The effect of balanced protein energy supplementation in undernourished pregnant women and child physical growth in low‐ and middle‐income countries: a systematic review and meta‐analysis

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 (1970English ( -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 lowand 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.

Severe malnutrition in infants aged <6 months—Outcomes and risk factors in Bangladesh: A prospective cohort study

“…For instance, our observed association between SAM infants and maternal anthropometric deficit on univariate analysis is consistent with other evidence that maternal nutritional status has both short‐ and long‐term associations with infant health (Liu et al, ; Wrottesley, Lamper, & Pisa, ). That supplementing undernourished mothers might have also benefits for their infants is biologically plausible but needs more evidence (Stevens et al, ).…”

Identification of High-Risk Pregnancies in a Remote Setting Using Ambulatory Blood Pressure: The MINDI Cohort

“…Several studies have examined the consequences of maternal dietary protein intake on pregnancy outcomes, particularly SGA. Although a Cochrane review concluded that there is no justification for prescribing high-protein nutritional supplements to pregnant women (67), a more recent meta-analysis of studies from low-medium income countries found that balanced protein-energy supplementation of undernourished women significantly improved birthweight (68). Although the link between maternal protein malnutrition and hypertension in the offspring has been established (69), one study with Dutch women showed that protein intake-related acid load was not associated with HDPs, in protein-replete women (70).…”

The Intergenerational Effects of Intimate Partner Violence in Pregnancy: Mediating Pathways and Implications for Prevention

“…Similarly, balanced protein energy supplementation programmes have shown promising effects on birth outcomes (e.g. Stevens et al, 2015) The role of nutrition in mediating the effects of P-IPV on the offspring should, we thus argue, be further explored as a number of gaps remain. It is unfortunate, for example, that in studies linking P-IPV to low birth weight (e.g., see Donovan et al, 2016 for a review), maternal nutrition has not been investigated as a mediator.…”