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 reviews 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. A systematic review of articles published in English (1970–2015) was conducted via MEDLINE, Scopus, the Cochrane Register and hand searching. Only peer‐reviewed experimental studies analysing the effects of balanced protein energy supplementation in undernourished pregnant women from low‐ and middle‐income countries with measures of physical growth as the primary outcome were included. Two reviewers independently assessed full‐text articles against inclusion criteria. Validity of eligible studies was ascertained using the Quality Assessment Tool for Quantitative Studies (EPHPP QAT). In total, seven studies met the inclusion criteria. All studies reported on birthweight, five on birth length, three on birth head circumference, and one on longer‐term growth. Standardised mean differences were calculated using a random‐effects meta‐analysis. Balanced protein energy supplementation significantly improved birthweight (seven randomised controlled trials, n = 2367; d = 0.20, 95% confidence interval, 0.03–0.38, P = 0.02). No significant benefit was observed on birth length or birth head circumference. Impact of intervention could not be determined for longer‐term physical growth due to limited evidence. Additional research is required in low‐ and middle‐income countries to identify impacts on longer‐term infant growth.
Highlights
RationaleThe nutritional status of a woman during pregnancy influences the physical growth of the child
This review identifies the effect of balanced protein energy supplementation during pregnancy on child physical growth in low- and middle-income countries and will identify the significance of targeting specific interventions to different economic contexts
The pooled results from these studies indicate that supplementation had a significant moderate effect on birthweight [randomised control trials (RCTs) = 7, intervention: n = 1228; control: n = 1139; d = 0.20, 95% confidence interval (CI): 0.03– 0.38, P = 0.02]
Summary
RationaleThe nutritional status of a woman during pregnancy influences the physical growth of the child. Little is known about the impact of balanced protein energy supplementation provided throughout pregnancy on birthweight and on the longer-term growth of the child, especially for undernourished women in low- and middle-income countries.A recent Cochrane review (Ota et al 2012) identified that balanced protein energy supplementation during pregnancy significantly improves birthweight and birth length. A similar review (Imdad & Bhutta 2011) argued that the effect is more pronounced in underweight women with no significant effect in adequately nourished women Both systematic reviews combined studies from low, middle and higher income countries (Imdad & Bhutta 2011; Ota et al 2012)
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