TABLE 6.

Antenatal Balanced Protein-Energy Supplementation

SourceLocation and Type of TrialInterventionMaternal OutcomePerinatal/Neonatal Outcome
Ceesay et al104The Gambia; rural setting; RCTTreatment group consisted of pregnant women who received high–protein energy biscuits; the control group consisted of women who did not receive the supplement (247 normal singleton live births among 1460 women; treatment group: 1010 live births; control group: 1037 live births).Incidence of stillbirths decreased by 53% in the intervention group (OR: 0.47; CI: 0.23–0.99; P < .05); a 46% decrease was recorded in the number of deaths occurring in the first week of life (OR: 0.54; CI: 0.35–0.85; P < .01), but there was no effect on mortality rates after 7 d of life (P > .2); there was a significant increase in birth weight of infants born to mothers in the intervention group (mean increase: 136 g; P < .001); a 39% decrease was seen in LBW rates among the infants of the intervention group (P < .001).
Kusin et al109East Java, Indonesia; rural setting; QTPregnant women (n = 542) were assigned to low- and high-energy supplementation groups.For women who consumed the supplements for >45 d, there was a significant difference in birth weight (463 g) between the 2 groups; a difference of 421 g (P = .017) was seen in infant weight at 12 mo of age.
Kardjati et al116East Java, Indonesia; rural setting; double-blind, randomized, controlled trial (DBRCT)Pregnant women (n = 741) in 3 villages were assigned to a high-energy (n = 272) or low-energy (n = 265) group; there were 204 noncompliers excluded from these groups; among these, 6 additional groups were formed according to the number of energy packets consumed during the trial.No difference in weight gain was seen among the women of the 2 groups compared with noncompliers.There was no significant effect of the supplementation on birth weight and LBW rates when compared to the baseline period during which no supplementation was provided.
Villar and Rivera111Guatemala; rural setting; QT169 mothers and their offspring were enrolled during 2 consecutive pregnancies and the interim lactation period; 2 types of supplements (atole, a high-protein and high-calorie gruel, and fresco, a no-protein/low-calorie cold liquid drink) were offered to pregnant and/or lactating women.There was an impact of the supplement on birth weight, with a linear trend for increased (P < .05) birth weight from the highest (atole) to the lowest (fresco) supplemented groups.
Tontisirin et al110Thailand; rural setting; RCTWomen (n = 43) in their third trimester were divided into 3 groups: groups 1 and 2 (14 in each group) received 2 different levels of supplementation, whereas group 3 (n = 15) acted as controls; group 2 had the highest protein and calorie content in their supplement.There was a significant increase in birth weight of infants born to women in group 1 (3089 ± 308 g; P < .025) and group 2 (3104 ± 259 g; P < .025) compared to the group 3 controls (2853 ± 247.9 g); the placental weights also were significantly higher in the 2 supplemented groups (630 ± 669 and 616 ± 68 g in groups 1 and 2, respectively; P = .005) that were supplemented compared to the control group (563 ± 509 g).
Girija et al117India; urban hospital setting; RCTPregnant women (n = 20) were recruited for the study: 1 group (n = 10) was supplemented in the last trimester with sesame cakes, jaggery (raw sugar), and oil; women in the control group (n = 10) were not given the supplement.There was no difference in weight gain of women in the supplement compared with the control group; women in the supplemented group, however, had a significantly greater increase in Hb levels.There was no significant difference in birth weight and length at birth of infants born to the 2 groups of women.
Prentice et al112The Gambia; rural setting; QTPregnant women who were, on average, in their 16th wk of gestation were supplemented with peanut-based biscuits and a vitamin-fortified tea drink (n = 652 nonsupplemented women and 577 supplemented women).Infants born to the supplemented mothers were significantly heavier (101 g) than those born to nonsupplemented mothers (P < .05); this beneficial effect of supplementation was seen only in the wet season, not during the dry season; a 67.5% decrease was observed in the proportion of LBW infants in the supplemented group over the year (P < .01); this effect was greater in the wet season, during which there was a decrease of 83.3% in the proportion of LBW infants (P < .01); supplementation also seemed to contribute to increased head circumference in infants.
McDonald et al108Taiwan; rural setting; DBRCTWomen (n = 212) were distributed randomly to groups A (n = 107) and B (n = 105); pregnant women in group A were given high-protein and -calorie liquid supplements, and the supplement was provided to group B was low in calories and had no protein; the trial started after the birth of the “first study infant,” and the women were supplemented until onset of lactation of the “second study infant.”There was no difference in the incidence of fetal deaths among the “first” and “second” study infants of the 2 groups; a mean increase in birth weight of 161.4 g was observed in the second study infants in group A (P < .05); LBW rates decreased to 2.8% for the second infant in group A (statistically insignificant), whereas it remained the same for group B at 6.8%; there was no effect of the supplements on prematurity rates.
Kielmann et al118India; rural setting; RCT3 groups of villages were randomized into nutrition care (NUT), nutrition care plus medical care (NUT + MC), or medical care (MC); a fourth group (emergency care only) served as the control group; nutrition care was comprised of nutrition education, surveillance, and food supplementation (1675 J and 11 g of protein per day, fortified with iron and folate) through special feeding centers; medical care included immunization, health education, early diagnosis, and treatment through frequent surveillance, provided singly and combined as needed; monitoring from birth to age 36 mo was done through longitudinal anthropometry, morbidity, and vital statistics.There was a 41.3% decrease in PMR in the nutrition group compared to the control group; this decrease was higher among the 3 intervention groups (MED, NUT, and MED + NUT groups) compared to controls; the decrease in NMR was highest in the nutrition intervention group (41%) compared to the control group.
Mora et al245*Colombia; urban setting; QTWomen (n = 456) in their third trimester and from a family having at least 50% of children malnourished were given dry milk, bread, and vegetable oil for the whole family.Antenatal weight gain significantly increased (mean increase: 140 g/wk; P = .05) among supplemented women who gave birth to male infants.Birth weight was significantly greater (95 g; P < .05) among male infants born to supplemented compared to nonsupplemented women; there was no significant effect of the supplement on LBW rates.
Mora et al105*Colombia; urban setting; RCT456 pregnant women were recruited for the study; women in the supplemented group (n = 226) were given a total of 230 g of dry skim milk, enriched bread, vegetable oil, and vitamin mineral supplement during the third trimester; controls (n = 230) were not supplemented.There was a 46% decrease in the NMR and a 25% reduction in the PMR. A 75% decrease was detected in the stillbirth rate among the infants of women in the supplemented group (on pooled sample of stillbirths and neonatal deaths, χ2 (1 df) = 4.1; P < .05).
Lechtig et al115Guatemala; rural setting; QTChronically malnourished women of 2 villages (n = 405) received atole (a high-protein/-calorie gruel), whereas women of 2 villages were given fresco (a low-calorie/no-protein cool drink).There was a significant correlation between caloric supplementation during pregnancy and birth weight (P = .01); the rate of LBW births was approximately half in the high-calorie/protein-supplemented mothers compared to the low-calorie/protein-supplemented mothers (P < .05).
Qureshi et al114India; rural setting; RCT3 groups of women (n = 126) were formed and followed from 20 wk gestation to birth; women in group 1 (n = 37) received an iron + folate supplement, and group 2 (n = 39) received a dietary supplement high in protein and calories, as well as the iron + folate supplement; group 3 (n = 50) received none of the above and served as the control group.Women in group 2 gained an average of 1 kg more during pregnancy than those in group 1.Infants born to women in group 1 were 0.27 kg heavier than the infants born to women in the control group; the infants born to women in group 2 were 0.81 kg heavier than those in the control group.
  • * Data are from the same trial.