Effect of prenatal food supplementation on birth weight: an observational study from Bangladesh. Energy supplementation in the last trimester of pregnancy in East Java, Indonesia: effect on maternal anthropometry. Linking maternal and infant benefits of a nutritional supplement during pregnancy and lactation. Formulation and evaluation of supplementary foods for Thai pregnant women. Outcome of maternal nutritional supplementation: a comprehensive review of the Bacon Chow study. Nutritional supplementation and the outcome of pregnancy. I. Birth weight. The Bacon Chow study: maternal nutrition supplementation and birth weight of offspring. Effects of prenatal food and micronutrient supplementation on infant development: a randomized trial from the Maternal and Infant Nutrition Interventions, Matlab (MINIMat) study. The Bacon Chow study: maternal supplementation and infant growth. Prenatal food supplementation fortified with multiple micronutrients increases birth length: a randomized controlled trial in rural Burkina Faso. Effects of prenatal food and micronutrient supplementation on child growth from birth to 54 months of age: a randomized trial in Bangladesh Effects on birth weight and perinatal mortality of maternal dietary supplements in rural gambia: 5 year randomised controlled trial A randomized controlled trial of prenatal nutritional supplementation in New York City. Energy supplementation in the last trimester of pregnancy in East Java: I. Effect on birthweight The bacon Chow study: effects of maternal nutritional supplementation on birth measurements of children, accounting for the size of a previous (unsupplemented) child. Influence of dietary supplementation during pregnancy on lactation performance.
BACKGROUND National nutrition programs in Bangladesh have included prenatal food supplementation to reduce maternal and child malnutrition . The knowledge base is weak regarding the effect of prenatal food supplementation on the birth weight ( BW ) of infants in population s in whom low BW is prevalent and regarding any variation in effect based on maternal nutritional status . OBJECTIVE We examined whether observational data support an effect of daily prenatal food supplementation on BW by considering the duration of supplementation and whether the effect is modified by maternal postpartum weight ( a proxy of prepregnancy weight ) groups . DESIGN A cohort of undernourished pregnant women ( n = 777 ) who received prenatal food supplementation ( 608 kcal/d ) was followed . The association between the uptake of food supplements and BW was analyzed after adjustment for potential confounders ( n = 619 with complete information ) . Differential effects in lower and higher maternal postpartum weight groups were examined . RESULTS The average BW was 2521 g. On average , the women received daily supplements for 4 mo , which result ed in an increase in BW of 118 g ( 1.0 g/d ) . The strongest effect was found for births occurring in January and February . There was a linear dose-response relation between duration of supplementation and BW for women with higher postpartum weights ( > or = 42 kg , above the median ) . In women with lower weights ( < 42 kg , below median ) , a shorter duration of supplementation ( < 4 mo ) had no such dose-response relation with BW , but there was a linear dose-response relation for longer duration s of supplementation . CONCLUSIONS The association between duration of prenatal food supplementation and BW varies with maternal postpartum weight . A large effect was observed after the season with food insecurity ( mid-August to mid-November ) The effect of prenatal energy supplementation on  maternal anthropometry was assessed in a controlled , r and omized trial in Madura , East Java . At 26 - 28 wk of gestation women were either given 465 kcal/d ( HE group ) or 52 kcal/d ( LE group ) . Two hundred seventy-six women were enrolled in the HE group and 266 women , in the LE group .  Supplement intake was variable . Testing of effect by treatment and compliance was thus done by subcategories ( HE 1 - 3 and LE 1 - 3 , corresponding to less than 45 , 45 - 89 , and greater than or equal to 90 packets of supplement consumed ) . Analysis of variance did not show significant differences among the six subcategories in third-trimester weight gain , sum of skinfold thicknesses , 4-wk postpartum weight , or body mass index . In this population energy supplementation for the short duration of the last 90 - 110 d of pregnancy was not sufficient to improve maternal nutrition as judged by anthropometry To evaluate the effect of a nutritional supplement on change in  women 's weight during a reproductive cycle and on the difference in birth weight between one infant and the previous one , we analyzed data on 176 complete reproductive cycles from an experiment that was conducted in rural Guatemala . Women with an initial weight < 50 kg were classified as marginally nourished or malnourished . Women whose intake of the supplement was in the top 2 tertiles were distinguished from those whose intake was in the lowest tertile . Linear regression modeling was used to estimate the effect of supplementation on these outcomes and to control for confounding factors . Malnourished women gained weight during the reproductive cycle , but their second ( study ) infant tended to weigh less at birth than their prior-born infant . Higher intakes of supplement were associated with a less negative difference in birth weight . Marginally nourished women lost weight during the reproductive cycle and their second ( study ) infant tended to weigh more at birth than their prior-born infant . Higher intakes of supplement were associated with a less negative weight [ corrected ] trend for the women themselves . Well-nourished women and their infants did not show any of these benefits from supplementation . These findings help explain past contradictory findings on maternal depletion as well as on the benefits of nutritional supplementation for mothers and their infants To improve maternal nutritional status and to ameliorate protein-energy malnutrition in pregnant women and infants , supplementary foods for rural pregnant women were formulated and evaluated . Six formulas with protein and energy contents of 16 - 22 g and 350 - 500 kcal/100 g food , respectively , were developed from locally available raw material s. A field evaluation of formulas I and V was conducted at the regional MCH Center at Rajchaburi , about 120 km from Bangkok .  Formulas providing 13 g protein and 350 kcal per day were given to two groups of mothers in the first or second pregnancy , starting at 28 + /- 2 wk of gestation . A third group , unsupplemented , served as controls .  Maternal weight gain and left mid-arm circumference were measured every 2 wk . Birth weight , length , head and chest circumferences of newborns , and placental weight were significantly higher in both supplemented groups . These findings suggest that among undernourished mothers , supplementation of as little as 13 g protein and 350 kcal daily during the last trimester can significantly improve maternal weight gain and birth weight of newborns In a double blind controlled intervention , two groups of nutritionally at-risk rural Taiwanese women were given a nutrient-rich dietary supplement ( group A , n = 114 ) or a placebo ( group B , n = 111 ) beginning after the birth of one child and continuing through the lactation period for a subsequent child . Outcome variables assessed include infant birth measurements postnatal physical growth , motor , mental , and dental development , morbidity , and maternal weight and skinfold changes during pregnancy and lactation . While few A-B differences in mean values of outcome variables were found , there were significant responses in subgroups of the sample . Comparisons of infants born after a nutrient-supplemented pregnancy ( A2 ) versus an unsupplemented pregnancy ( A1 ) showed that A2 male infants weighed more than A1 males at birth , and A1-A2 sibling correlations in birth measurements , especially Rohrer 's index ( wt/l3 ) were significantly reduced . Important mediators of supplement effects included sex of the offspring , season of birth , maternal body size , and birth of a previous infant characterized by dysmorphic prenatal growth . The limited effects of supplementation on the population as a whole may reflect the operation of long term adaptations which allow women to maintain reproductive success despite their apparent marginal nutritional status Colombian women at risk of malnutrition were enrolled in a health care program and r and omly assigned to supplementation and control groups at the beginning of the third trimester of pregnancy . The net dietary intake increments result ing from supplementation amounted to 155 cal and 20 g of protein per day . Supplementation had a significant effect on the mean birth weight of male infants , but not that of female infants ; the mechanisms responsible for the sex differences remain to be eluci date d. The r and omized trial design of the experiment and the documented similarity between the experimental and control groups at the onset permit the conclusion that the observed differences were caused by the food supplementation program . The effect of  supplementation  on maternal weight gain and the association of the latter with birth weight strongly suggest that improved maternal nutrition mediated the effect on birth weight This study is a r and omized controlled double-blind trial on the effects of nutrition supplement of pregnant and lactating women on their offspring . The study was conducted by the late Dr. Bacon Chow in 14 villages in Sui-Lin township , a farming area about 180 miles from Taipei , Taiwan . Two hundred ninety-four women were r and omly assigned to one of two treatment groups . The daily supplement for one group provided 800 kcal and 40 g of protein/day ; for the other group it only provided 80 kcal/day . Supplementation began after 3 wk of the delivery of a first study infant , continued throughout lactation , and through the pregnancy and lactation of a second study infant . Between group comparisons on the birth weight , number of low birth weight infants , or incidence of fetal deaths showed no statistically significant findings . However , the birth weight of the second study infant was statistically different and higher than that of the first study infant in the high supplement group . Moreover , in the low supplement group there was a correlation of 0.22 ( p = 0.06 ) between the change scores for birth weight from the first to the second study infant and the quantity of supplements consumed during the last trimester of pregnancy . There was also in this same group a significant slope in a linear regression of birth weight on total daily caloric intake during the 3rd trimester of pregnancy for the male second study infants . These findings are partly in agreement with findings from three other large supplementation studies in Colombia , Guatemala , and New York . In this study the findings indicate that caloric supplementation does result in a small yet statistically meaningful increment in birth weight within a population which is not nutritionally at risk BACKGROUND Few data exist for the effects of multiple micronutrient ( MM ) or food supplementation to undernourished pregnant women on their offsprings ' development . OBJECTIVE We aim ed to compare the effects on infant development of early ( 8 - 10 wk gestation ) or usual ( approximately 17 wk gestation ) supplementation with food and MM , 30 mg Fe + 400 microg folate , or 60 mg Fe + 400 microg folate . DESIGN A large , r and omized , controlled trial of pregnancy supplementation was conducted in Bangladesh . A sub sample of infants ( n = 2853 ) were assessed on 2 problem-solving tests ( support and cover tests ) , the motor index of the Bayley Scales of Infant Development , and Wolke 's behavior ratings at 7 mo of age . RESULTS There were no significant effects of any intervention in the group as a whole . However , infants of undernourished mothers [ body mass index ( BMI ; in kg/m2 ) < 18.5 ] who received early food supplementation performed slightly but significantly ( P = 0.035 ) better on the support test than did infants of mothers who received usual food supplementation ( z score : 0.17 ; 95 % CI : 0.01 , 0.33 ) . There were no benefits in infants of higher- BMI mothers ( P = 0.024 for BMI x food interaction ) . Children of low- BMI mothers who received MMs had slightly better motor scores ( z score : 0.28 ; 95 % CI : 0.08 , 0.48 ) and activity ratings ( z score : 0.24 ; 95 % CI : 0.037 , 0.45 ) than did those who received 30 mg Fe + 400 microg folate , whereas other children did not benefit ( P = 0.05 for both motor scores and BMI x micronutrients and for activity and BMI x micronutrients ) . CONCLUSIONS Small benefits from early food and MM supplementation were found in infants of low- BMI but not of high- BMI mothers . However , the benefits were of doubtful functional importance , and longer follow-up is required to determine programmatic implication The effect of  maternal supplementation during both gestation and lactation on infant growth from birth to 12 mth was investigated in the double-blind , r and omly allocated control trial conducted in Taiwan by the late Bacon F. Chow . The supplement was a milk-based formula providing 800 kcal and 40 g protein daily . The placebo provided less than 40 kcal per diem but resembled the supplement in appearance . Supplementation was limited to mothers and began after birth of one infant and continued without interruption until weaning of a second infant . Supplement effects were tested by comparing both supplement and placebo groups and first- and second-infant groups with respect to weight , length and head circumference . Both comparisons of growth curves and analyses of variance were carried out . Both strategies agreed in failing to detect differences in growth between supplement and placebo groups . However , differences were found between first and second infants in the supplement group BACKGROUND Prenatal multiple micronutrient ( MMN ) or balanced energy and protein supplementation has a limited effect on birth size of the offspring . OBJECTIVE The objective was to determine whether a prenatal MMN-fortified food supplement ( FFS ) improves anthropometric measures at birth compared with supplementation with an MMN pill alone . DESIGN We conducted a nonblinded , individually r and omized controlled trial in 1296 pregnant women in 2 villages in rural Burkina Faso . Supplements were provided on a daily basis , and compliance was closely verified by using a community-based network of home visitors . RESULTS Anthropometric measures at birth were available for analysis for 87 % of the 1175 live singleton deliveries enrolled . After adjustment for gestational age at birth , the FFS group had a significantly higher birth length ( + 4.6 mm ; P = 0.001 ) . FFS supplementation result ed in a modestly higher birth weight ( + 31 g ; P = 0.197 ) . Subgroup analyses showed clinical ly important treatment effects on birth length ( + 12.0 mm ; P = 0.005 ) and on birth weight ( + 111 g ; P = 0.133 ) for underweight [ body mass index ( in kg/m(2 ) ) < 18.5 ] pregnant women . Women with early pregnancy anemia who received FFS gave birth to longer newborns ( + 7.3 mm ; P = 0.002 ) than did those who received MMN supplementation . CONCLUSIONS The provision of FFS to pregnant women result ed in higher birth length than did MMN supplementation . For women with a suboptimal prepregnancy nutritional status , MMN supplementation should be complemented with a balanced energy and protein supplement to produce a clinical effect on birth size . The trial was registered at clinical trials.gov as NCT00909974 Background There is a lack of information on the optimal timing of food supplementation to malnourished pregnant women and possible combined effects of food and multiple micronutrient supplementations ( MMS ) on their offspring 's growth . We evaluated the effects of prenatal food and micronutrient interventions on postnatal child growth . The hypothesis was that prenatal MMS and early invitation to food supplementation would increase physical growth in the offspring during 0 - 54 months and a combination of these interventions would further improve these outcomes . Methods In the large , r and omized MINIMat trial ( Maternal and Infant Nutrition Interventions in Matlab ) , Bangladesh , 4436 pregnant women were enrolled between November 2001 and October 2003 and their children were followed until March 2009 . Participants were r and omized into six groups comprising 30 mg Fe and 400 μg folic acid ( Fe30F ) , 60 mg Fe and 400 μg folic acid ( Fe60F ) or MMS combined with either an early ( immediately after identification of pregnancy ) or a later usual ( at the time of their choosing , i.e. , usual care in this community ) program invitation to food supplementation .  The anthropometry of 3267 children was followed from birth to 54 months , and 2735 children were available for analysis at 54 months . Results There were no differences in characteristics of mothers and households among the different intervention groups . The average birth weight was 2694 g and birth length was 47.7 cm , with no difference among intervention groups . Early invitation to food supplementation ( in comparison with usual invitation ) reduced the proportion of stunting from early infancy up to 54 months for boys ( p = 0.01 ) , but not for girls ( p = 0.31 ) . MMS result ed in more stunting than st and ard Fe60F ( p = 0.02 ) . There was no interaction between the food and micronutrient supplementation on the growth outcome . Conclusions Early food supplementation in pregnancy reduced the occurrence of stunting during 0 - 54 months in boys , but not in girls , and prenatal MMS  increased the proportion of stunting in boys . These effects on postnatal growth suggest programming effects in early fetal life . Trial registration numberIS RCT N : IS RCT Abstract Objective : To test the efficacy in terms of birth weight and infant survival of a diet supplement programme in pregnant African women through a primary healthcare system . Design : 5 year controlled trial of all pregnant women in 28 villages r and omised to daily  supplementation with high energy groundnut biscuits ( 4.3MJ/day ) for about 20 weeks before delivery ( intervention ) or after delivery ( control ) . Setting : Rural Gambia . Subjects : Chronically undernourished women ( twin bearers excluded ) , yielding 2047 singleton live births and 35 stillbirths . Main outcome measures : Birth weight ; prevalence of low birth weight ( < 2500 g ) ; head circumference ; birth length ; gestational age ; prevalence of stillbirths ; neonatal and postneonatal mortality . Results : Supplementation increased weight gain in pregnancy and significantly increased birth weight , particularly during the nutritionally debilitating hungry season ( June to October ) . Weight gain increased by 201 g ( P<0.001 ) in the hungry season , by 94 g ( P<0.01 ) in the harvest season ( November to May ) , and by 136 g ( P<0.001 ) over the whole year . The odds ratio for low birthweight babies in supplemented women was 0.61 ( 95 % confidence interval 0.47 to 0.79 , P<0.001 ) . Head circumference was significantly increased ( P<0.01 ) , but by only 3.1 mm . Birth length and duration of gestation were not affected . Supplementation significantly reduced perinatal mortality : the odds ratio was 0.47 ( 0.23 to 0.99 , P<0.05 ) for stillbirths and 0.54 ( 0.35 to 0.85 , P<0.01 ) for all deaths in first week of life . Mortality after 7 days was unaffected . Conclusion : Prenatal dietary supplementation reduced retardation in intrauterine growth when effectively targeted at genuinely at-risk mothers . This was associated with a substantial reduction in the prevalence of stillbirths and in early neonatal mortality . The intervention can be successfully delivered through a primary healthcare system . Key messages In developing countries chronic maternal undernutrition is a prime contributor to the birth of over 25 million low birthweight babies annually and to high rates of neonatal mortality . An absence of well design ed field trials has created uncertainty about the potential efficacy of maternal feeding programmes This large scale r and omised controlled trial shows that dietary supplementation in pregnancy can be highly effective in reducing the proportion of low birthweight babies and perinatal mortality Incorporating supplementary feeding into a rural primary healthcare system is feasible Late pregnancy is the period most amenable to This r and omized controlled trial of nutritional supplementation in pregnancy , in a poor black urban population in the United States , aim ed to increase the birth weight and influence the postnatal development of the offspring of mothers at high risk of having low birth weight infants . The execution of the research design and adherence to the treatment regimen among the experimental population appeared adequate for a reasonable test of the treatments . At birth , the only significant favorable effect of supplementation observed was the prevention of depressed birth weight among the offspring of mothers who smoked heavily . With balanced protein-calorie supplementation , length of gestation was increased , the proportion of low-birth-weight infants reduced , and mean birth weight raised by 41 gm ( not statistically significant ) . With high protein supplementation , there was an excess of very early premature births and associated neonatal deaths , and there was significant growth retardation up to 37 weeks of gestation . At 1 year of age , significant effects of high protein supplement were found on three psychological measures : visual habituation , visual dishabituation , and mean length of free play episodes . These measures were unrelated to measures of growth at birth and at 1 year of age . There were no detectable residual adverse effects of high protein supplementation at 1 year of age Summary . The effect of two levels of energy supplementation in the last trimester of pregnancy on birthweight  was tested in a controlled r and omized trial in three villages in Madura , East Java .  The high and low energy supplements provided 1·95 MJ ( 465 kcal ) and 218 kj ( 52 kcal ) per day respectively . In the baseline period the home diet provided on average 6·28 MJ ( 1500 kcal ) ( SD 2·1 MJ ( 499 kcal ) ) and 41g(SD 13 g ) of protein . The mean birthweight  was 2835 g and the rate of low birth‐weight 12·2 % . In the experimental period the home diet was better . The average intake ranged from 6·45 to 7·19 MJ ( 1541–1717 kcal ) and 41·4–44·2 g per day , depending on the degree of compliance . Mean birth‐weight increased by 100 g and the rate of low birthweight dropped to 9·5 % . There was no difference between the high and low energy supplemented group as a whole , probably due to the masking effect of the better home diet in the experimental period . It is likely that a positive effect of energy supplementation on birthweight was restricted to the group of pregnant women with the lowest home dietary intake and /or a low prepregnant weight . In this community targeting of supplementation to lean seasons and /or to women with a low prepregnant weight may be cost‐effective Studies on nutritional supplementation  of pregnant mothers have observed small but sometimes significant effects on fetal growth . Previously we also reported significant changes in physical resemblance of siblings at birth due to this kind of supplementation , using data collected by the late Dr. Bacon Chow and associates . This suggested that components of variation in physical growth may change as a result of supplementation . To explore this further , we sought the effects of nutritional supplementation on somatic growth , holding constant the birth measurements of a previous ( unsupplemented ) sibling . Only head circumference at birth came close to showing a statistically significant ( P less than 0.06 ) supplement effect on its mean ( + 0.36 cm ) when the measurement of the first infant was held constant . Both increases and decreases in weight for length as assessed by Rohrer 's Index ( wt/l3 ) occurred with supplementation . Increases in the index occurred by a significant ( P less than 0.01 ) gain in birth weight ( 238 g ) between 1st and 2nd siblings in the supplement group but not in the placebo group . Decreases in this index result ed from a significant gain in birth length ( 1.3 cm ) in supplemented families with a previous ( untreated ) sibling having a below average length for average weight . These non-linear effects on somatic growth suggest that responses to maternal nutritional supplementation may be more effective in a subgroup of the population where the normal adaptive responses to low energy protein intakes may have failed or where nutritional conditions over pregnancy may have varied considerably This study assesses the effect of supplementation of energy and protein to meet the nutrient requirements of pregnant women in India on the basis of lactation performance and the nutritional status of the infant . 20 pregnant women between the ages of 20 - 23 belonging to a low socioeconomic group who were in their last trimester of pregnancy were selected . Out of 20 10 women were supplemented while the other 10 served as controls . The results reveal that the mean milk yield of supplemented women did not increase significantly ( P<0.05 ) when compared to that of control women during the 1st month of lactation suggesting that lactation potential may be the same in all women in the 1st month irrespective of inadequacies in food intake during the last trimester of pregnancy . The milk yield was significantly higher ( 307 g ) in supplemented women than that of controls in the 3rd month of lactation . Although no difference in weight gain was observed due to supplementation in pregnancy additional food intake supported lactation for a longer period . The birth weight and length of infants born to women who received the supplement were higher by 264 g and 1.81 cm respectively suggesting the effect of supplementary food . Supplementation also brought about a significant increase ( P<0.05 ) in hemoglobin levels which may be attributed to the contribution of iron and protein contained in the supplement . A comparison of length weight and arm circumference of infants in the present study during the 1st 3 months of infancy with those of Harvard st and ards revealed that the increments in these measurements were equal to those of the st and ards though the actual values were 90 - 95 % of Harvard st and ards in the case of the supplemented group and 80 - 85 % in the control group . From the investigation it can be concluded that dietary supplementation during the last trimester of pregnancy has beneficial effects on maternal hemoglobin levels and on morbidity lactation performance birth weight and the physical development of the infant
Abstract The beneficial effect of balanced protein energy supplementation during pregnancy on subsequent child growth is unclear and may depend upon the mother entering pregnancy adequately nourished or undernourished .
Systematic review s to‐ date have included studies from high‐ , middle‐ and low‐income countries .
However , the effect of balanced protein energy supplementation should not be generalised .
This review assesses the effect of balanced protein energy supplementation in undernourished pregnant women from low‐ and middle‐income countries on child growth .