Gestational Weight GainIMNiMNCT04868669
Improving Maternal Nutrition in Matlab
A study testing In-home, intensive nutrition counseling in people with Gestational Weight Gain, run by International Centre for Diarrhoeal Disease Research, Bangladesh at 1 site in Bangladesh.
Trial summary
Background: Maternal undernutrition and inadequate gestational weight gain (GWG) are prevalent in rural communities of low- and middle-income countries (LMICs). In Matlab, Bangladesh, 54% of the women fail to gain adequate weight (>4 kg) in the third trimester. Read more about this study
- Who is it for?
- Ages 18 to 39 years, women onlyHealthy volunteers can take part
- Conditions the study is for
- Gestational Weight Gain
- What is being tested?
- In-home, intensive nutrition counseling
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 285 participants
- Where
- 1 siteBangladesh
- Study dates
- 15 Jan 2020to 24 Oct 2021
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 39 years
- Women only
- Healthy volunteers accepted
- Adult
Who may be able to join
- aged 18-39 years
- in the first trimester of pregnancy (before 14 weeks of gestation)
- BMI 16-24.99 kg/m^2 measured on enrollment
- willing to participate in the study
Who cannot join
- multiple pregnancy (carrying two or more fetuses)
- threatened abortion, persistent pervaginal bleeding, or cervical incompetence
- history of three or more consecutive abortions
- history of gestational diabetes, macrosomia, gestational hypertension, preeclampsia/eclampsia in a prior pregnancy
- chronic diseases, such as hypertension, heart disease, chronic obstructive pulmonary disease, chronic kidney disease, chronic liver disease, pancreatic diseases, Crohn's disease, ulcerative colitis, diabetes mellitus, thyroid dysfunction, immunological diseases, malignancy or any other diseases which could impede compliance with the study protocol
- taking medications known to influence fetal growth, such as insulin, thyroid hormones, glucocorticoids
Show all 13Show fewer
- known case of serious psychiatric or behavioral disorders, such as schizophrenia, bipolar disorder
- scored as moderate or worse on enrollment on any one of the subscales of the Depression, Anxiety and Stress Scales-21 (DASS-21)
- inability to read or write Bengali
- belonging to moderately or severely food insecure households as measured by the Household Food Insecurity Access Scale (HFIAS)
- having a plan to move or deliver outside the study area
- women practicing some form of vegetarianism
- women belonging to a household from which another woman is already enrolled in the study
Trial locations and contacts
1 site in 1 country.
Bangladesh1 site
International Centre for Diarrhoeal Disease Research, Bangladesh
Chāndpur
About this study
Official title: In-home, Intensive Nutrition Counseling to Improve Gestational Weight Gain in Rural Bangladesh: A Cluster-Randomized Controlled Trial
Background: Maternal undernutrition and inadequate gestational weight gain (GWG) are prevalent in rural communities of low- and middle-income countries (LMICs). In Matlab, Bangladesh, 54% of the women fail to gain adequate weight (>4 kg) in the third trimester. Risks associated with inadequate GWG include giving birth to a small-for-gestational age (SGA) infant, low birth weight (LBW) infant, preterm birth (PTB), etc. Few contemporary studies examined the efficacy of nutrition counseling on GWG improvement in LMICs.
Objectives: The primary objective of this study is to assess whether in-home, intensive nutrition counseling during pregnancy, compared to standard antenatal care, could improve GWG among pregnant women in rural Bangladesh.
Read more
Methods: This prospective, two-arm, parallel group, equal allocation, open-label, community-based, cluster-randomized controlled trial will be conducted in the icddr,b service area of Matlab, a rural subdistrict of Bangladesh. Clusters will be randomly allocated 1:1 to the intervention arm in which pregnant women will receive monthly in-home, intensive nutrition counseling or the control arm in which pregnant women will receive standard antenatal care as offered by icddr,b and Govt. facilities. Fixed Site Clinics (FSCs) located at the homes of the community health research workers (CHRWs) will act as clusters. Of the 33 FSCs serving rural areas in the icddr,b service area, 20 will be selected randomly and listed. These 20 clinics will then be randomly allocated 1:1 to either an intervention or control group using a computer-generated random allocation sequence. To fulfil the required sample size, each selected CHRW will enroll 16 consecutive pregnancies. Required sample size is 16 women per cluster i.e. 160 women per arm. Eligible participants will be enrolled upon obtaining their consent by 13 and 6/7 weeks of gestation (first trimester) and followed up to 6 weeks postpartum. Trained health workers will visit the homes of the women in the intervention arm once a month and provide nutrition counseling to the women and her influential family members such as mothers, mothers-in-law and husbands. Both intention-to-treat and per-protocol analyses will be performed.
Outcome measures/variables: Proportion of women with inadequate rate of weight gain in the second and third trimester of pregnancy according to the US Institute of Medicine (IOM) 2009 guidelines is the primary outcome variable.
- Conditions
- Gestational Weight Gain
- Being tested
- In-home, intensive nutrition counseling
- Keywords
- nutrition counseling, gestational weight gain, cluster randomized controlled trial, birth weight
- Medical subject headings
- Gestational Weight Gain, Birth Weight
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
In-home, intensive nutrition counselingBehavioural
- Individualized sessions will be conducted by trained health workers following a standard document (counseling booklet)
- The messages to be provided through the counseling will be contextualized
- Sessions will start from the early second trimester and repeat monthly until 36 weeks of gestation
- Counseling sessions will be conducted at the participant's place
- Sessions will involve influential family members such as the husband, mother-in-law, mother, and the household head along with the pregnant women
- Women will receive personalized feedback on their dietary intake pattern (dietary diversity) and the rate of weight gain in each session
- Sessions will be tailored according to each participant's need and progress
| Study group | Role | What they receive |
|---|---|---|
| Intervention | Experimental | In this arm, pregnant women, along with their influential family members such as mothers, mothers-in-law, and husbands, will receive monthly in-home, intensive nutrition counseling during the prenatal period. Receives: Behavioral: In-home, intensive nutrition counseling |
| Control | No intervention | Pregnant women in this arm will receive standard antenatal care. |
What is being measured
The primary outcome is the main question the study is designed to answer.
proportion of women with inadequate rate of weight gain in the second and third trimester of pregnancy according to IOM 2009 guidelines
Pregnancy trimesters are defined as follows: 1st trimester (0 weeks - 13+6 weeks), 2nd trimester (14 completed weeks - 27+6 weeks), and 3rd trimester (28 completed weeks - childbirth). Rate of weight gain between two time points (trimesters) will be calculated by subtracting the weight measured at the first time point from the weight measured at the second time point and dividing the derived value by the difference in weeks between the two time points.
Measured: Pre-delivery
Secondary outcomes (30)
total gestational weight gain (kg)
Measured: pre-delivery
rate of weight gain during the 2nd and 3rd trimester (kg/week)
Measured: pre-delivery
proportion of women with inadequate total GWG according to IOM criteria
Measured: pre-delivery
proportion of women with inadequate total GWG according to local criteria
Measured: pre-delivery
proportion of women with inadequate third trimester weight gain according to local criteria
Measured: pre-delivery
proportion of preterm births
childbirth before 37 completed weeks
Measured: at delivery
maternal mid-upper arm circumference (MUAC) (mm)
Measured: baseline, 36 weeks of gestation, at delivery and 6 weeks post-partum
maternal weight (kg)
Measured: baseline, 36 weeks of gestation, pre-delivery, at delivery and 6 weeks post-partum
maternal body mass index (BMI) (kg/m^2)
weight and height (at baseline) will be combined to report BMI
Measured: baseline, 36 weeks of gestation, pre-delivery, at delivery and 6 weeks post-partum
infant weight (g)
Measured: at birth (delivery) and after 4 weeks
infant length (cm)
Measured: at birth (delivery) and after 4 weeks
infant head circumference (cm)
Measured: at birth (delivery) and after 4 weeks
proportion of low birth weight (< 2500 g) infants
Measured: at birth (delivery)
proportion of small for gestational age (<10th percentile) infants according to Intergrowth-21st standards
Measured: at birth (delivery)
proportion of women with pregnancy complications e.g. anemia, preeclampsia
Measured: at delivery
proportion of women with obstetric complications e.g. induction of labor, caesarean section
Measured: at delivery
newborn Apgar score
Measured: at birth (delivery)
proportion of infants developing morbidity
Measured: 4 weeks after birth
proportion of infant mortality
Measured: 4 weeks after birth
dietary diversity score according to the "Guidelines for Measuring Household and Individual Dietary Diversity"
score range: 0-9; higher scores indicate a better outcome
Measured: baseline, 36 weeks of gestation and 6 weeks post-partum
dietary diversity score according to the "Minimum Dietary Diversity for Women: A Guide to Measurement"
score range: 0-10; higher scores indicate a better outcome
Measured: baseline, 36 weeks of gestation and 6 weeks post-partum
proportion of women with inadequate dietary diversity accroding to the "Minimum Dietary Diversity for Women: A Guide to Measurement"
score range: 0-10; <5 indicates inadequate dietary diversity
Measured: baseline, 36 weeks of gestation and 6 weeks post-partum
energy consumption (kcal)
Measured: baseline, 36 weeks of gestation and 6 weeks post-partum
protein consumption (g)
Measured: baseline, 36 weeks of gestation and 6 weeks post-partum
proportion of women with symptoms of depression as measured by Depression, Anxiety, and Stress Scales-21 (DASS-21) scales
DASS-21 is a validated, widely used, standardized self-report scale with 7 items in each subscale category of Depression, Anxiety, and Stress symptoms. Responses are scored on a 4-point Likert scale ranging from 0 (did not apply to me at all) to 3 (applied to me very much/most of the time), with higher scores indicating higher levels of depression, anxiety or stress.
Measured: baseline, 36 weeks of gestation and 6 weeks post-partum
proportion of women with symptoms of anxiety as measured by Depression, Anxiety, and Stress Scales-21 (DASS-21) scales
DASS-21 is a validated, widely used, standardized self-report scale with 7 items in each subscale category of Depression, Anxiety, and Stress symptoms. Responses are scored on a 4-point Likert scale ranging from 0 (did not apply to me at all) to 3 (applied to me very much/most of the time), with higher scores indicating higher levels of depression, anxiety or stress.
Measured: baseline, 36 weeks of gestation and 6 weeks post-partum
proportion of women with symptoms of stress as measured by Depression, Anxiety, and Stress Scales-21 (DASS-21) scales
DASS-21 is a validated, widely used, standardized self-report scale with 7 items in each subscale category of Depression, Anxiety, and Stress symptoms. Responses are scored on a 4-point Likert scale ranging from 0 (did not apply to me at all) to 3 (applied to me very much/most of the time), with higher scores indicating higher levels of depression, anxiety or stress.
Measured: baseline, 36 weeks of gestation and 6 weeks post-partum
healthcare seeking and services utilization e.g. number of prenatal visits
Measured: at delivery
components of gut microbiota/microbiome, proteome, and metabolome of women (subsample)
Measured: at 24, 28, 32, 36 weeks of gestation and 6 weeks post-partum
components of gut microbiota/microbiome of infants (subsample)
Measured: 4 weeks after birth
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 May 2021
- Study start15 Jan 2020
- Primary completion22 Aug 2021
- Study completion24 Oct 2021
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Gestational Weight GainStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- prospective, two-arm, parallel-group, equal allocation, open-label, community-based, cluster-randomized controlled trial
- Masking
- None (open label)
- Enrolment
- 285 participants (actual)
Sponsor and investigators
- Lead sponsor
- International Centre for Diarrhoeal Disease Research, Bangladesh
- Sponsor type
- University, hospital or other
- Collaborators
- Obstetrical and Gynaecological Society of Bangladesh (OGSB)
- Responsible party
- Sponsor
- Investigators
- S. M. Tafsir Hasan, MBBS, MS, Principal investigator, Nutrition and Clinical Services Division, icddr,b
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04868669
- Sponsor's protocol ID
- PR-19109
- Acronym
- IMNiM
- Status last verified
- Oct 2026
- First submitted
- 28 Dec 2019
- Last updated
- 21 Oct 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 21 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- In-home, Intensive Nutrition Counseling to Improve Gestational Weight Gain in Rural Bangladesh: A Cluster-Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT04868669
- Acronym / sponsor ID
- IMNiM / PR-19109
- Conditions
- Gestational Weight Gain
- Keywords
- nutrition counseling, gestational weight gain, cluster randomized controlled trial, birth weight
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 285 participants (actual)
- Lead sponsor
- International Centre for Diarrhoeal Disease Research, BangladeshUniversity, hospital or other
- Collaborators
- Obstetrical and Gynaecological Society of Bangladesh (OGSB)
- Study start
- 15 Jan 2020 (actual)
- Primary completion
- 22 Aug 2021 (actual)
- Study completion
- 24 Oct 2021 (actual)
- First posted
- 3 May 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Background: Maternal undernutrition and inadequate gestational weight gain (GWG) are prevalent in rural communities of low- and middle-income countries (LMICs). In Matlab, Bangladesh, 54% of the women fail to gain adequate weight (>4 kg) in the third trimester. Risks associated with inadequate GWG include giving birth to a small-for-gestational age (SGA) infant, low birth weight (LBW) infant, preterm birth (PTB), etc. Few contemporary studies examined the efficacy of nutrition counseling on GWG improvement in LMICs.
Objectives: The primary objective of this study is to assess whether in-home, intensive nutrition counseling during pregnancy, compared to standard antenatal care, could improve GWG among pregnant women in rural Bangladesh.
Methods: This prospective, two-arm, parallel group, equal allocation, open-label, community-based, cluster-randomized controlled trial will be conducted in the icddr,b service area of Matlab, a rural subdistrict of Bangladesh. Clusters will be randomly allocated 1:1 to the intervention arm in which pregnant women will receive monthly in-home, intensive nutrition counseling or the control arm in which pregnant women will receive standard antenatal care as offered by icddr,b and Govt. facilities. Fixed Site Clinics (FSCs) located at the homes of the community health research workers (CHRWs) will act as clusters. Of the 33 FSCs serving rural areas in the icddr,b service area, 20 will be selected randomly and listed. These 20 clinics will then be randomly allocated 1:1 to either an intervention or control group using a computer-generated random allocation sequence. To fulfil the required sample size, each selected CHRW will enroll 16 consecutive pregnancies. Required sample size is 16 women per cluster i.e. 160 women per arm. Eligible participants will be enrolled upon obtaining their consent by 13 and 6/7 weeks of gestation (first trimester) and followed up to 6 weeks postpartum. Trained health workers will visit the homes of the women in the intervention arm once a month and provide nutrition counseling to the women and her influential family members such as mothers, mothers-in-law and husbands. Both intention-to-treat and per-protocol analyses will be performed.
Outcome measures/variables: Proportion of women with inadequate rate of weight gain in the second and third trimester of pregnancy according to the US Institute of Medicine (IOM) 2009 guidelines is the primary outcome variable.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- prospective, two-arm, parallel-group, equal allocation, open-label, community-based, cluster-randomized controlled trial
| Arm | Type | Receives |
|---|---|---|
| Intervention | Experimental | Behavioral: In-home, intensive nutrition counselingIn this arm, pregnant women, along with their influential family members such as mothers, mothers-in-law, and husbands, will receive monthly in-home, intensive nutrition counseling during the prenatal period. |
| Control | No intervention | –Pregnant women in this arm will receive standard antenatal care. |
Who may qualify
- Ages
- 18 to 39 years
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (4 listed)
- aged 18-39 years
- in the first trimester of pregnancy (before 14 weeks of gestation)
- BMI 16-24.99 kg/m^2 measured on enrollment
- willing to participate in the study
Key exclusion criteria (13 listed)
- multiple pregnancy (carrying two or more fetuses)
- threatened abortion, persistent pervaginal bleeding, or cervical incompetence
- history of three or more consecutive abortions
- history of gestational diabetes, macrosomia, gestational hypertension, preeclampsia/eclampsia in a prior pregnancy
- chronic diseases, such as hypertension, heart disease, chronic obstructive pulmonary disease, chronic kidney disease, chronic liver disease, pancreatic diseases, Crohn's disease, ulcerative colitis, diabetes mellitus, thyroid dysfunction, immunological diseases, malignancy or any other diseases which could impede compliance with the study protocol
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| In-home, intensive nutrition counseling* Individualized sessions will be conducted by trained health workers following a standard document (counseling booklet) * The messages to be provided through the counseling will be contextualized * Sessions will start from the early second trimester and repeat monthly until 36 weeks of gestation * Counseling sessions will be conducted at the participant's place * Sessions will involve influential family members such as the husband, mother-in-law, mother, and the household head along with the pregnant women * Women will receive personalized feedback on their dietary intake pattern (dietary diversity) and the rate of weight gain in each session * Sessions will be tailored according to each participant's need and progress | Behavioural | Intervention |
Primary outcome
proportion of women with inadequate rate of weight gain in the second and third trimester of pregnancy according to IOM 2009 guidelines
Time frame: Pre-delivery
Pregnancy trimesters are defined as follows: 1st trimester (0 weeks - 13+6 weeks), 2nd trimester (14 completed weeks - 27+6 weeks), and 3rd trimester (28 completed weeks - childbirth). Rate of weight gain between two time points (trimesters) will be calculated by subtracting the weight measured at the first time point from the weight measured at the second time point and dividing the derived value by the difference in weeks between the two time points.
30 secondary outcomes
total gestational weight gain (kg)
Time frame: pre-delivery
rate of weight gain during the 2nd and 3rd trimester (kg/week)
Time frame: pre-delivery
proportion of women with inadequate total GWG according to IOM criteria
Time frame: pre-delivery
proportion of women with inadequate total GWG according to local criteria
Time frame: pre-delivery
proportion of women with inadequate third trimester weight gain according to local criteria
Time frame: pre-delivery
proportion of preterm births
Time frame: at delivery
maternal mid-upper arm circumference (MUAC) (mm)
Time frame: baseline, 36 weeks of gestation, at delivery and 6 weeks post-partum
maternal weight (kg)
Time frame: baseline, 36 weeks of gestation, pre-delivery, at delivery and 6 weeks post-partum
maternal body mass index (BMI) (kg/m^2)
Time frame: baseline, 36 weeks of gestation, pre-delivery, at delivery and 6 weeks post-partum
infant weight (g)
Time frame: at birth (delivery) and after 4 weeks
infant length (cm)
Time frame: at birth (delivery) and after 4 weeks
infant head circumference (cm)
Time frame: at birth (delivery) and after 4 weeks
proportion of low birth weight (< 2500 g) infants
Time frame: at birth (delivery)
proportion of small for gestational age (<10th percentile) infants according to Intergrowth-21st standards
Time frame: at birth (delivery)
proportion of women with pregnancy complications e.g. anemia, preeclampsia
Time frame: at delivery
proportion of women with obstetric complications e.g. induction of labor, caesarean section
Time frame: at delivery
newborn Apgar score
Time frame: at birth (delivery)
proportion of infants developing morbidity
Time frame: 4 weeks after birth
proportion of infant mortality
Time frame: 4 weeks after birth
dietary diversity score according to the "Guidelines for Measuring Household and Individual Dietary Diversity"
Time frame: baseline, 36 weeks of gestation and 6 weeks post-partum
dietary diversity score according to the "Minimum Dietary Diversity for Women: A Guide to Measurement"
Time frame: baseline, 36 weeks of gestation and 6 weeks post-partum
proportion of women with inadequate dietary diversity accroding to the "Minimum Dietary Diversity for Women: A Guide to Measurement"
Time frame: baseline, 36 weeks of gestation and 6 weeks post-partum
energy consumption (kcal)
Time frame: baseline, 36 weeks of gestation and 6 weeks post-partum
protein consumption (g)
Time frame: baseline, 36 weeks of gestation and 6 weeks post-partum
proportion of women with symptoms of depression as measured by Depression, Anxiety, and Stress Scales-21 (DASS-21) scales
Time frame: baseline, 36 weeks of gestation and 6 weeks post-partum
proportion of women with symptoms of anxiety as measured by Depression, Anxiety, and Stress Scales-21 (DASS-21) scales
Time frame: baseline, 36 weeks of gestation and 6 weeks post-partum
proportion of women with symptoms of stress as measured by Depression, Anxiety, and Stress Scales-21 (DASS-21) scales
Time frame: baseline, 36 weeks of gestation and 6 weeks post-partum
healthcare seeking and services utilization e.g. number of prenatal visits
Time frame: at delivery
components of gut microbiota/microbiome, proteome, and metabolome of women (subsample)
Time frame: at 24, 28, 32, 36 weeks of gestation and 6 weeks post-partum
components of gut microbiota/microbiome of infants (subsample)
Time frame: 4 weeks after birth
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 21 Oct 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
S. M. Tafsir Hasan, MBBS, MS principal investigator
Nutrition and Clinical Services Division, icddr,b
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing In-home, intensive nutrition counseling in people with Gestational Weight Gain, run by International Centre for Diarrhoeal Disease Research, Bangladesh at 1 site in Bangladesh.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 21 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Bangladesh. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
proportion of women with inadequate rate of weight gain in the second and third trimester of pregnancy according to IOM 2009 guidelines (time frame: Pre-delivery). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Oct 2026.