Does dietitian involvement during pregnancy improve birth outcomes? A systematic review
Bibliographic record
Abstract
Healthy pregnancies can be achieved through sufficient weight gain, balanced diets, appropriate vitamin and mineral supplementation, avoidance of alcohol and harmful substances, as well as food safety (Procter et al., 2014). While most prenatal care providers do not have substantial training in nutrition, we believe that registered dietitians being healthcare professionals, can assist pregnant patients in attaining optimal birth outcomes. In Canada and the US, registered dietitians are not required members of health care teams for prenatal care, but can be referred to for medical nutrition therapy to assist women with weight gain, hyperemesis, multiple gestations, poor dietary patterns, and chronic disease (Procter et al, 2014). Given their expertise in nutrition and the importance of nutrition during pregnancy, registered dietitians have the potential to positively influence birth outcomes. However, studies supporting their roles have not been comprehensively evaluated (Pari-Keener et al., 2020) and existing studies have been inconsistent. Some studies have supported that interventions provided by dietitians improve infant birth outcomes. Research by Vesco et al. suggests that intensive dietary intervention initiated by dietitians is associated with a decrease in prevalence of large-for-gestational age infants (9%) compared to groups receiving only one-time dietary advice (26%) (2014). Additionally, research by Crowther et al. shows a significantly low incidence of large-for-gestational age (13%) and macrosomia (10%) infants as a result of dietitian involvement compared to its control group (22% and 21%) (2005). However, other studies indicate no effect on infant or maternal outcomes (Koivusalo et al., 2016; Dodd, Deussen & Louise, 2019). So far, no systematic review has directly studied the effect of dietitian involvement on birth outcomes. Thus, this review will examine the extent to which dietitian involvement during pregnancy is associated with improved birth outcomes. References Crowther, C. A., Hiller, J. E., Moss, J. R., McPhee, A. J., Jeffries, W. S., Robinson, J. S., & Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group (2005). Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. The New England journal of medicine, 352(24), 2477–2486. https://doi.org/10.1056/NEJMoa042973 Dodd, J. M., Deussen, A. R., & Louise, J. (2019). A Randomised Trial to Optimise Gestational Weight Gain and Improve Maternal and Infant Health Outcomes through Antenatal Dietary, Lifestyle and Exercise Advice: The OPTIMISE Randomised Trial. Nutrients, 11(12), 2911. https://doi.org/10.3390/nu11122911 Koivusalo, S. B., Rönö, K., Klemetti, M. M., Roine, R. P., Lindström, J., Erkkola, M., Kaaja, R. J., Pöyhönen-Alho, M., Tiitinen, A., Huvinen, E., Andersson, S., Laivuori, H., Valkama, A., Meinilä, J., Kautiainen, H., Eriksson, J. G., & Stach-Lempinen, B. (2016). Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL): A Randomized Controlled Trial. Diabetes care, 39(1), 24–30. https://doi.org/10.2337/dc15-0511 Pari-Keener, M., Gallo, S., Stahnke, B., McDermid, J. M., Al-Nimr, R. I., Moreschi, J. M., Hakeem, R., Handu, D., & Cheng, F. W. (2020). Maternal and Infant Health Outcomes Associated with Medical Nutrition Therapy by Registered Dietitian Nutritionists in Pregnant Women with Malnutrition: An Evidence Analysis Center Systematic Review. Journal of the Academy of Nutrition and Dietetics, 120(10), 1730–1744. https://doi.org/10.1016/j.jand.2019.10.024 Procter, S. B., & Campbell, C. G. (2014). Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome. Journal of the Academy of Nutrition and Dietetics, 114(7), 1099–1103. https://doi.org/10.1016/j.jand.2014.05.005 Vesco, K. K., Karanja, N., King, J. C., Gillman, M. W., Leo, M. C., Perrin, N., McEvoy, C. T., Eckhardt, C. L., Smith, K. S., & Stevens, V. J. (2014). Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: a randomized trial. Obesity (Silver Spring, Md.), 22(9), 1989–1996. https://doi.org/10.1002/oby.20831
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.044 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.007 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".