4. Discussion
weight gain, wasting, stunting
STDS, WASTING
The preconception maternal mentoring program described herein is the only program of its kind to be delivered as an intervention in Indonesian women with an overall goal of improving maternal and child health [A number of previous preconception interventions have been conducted to examine their impacts on maternal knowledge [Although one study showed that preconception education and counseling did not significantly reduce low birth weight, the intervention materials used in the study were only delivered to women at one time point during the preconception stage [Herein, we reported that the maternal mentoring program in our study led to greater reported readiness for pregnancy (i.e., women felt more prepared for pregnancy, had more time for motherhood, had time to discuss their pregnancy with their partner, were more likely to consume recommended iron and folic acid supplementation, were more likely to maintain a healthy diet, were more likely to not smoke, were more likely to avoid over-the-counter and herbal drugs, were more likely to have health care insurance, were more able to manage stress, and were more likely to seek early detection of STDs) [We believe our intervention is unique from previous studies focused on providing maternal mentoring programs in other settings, as our intervention included a comprehensive package of educational materials and multiple time points for delivery from preconception to post-delivery. Meanwhile, many previous studies have only consisted of one single educational or counseling session [In the present study, each woman in the intervention group received basic education during preconception, as well as monthly WhatsApp/SMS messages until pregnancy, and other message reminders every other day to comply with routine provider visits and recommended iron supplementation during pregnancy until delivery. This approach is comprehensive and could be considered a strength of our study. In addition, as many women have access to mobile devices, this approach is also likely to be feasible among the broader population of women in this setting and should be considered by healthcare providers and the national government given the ease and low cost of sending automated messages.Importantly, a previous study found that monthly nutritional education delivered during the third trimester led to 60% higher weight gain, 20% higher birth weight, and 94% lower LBW for newborns [Additionally, there is a lack of evidence to show that maternal mentoring significantly impacts newborn birth length. In our study, the newborn length-for-age Z-score was not found to be different between the intervention and control groups. However, one multi-country randomized controlled trial conducted in rural and semi-rural settings demonstrated that the newborn birth length-for-age Z-score was 0.19 points higher for women who received nutritional supplementation at least 3 months prior to conception compared with women who did not receive any nutritional intervention [Given that inadequate fetal growth is strongly associated with stunting in developing countries, including Indonesia, the present study provides strong support for implementing maternal mentoring in addition to standard care for preconception and pregnant women in this setting. It is important to note that this study sample was obtained from women in Yogyakarta, who mostly have mobile devices, and may not be representative of all women across rural and urban regions of Indonesia; therefore, future research should explore the impact of such programs in broader populations in order to successfully reach the national goals for reduced stunting and wasting among children.