, important improvements in infant length gain and length-for-age were observed. The benefits of maternal postpartum deworming should be further investigated in study populations having higher overall prevalences and intensities of STH infections and, in particular, where whipworm and hookworm infections are of public health concern.Trial registrationClinicalTrials.gov (NCT01748929)

Baseline characteristics of mothers and infants (N = 1010) by intervention group, Iquitos, Peru (February–August 2014).

<p>Baseline characteristics of mothers and infants (N = 1010) by intervention group, Iquitos, Peru (February–August 2014).</p

Effect of maternal postpartum deworming on prevalence of infant underweight, wasting, and stunting at 6 months of age (N = 1010^*), Iquitos, Peru (August 2014 –February 2015).

<p>Effect of maternal postpartum deworming on prevalence of infant underweight, wasting, and stunting at 6 months of age (N = 1010^{<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005098#t004fn002" target="_blank">*</a>}), Iquitos, Peru (August 2014 –February 2015).</p

Baseline characteristics of mothers and infants (N = 1010) by intervention group, Iquitos, Peru (February–August 2014).

<p>Baseline characteristics of mothers and infants (N = 1010) by intervention group, Iquitos, Peru (February–August 2014).</p

Effect of maternal postpartum deworming on infant anthropometric outcomes over their first 6 months of life (N = 1010^*), Iquitos, Peru (February 2014 –February 2015).

<p>Effect of maternal postpartum deworming on infant anthropometric outcomes over their first 6 months of life (N = 1010^{<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005098#t003fn003" target="_blank">*</a>}), Iquitos, Peru (February 2014 –February 2015).</p

Effect of maternal postpartum deworming on infant morbidity indicators at 6 months of age (N = 1010^*), Iquitos, Peru (February 2014 –February 2015).

<p>Effect of maternal postpartum deworming on infant morbidity indicators at 6 months of age (N = 1010^{<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005098#t006fn002" target="_blank">*</a>}), Iquitos, Peru (February 2014 –February 2015).</p

Effect of maternal postpartum deworming on infant anthropometric outcomes over their first 6 months of life in women who tested positive for infection with any helminth species at baseline (N = 139^*), Iquitos, Peru (February 2014 –February 2015).

<p>Effect of maternal postpartum deworming on infant anthropometric outcomes over their first 6 months of life in women who tested positive for infection with any helminth species at baseline (N = 139^{<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005098#t005fn003" target="_blank">*</a>}), Iquitos, Peru (February 2014 –February 2015).</p

CONSORT trial flow diagram.

<p>*63 women were pre-recruited but were not enrolled because the sample size was already met. It should be noted that some participants who were lost to follow-up at the 1-month visit were recuperated at the 6-month visit.</p