Fortified balanced energy protein supplementation for pregnant women in Burkina Faso
This is a summary of the following paper: Hanley-Cook G, Toe LC, Tesfamariam K et al (2022) Fortified balanced energy-protein supplementation, maternal anemia, and gestational weight gain: A randomized controlled efficacy trial among pregnant women in rural Burkina Faso. The Journal of Nutrition, 152, 10, 2277-2286. https://doi.org/10.1093/jn/nxac171
Anaemia and suboptimal gestational weight gain (GWG) are associated with adverse maternal and birth outcomes. Maternal GWG is a cumulative measure reflecting the altering physiology of the mother, specifically the changes in maternal and foetal weights across pregnancy.
This randomised controlled trial, which took place in rural Burkina Faso, enrolled pregnant women aged 15–40 at <21 weeks of gestation. The study assessed the efficacy of a micronutrient-fortified balanced energy protein (BEP) supplement on the outcomes of anaemia, GWG, and GWG rate in relation to the Institute of Medicine (IOM)’s recommendations (categorised into severely inadequate, inadequate and excessive GWG), compared against iron–folic acid supplementation.
Women in the intervention group received a daily fortified BEP supplement and an iron–folic acid tablet, whereas women in the control group only received the iron–folic acid tablet. The BEP supplement was a daily 72 g lipid-based nutrient supplement in the form of an energy-dense peanut paste fortified with multiple micronutrients. The BEP supplement provided 393 kcal/d and 22 mg/d of iron. All women received malaria prophylaxis at the relevant antenatal care visits. Haemoglobin (g/dL) concentrations were measured at baseline and at the third antenatal care visit, whereas maternal weight was measured at baseline and at all subsequent ∼7-weekly antenatal care visits. Statistical analyses followed the intention-to-treat principle.
A total of 2,016 women were assessed for eligibility, of whom 1,897 were randomly assigned (960 control, 937 intervention) and 119 were excluded for not meeting the trial’s inclusion criteria. Approximately 3% of both control and intervention arms were lost to follow-up at the third antenatal care visit. A further 22 control (2.42%) and 27 intervention arm mothers (3.07%) were lost to follow-up before delivery.
The results show that a combined daily BEP and iron–folic acid tablet had no effect on maternal Hb concentration, anaemia or prevalence of severe anaemia. In the combined BEP and iron–folic acid arm, maternal GWG was 6.27 kg, and the GWG rate was 0.274 kg/week, but both indicators showed no significant difference in comparison with the control arm. There were also no significant differences between study arms in terms of GWG adequacy, inadequate GWG, severely inadequate GWG or excess GWG prevalence. The main (null) findings were further confirmed by subsequent models that adjusted for various factors at baseline, as well as by the per-protocol analysis. Nonetheless, the full case analysis showed small but significant differences in absolute GWG and GWG adequacy.
In conclusion, the study showed that fortified BEP supplementation did not reduce maternal anaemia, nor did it increase GWG, in comparison with iron–folic acid. The authors suggest that future randomised interventions might assess whether preconception environments conducive to adequate GWG allow the mother to be more nutritionally replete, therefore channelling the additional nutrients from supplementation to support improved foetal growth and development.
More like this
FEX: Micronutrient powders v iron-folic acid tablets in controlling anaemia in pregnancy
Summary of research1 The major cause of anaemia in pregnancy is iron deficiency, which is preventable. It is estimated that 56% of pregnant women in developing countries...
FEX: Ensuring pregnancy weight gain: An integrated community-based approach to tackle maternal nutrition in India
View this article as a pdf Lisez cet article en français ici By Sreeparna Ghosh Mukherjee, Pia Sen and Dr Nagma Nigar Shah Sreeparna Ghosh Mukherjee is Senior...
FEX: Nutritious supplemental foods for pregnant women from food-insecure settings
This is a summary of the following paper: Mihaela A, Ciulei AM, Nandita P et al (2023) Nutritious supplemental foods for pregnant women from food insecure settings: Types,...
FEX: Improving maternal nutrition in South Asia: Implications for child wasting prevention efforts
View this article as a pdf Lisez cet article en français ici By Zivai Murira and Harriet Torlesse Zivai Murira is Nutrition Specialist at United Nations Children's...
FEX: Using flow charts and health systems strengthening to improve antenatal nutrition services in India
Vani Sethi is a Nutrition Specialist at UNICEF Regional Office of South Asia. Archana Mishra is a Deputy Director at the Maternal Health Division, Government of Madhya...
Resource: Women's nutrition: A summary of evidence, policy and practice including adolescent and maternal life stages
Please scroll down for links to download the Executive Summary (also available in French) and full report Lisez cet document d'information technique en français ici...
FEX: Prevention of child wasting in Asia: Possible role for multiple micronutrient supplementation in pregnancy
View this article as a pdf Lisez cet article en français ici By Kristen M. Hurley, Endang L Achadi, Clayton Ajello, Sufia Askari, Madhavika Bajoria, Kalpana...
FEX: Current evidence on anaemia and micronutrient supplementation strategies in school-age children and adolescents
View this article as a pdf Lisez cet article en français ici By Elena Hemler, Wafaie Fawzi and Stephanie Wrottesley Elena Hemler is senior project coordinator for the...
FEX: Analysis of gestational weight gain using nationally representative data
View this article as a pdf Research snapshot1 Adequate gestational weight gain (GWG) is an important measure of maternal health during pregnancy; inadequate GWG is associated...
FEX: Preconception and periconception interventions to prevent adverse birth outcomes
View this article as a pdf This is a summary of the following paper: Partap U, Chowdhury R, Taneja S et al (2022) Preconception and periconception interventions to prevent low...
FEX: Improving maternal nutrition in South Asia: Implications for child wasting prevention efforts
This is a summary of a Field Exchange 'views' article that was included in issue 63 - a special edition on child wasting in South Asia. The original article was authored by...
Nepal’s success story: What helped to improve maternal anaemia?
View this article as a pdf Dr Ram Padarath Bichha is Director of the Family Welfare Division, Department of Health Services, Ministry of Health and Population, Nepal. Kedar...
Collective Statement of Support for multiple micronutrient supplements (MMS)
We've joined global experts & practitioners calling for urgent scale-up of MMS ensuring mothers receive more effective prenatal care & in turn babies have the best chance...
Harnessing the potential of India’s medical colleges to bring maternal nutrition services to scale
View this article as a pdf Dr Sebanti Ghosh is Programme Director with Alive & Thrive (A&T), India. Dr Kaushal Kishore is a member of the Indian Administrative Service (IAS)...
FEX: Results and lessons learned from WFP’s efforts to support adolescent girls in Niger
By Alexandra Pirola, Benedict Tabiojong Mbeng and Mica Jenkins View this article as a pdf Lisez cet article en français ici Benedict Tabiojong Mbeng is Head of...
FEX: Multiple micronutrient supplementation to improve the quality of nutrition care and prevent low birthweight
View this article as a pdf This is a summary of the following report: UNICEF (2022) Multiple Micronutrient Supplementation: An approach to improving the quality of nutrition...
FEX: Food for thought: Supplementary feeding programme or ‘antenatal feeding programme’ for pregnant women
By Michael H Golden Michael Golden is Emeritus Professor at the University of Aberdeen, Scotland. An independent physician and researcher, he has over 40 years of experience...
FEX: Multi–micronutrient supplements for pregnant women from developing countries
Summary of a workshop report* UNICEF/WHO and the United Nations Universities (UNU) recently convened a meeting to decide upon the composition of a multi-micronutrient...
Creating an enabling environment for delivering maternal nutrition interventions in Bhutan
Creating an enabling environment for delivering maternal nutrition interventions in Bhutan View this article as a pdf Laigden Dzed is a Senior Programme Officer in the...
FEX: Intensified antenatal care nutrition interventions in Burkina Faso
View this article as a pdf Lisez cet article en français ici This is a summary of the following paper: Kim S, Zagré R, Ouédraogo C et al (2023)...
Reference this page
Fortified balanced energy protein supplementation for pregnant women in Burkina Faso. Field Exchange 69, May 2023. p31. www.ennonline.net/fex/69/fortified-balanced-energy-protein-supplementation-for-pregnant-women-in-burkina-faso
(ENN_7615)