Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data

Abstract

Background Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). Objectives To investigate the effects of multiple micronutrient supplements (MMS) and small-quantity lipid-based nutrient supplements (LNS) on GWG in LMICs. Methods A two-stage meta-analysis of individual participant data was conducted to examine the effects of MMS (45,507 women from 14 trials) and small-quantity LNS (6,237 women from 4 trials) on GWG compared to iron and folic acid supplements only. Percent adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (% adequacy < 70%), inadequate (< 90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I2, stratified analysis, and meta-regression. Results MMS resulted in a greater % adequacy of GWG (weighted mean difference (WMD): 0.86%; 95% CI: 0.28%,1.44%; P < 0.01) and higher GWG at delivery (WMD: 209 g; 95% CI: 139, 280; P < 0.01) than among those in the control arm. Women who received MMS had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P < 0.01). No association was found between small-quantity LNS and GWG % adequacy (WMD: 1.51%; 95% CI: -0.38%, 3.40%; P = 0.21). Neither MMS nor small-quantity LNS was associated with excessive GWG. Conclusions Maternal MMS was associated with a greater GWG % adequacy and total GWG at delivery compared to iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendation of switching routine prenatal iron and folic acid supplements to MMS.

Associations between gestational weight gain under different guidelines and adverse birth outcomes: A secondary analysis of a randomized controlled trial in rural western China

“…First, the mother-infant pairs in our cohort study derived from the prenatal cluster-randomized controlled trial, in which pregnant women received micronutrient supplementation (folic acid, IFA, and MMN), and consequently the generalization of the results might be limited. Recently, a meta-analysis of IPD among LMICs showed that maternal MMN supplementation was associated with greater GWG percentage adequacy of GWG (defined by IOM according to total GWG) than was iron and folic acid only [ 37 ]. Therefore, the intervention in our study might reduce the percentage of inappropriate GWG.…”

Targeting strategies of antenatal balanced energy and protein supplementation in Addis Ababa, Ethiopia: study protocol for a randomized effectiveness study

“…We used individual characteristics, including current gestational weight, current gestational age, and height, as potential predictors. We developed the equation using the GWG Pooling Project data, which combined data from 55 studies and approximately 150,000 pregnant women in LMICs [ 28 , 29 ]. The GWG Pooling Project has accumulated a wealth of data on longitudinal gestational weights, including pre-pregnancy weights from some studies and early-pregnancy weights from many studies [ 28 , 29 ].…”

“…We developed the equation using the GWG Pooling Project data, which combined data from 55 studies and approximately 150,000 pregnant women in LMICs [ 28 , 29 ]. The GWG Pooling Project has accumulated a wealth of data on longitudinal gestational weights, including pre-pregnancy weights from some studies and early-pregnancy weights from many studies [ 28 , 29 ]. We conducted external validation of the tool using internal data from Ethiopia [ 30 ].…”

“…GWG adequacy ratio accounts for the gestational age at each weight measurement and takes advantage of the well-established IOM recommendations. To account for the allowable range specified in the IOM standards and in accordance with previous studies [ 28 , 29 , 31 – 33 ], we will define inadequate GWG at each visit as a percent adequacy ratio less than 90%, adequate GWG as a percent adequacy ratio between 90 and 125%, and excessive GWG as a percent adequacy ratio greater than 125%.…”

Dietary supplements, guideline alignment and biochemical nutrient status in pregnancy: Findings from the Queensland Family Cohort pilot study

“…weight gain, birth weight and may reduce preterm births (Keats et al, 2019;Liu et al, 2022), there is no evidence for childhood health benefits (Devakumar et al, 2016) and the potential benefits and/or harms for people in high-income countries remains inconclusive (Petry et al, 2020;Raghavan et al, 2018;Wolf et al, 2017). This aims of this study were as follows: (1) to describe the types of supplements taken in pregnancy by maternal characteristics; (2) identify whether supplement use and/or type affect alignment with nutrient target recommendations and plasma concentrations of folate, zinc, calcium, iodine and iron, and urine iodine levels; and (3) assess whether mean daily dose of supplemental nutrients could be predicted by certain maternal characteristics.…”