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Nutrition During Early Life: Findings From Conception and Early Life (Poster Theater Flash Session 6)

(PTFS06-02-25) The Effect of Balanced Energy-Protein Supplementation Provided to Pregnant Women on Infant Birth Weight: An Individual Participant Data Meta-Analysis

Sunday, June 1, 2025
2:04 PM - 2:08 PM ET
Location: South Hall B (The Hub) - Poster Theater / Poster Board Number PT-2
Objectives: The WHO recommends balanced energy-protein (BEP) supplementation during pregnancy in settings with >20% prevalence of underweight (BMI < 18.5 kg/m2) to reduce stillbirth and small for gestational age newborns. The Maternal BEP Studies Harmonization Initiative aimed to assess the effect of antenatal BEP on birth weight, to provide updated evidence from new trials.

Methods: This individual participant data (IPD) meta-analysis included 5 randomized controlled trials in Burkina Faso (MISAME-III, n=1689), Ethiopia (ENAT, n=662), India (WINGS, n=1318), Nepal (MINT, n=706), and Pakistan (Mumta, n=502). At enrollment, pregnant persons were randomized (except ENAT randomized health centers) to receive BEP or routine care that included iron and folic acid; supplementation continued until delivery. The maternal BEP intervention consisted of prepared meals and snacks and a multiple micronutrient supplement in WINGS and a micronutrient fortified food product in MISAME-III, ENAT, MINT, and Mumta. Energy provided ranged from ~400-800 kcal; protein was 15-28 g. ENAT, WINGS, and Mumta provided additional health interventions with BEP. We combined all interventions that included BEP to assess a “BEP package” effect. We calculated birth weight-for-gestational age z-scores (BWZ) with INTERGROWTH-21st standards. The effect of BEP package vs routine care on BWZ was tested with mixed effects linear regression; we also tested the effect of BEP alone without co-interventions (n=2623). Multivariable analyses included baseline characteristics (maternal age, weight, and height and infant sex). We tested effect modification by infant sex.

Results: The mean (SD) birth weight and BWZ, respectively, was 2.90 (0.49) kg and -0.86 (1.03) z score in the control group and 2.94 (0.45) kg and -0.72 (1.06) z score in the BEP package group. In multivariable analysis, the BEP package resulted in a 0.087 (95% CI 0.029, 0.143) higher BWZ compared to control; the effect of BEP alone was close to 0 (0.045 (95% CI -0.031, 0.120) BWZ). There was no interaction by sex.

Conclusions: These preliminary IPD meta-analysis results indicate that an antenatal package including micronutrient fortified BEP supplementation increased the BWZ of infants in low-and middle-income countries compared to routine care; however BEP alone did not meaningfully change BWZ.

Funding Sources: Bill & Melinda Gates Foundation