SPH Project Aims to Improve Health Outcomes for Infants in Nepal

A GW researcher was awarded $4.9 million to study how nutritional supplements impact pregnancy risks and tackle intergenerational health challenges.

A Milken Institute School of Public Health researcher was awarded $4.9 million to study how nutritional supplements impact pregnancy risks in Nepal. (Photo: Michal Knitl)
November 28, 2017

The Milken Institute School of Public Health recently received a $4.9 million grant for a four-year project that aims to reduce the risk of small-for-gestational-age babies born in southern Nepal and improve growth in early infancy.

James Tielsch, a SPH professor and chair of the Department of Global Health, will lead the research team. The grant was awarded by the Bill & Melinda Gates Foundation. The research team will evaluate whether a protein and energy supplement taken during pregnancy and breastfeeding can improve health outcomes.

Many pregnant women in Nepal and other areas of South Asia are undernourished, which puts them at risk of delivering a small baby with health consequences that can be lifelong. Food intake may be inadequate during pregnancy for a variety of reasons, including a lack of appetite. Research suggests these babies are more likely to develop diabetes, cardiovascular disease and other chronic health issues as adults.

“There is a change in the metabolic reprogramming that happens in utero that sets the stage for what’s going to happen for the rest of their lives,” Dr. Tielsch said.

Babies born small face stunted growth throughout their lives, which has a lasting impact. Women who grow up stunted tend to have smaller babies, Dr. Tielsch said, which introduces a difficult intergenerational challenge.

One way to combat this cycle is by providing women with better nutrition while pregnant and in the six months following delivery to improve the quality of breast milk. Dr. Tielsch and his team are exploring several different kinds of supplements for the women to try, ranging from sweet beverages to savory biscuits. It’s important that the supplement appeals to taste preferences in the region, he said.

“The estimated incidence of small-for-gestational-age births is from 30 to 40 percent in Nepal,” Dr. Tielsch said. “In this project, we hope to identify a nutritional supplement that could reduce that percentage and help Nepalese women get the nutrients they need to deliver a healthy baby and improve their growth in those important first six months of life.”

The research team will test the selected nutritional supplement in about 1,800 pregnancies in the Sarlahi District of Nepal, which is along the border with India, where the problem is acute and difficult to solve. Women will be randomly assigned to one of four groups: those receiving the daily supplement during pregnancy and the first six months following delivery, those receiving the supplement only during pregnancy, those receiving the supplement only after the baby is born and a control group that consumes their regular diet.

All mothers and babies will be followed through pregnancy and until six months postpartum. A sample will be followed until 12 months to assess whether there are benefits that extend past the supplementation period.

“We’ll be looking to see if there is increased growth in the first six months of life, is that increased growth maintained, is it accelerated, is this a situation where we’ve changed the metabolic in utero programming such that those kids can take more advantage of the food that’s available to them,” Dr. Tielsch said. “We have to wait and see what’s going to happen.”

The research team includes investigators from GW, the Johns Hopkins Bloomberg School of Public Health and the Harvard T.H. Chan School of Public Health.

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