{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T19:50:24Z","timestamp":1780429824454,"version":"3.54.1"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T00:00:00Z","timestamp":1724889600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The prevalence of underweight in women of reproductive age (WRA) in South Asia remains unacceptably high. Underweight women suffer from lowered immunity, infertility, and a risk of developing non-communicable diseases. In pregnancy, undernutrition results in poor neonatal and maternal outcomes. We present the findings and the management strategy of undernutrition in the preconception and pregnancy phase intervention group in the WING study in low- to lower-middle-income neighborhoods of North India.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed data from the Women and Infants Integrated Interventions for Growth Study (WINGS) intervention group. In this individually randomized factorial design trial, 13,500 women were enrolled from low to middle-income neighborhoods of Delhi: 6,722 women in the preconception group and 2,640 from the pregnancy group. Food supplements in the form of locally prepared snacks were given to provide necessary calories and protein requirements as per the Body mass index (BMI) during the preconception period and each trimester of pregnancy. The snacks (sweet or savory) and milk or egg as a source of high-quality protein were delivered at home, and intakes were observed. Individual tracking and close monthly monitoring were done for compliance, besides screening and treatment of infections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The enrolled women's mean (SD) age was 24.2 (3.1) years. Approximately 35% of women had a height of &amp;lt; 150 cm, and 50% had schooling &amp;gt;12 years. 17% of women in preconception and 14 % in pregnancy intervention groups were Underweight. Approximately two-thirds of underweight women improved 9\u201312 months after management in the preconception group, and the same proportion improved 4 weeks after management during pregnancy. The proportion of women with inadequate weight gain (IWG) during pregnancy was higher in women who were underweight during preconception.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>A comprehensive approach to managing undernutrition with high-quality energy-dense food supplementation substantially improved weight gain in women during preconception and pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p><jats:ext-link>http:\/\/ctri.nic.in\/Clinicaltrials\/pmaindet2.php?trialid=19339%26EncHid=%26userName=societyforappliedstudies<\/jats:ext-link>, identifier: Clinical Trial Registry India #CTRI\/2017\/06\/008908.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1405247","type":"journal-article","created":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T04:51:58Z","timestamp":1724907118000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Management of undernutrition during preconception and pregnancy in an urban setting in North India"],"prefix":"10.3389","volume":"12","author":[{"given":"Neeta","family":"Dhabhai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranadip","family":"Chowdhury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunita","family":"Taneja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Medha","family":"Shekhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmine","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pratima","family":"Mittal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupali","family":"Dewan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nita","family":"Bhandari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,8,29]]},"reference":[{"key":"B1","volume-title":"UNICEF Programming Guidance. Prevention of Malnutrition in Women Before and During Pregnancy and While Breastfeeding","author":"United","year":"2021"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.1186\/s12889-023-16045-4","article-title":"Double burden of malnutrition and its associated factors among women in low- and middle-income countries: findings from 52 nationally representative data","volume":"23","author":"Alem","year":"2023","journal-title":"BMC Public Health."},{"key":"B3","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1093\/advances\/nmz078","article-title":"Double burden of underweight and overweight among women in south and Southeast Asia: a systematic review and meta-analysis","volume":"11","author":"Biswas","year":"2020","journal-title":"Adv Nutr."},{"key":"B4","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1111\/tmi.12679","article-title":"Economic burden of underweight and overweight among adults in the Asia-Pacific region: a systematic review","volume":"21","author":"Hoque","year":"2016","journal-title":"Trop Med Int Health."},{"key":"B5","unstructured":"Undernourished and Overlooked: A Global Nutrition Crisis in Adolescent Girls and Women2023"},{"key":"B6","unstructured":"National Family Health Survey (NFHS-5)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1097\/GRF.0b013e31829cb9ca","article-title":"The obstetric origins of health for a lifetime","volume":"56","author":"Barker","year":"2013","journal-title":"Clin Obstet Gynecol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1842","DOI":"10.1016\/S0140-6736(18)30312-X","article-title":"Origins of lifetime health around the time of conception: causes and consequences","volume":"391","author":"Fleming","year":"2018","journal-title":"Lancet."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1830","DOI":"10.1016\/S0140-6736(18)30311-8","article-title":"Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health","volume":"391","author":"Stephenson","year":"2018","journal-title":"Lancet."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e072046","DOI":"10.1136\/bmj-2022-072046","article-title":"Impact of a package of health, nutrition, psychosocial support, and WaSH interventions delivered during preconception, pregnancy, and early childhood periods on birth outcomes and on linear growth at 24 months of age: factorial, individually randomised controlled trial","volume":"379","author":"Taneja","year":"2022","journal-title":"BMJ."},{"key":"B11","unstructured":"Body Mass Index (BMI) Among Adults"},{"key":"B12","doi-asserted-by":"publisher","first-page":"757","DOI":"10.3390\/ijerph21060757","article-title":"Advantages and limitations of the body mass index (BMI) to assess adult obesity","volume":"21","author":"Wu","year":"2024","journal-title":"Int J Environ Res Public Health."},{"key":"B13","article-title":"The national academies collection: reports funded by national institutes of health","volume-title":"Weight Gain During Pregnancy: Reexamining the Guidelines","author":"Rasmussen","year":"2009"},{"key":"B14","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s13063-020-4059-z","article-title":"Impact of an integrated nutrition, health, water sanitation and hygiene, psychosocial care and support intervention package delivered during the pre- and peri-conception period and\/or during pregnancy and early childhood on linear growth of infants in the first two years of life, birth outcomes and nutritional status of mothers: study protocol of a factorial, individually randomized controlled trial in India","volume":"21","author":"Taneja","year":"2020","journal-title":"Trials."},{"key":"B15","unstructured":"Intensified Iron Plus Initiative (I-NIPI)2018"},{"key":"B16","unstructured":"Integrated Child Development Services (ICDS)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"522","DOI":"10.4103\/ijmr.IJMR_1762_18","article-title":"Country-specific nutrient requirements & recommended dietary allowances for Indians: Current status & future directions","volume":"148","author":"Nair","year":"2018","journal-title":"Indian J Med Res."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1812","DOI":"10.3390\/nu11081812","article-title":"Energy intake requirements in pregnancy","volume":"11","author":"Most","year":"2019","journal-title":"Nutrients."},{"key":"B19","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1002\/ijgo.13334","article-title":"Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non-Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline","volume":"151","author":"McAuliffe","year":"2020","journal-title":"Int J Gynecol Obstetr."},{"key":"B20","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1002\/ijgo.13939","article-title":"Screening and management options for severe thinness during pregnancy in India","volume":"155","author":"Sethi","year":"2021","journal-title":"Int J Gynecol Obstetr."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e32302","DOI":"10.7759\/cureus.32302","article-title":"Utilization of nutritional supplementation services and their predictors in pregnant and lactating women living in an urban resettlement colony of Delhi, India: a cross-sectional study","volume":"14","author":"Paul","year":"2022","journal-title":"Cureus."},{"key":"B22","unstructured":"Ensuring pregnancy weight gain: an integrated community-based approach to tackle maternal nutrition in India14\n            Sreeparna Ghosh MukherjeePS\n            ShahDNN\n          Field Exchange.612019"},{"key":"B23","unstructured":"POSHAN Abhiyan -PM's Overarching Scheme for Holistic Nourishment"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1405247\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T04:52:02Z","timestamp":1724907122000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1405247\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,29]]},"references-count":23,"alternative-id":["10.3389\/fpubh.2024.1405247"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1405247","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,29]]},"article-number":"1405247"}}