Results from clinical trials provide the most powerful scientific evidence to guide policy and programmatic public health strategies. Interventions aimed at preventing low birthweight either acting toward preterm delivery or IUGR have usually not proven to be effective by randomized clinical trials. The multicausal nature of these conditions is likely responsible for the fact that single interventions do not show an effect of enough magnitude to be detected by medium-sized clinical trials. Thus, appropriate combinations of interventions should be a priority for evaluation in the context of large, methodologically sound trials. Evidence shows that some interventions may be effective and their combined implementation may have a significant public health impact. Interventions likely to be beneficial in preventing IUGR are smoking cessation, antimalarial chemoprophylaxis in primigravide, and balanced protein energy supplementation. Treatment of urinary tract infection, placement of circumferential stitches on a structurally weak uterine cervix (cerclage), and treatment of bacterial vaginosis in high-risk women have been shown to be effective in preventing preterm birth. Unfortunately, these interventions are applicable only to a small number of high-risk women, and their overall effect in the general population is likely to be limited.
In the following sections, nutritional interventions to prevent preterm delivery and IUGR are reviewed with the aim of identifying potentially effective interventions and suggesting possible mechanisms that may link maternal nutritional status to low birthweight. The focus is on the review of randomized clinical trials that provide the most unbiased epidemiological evidence on the effectiveness of interventions. Clinical trials testing the same or similar interventions can be pooled together to estimate an overall effect by means of a systematic review of published and unpublished studies and the meta-analysis of the trials' results.
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