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Effective of Balanced Protein Energy Supplementation during Pregnancy on Birth Outcomes

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More Intervention Effect Estimate Summaries

Imdad A and Bhutta ZA. Effect of balanced protein energy supplementation during pregnancy on birth outcomes. BMC Public Health. 2011; 11 (Suppl 3): S17.


  • Approximately 30 million newborns per year are affected with intrauterine growth restriction (IUGR) in developing countries. (1)  IUGR is associated with an increase in perinatal mortality and morbidities such as hypothermia, hypoglycemia, prematurity, etc. (2)
  • Poor maternal nutritional status at conception and inadequate maternal nutrition during pregnancy can result in IUGR. (3, 6)  Previous reviews on maternal nutritional supplementation during pregnancy have shown that balanced protein energy supplementation (BPES) has a positive impact on both maternal and perinatal birth outcomes (5, 6).  It was also associated with a significant reduction in small-for-gestational-age (SGA) infants and stillbirths and with a non-significant reduction in neonatal mortality.
  • Although the terms SGA and IUGR are not synonymous, there is correlation between the two and the higher the SGA rate, the greater the likelihood that SGA is a result of IUGR (7).

Intervention Effects

Balanced Protein Energy Supplementation (BPES) to Pregnant Women on SGA (proxy for IUGR)

  • BPES was defined as nutritional supplementation during pregnancy in which proteins provided less than 25% of the total energy content.
  • 31% reduction in risk of giving birth to SGA infants (RR: 0.69; 95% CI 0.56-0.85) - meta-analysis of 6 studies (moderate quality of evidence) - estimate recommended as a proxy for reduction in IUGR

Balanced Protein Energy Supplementation (BPES) to Pregnant Women on Mean Birth Weight

  • BEPS group gained more weight compared to control (mean difference 59.89 g, 95% CI 33.09-86.68) 
  • This was more pronounced in malnourished women (mean difference 74.89g; 95%CI 42.42-107.36) compared to adequately nourished women (mean difference 27.87g; 95% CI19.57-75.31).

Balanced Protein Energy Supplementation (BPES) to Pregnant Women on Neonatal Mortality 

  • No significant effect of BPES on neonatal mortality (RR: 0.63; 95% CI 0.37-1.06) 
  • Pooled analysis of 3 studies - low quality of evidence

Intervention Recommendation  

  • Balanced protein energy supplementation is recommended as an intervention among undernourished women for inclusion in the LiST model with a point estimate of 31% (95% CI 15-44%) reduction in IUGR.

References from Imdad Paper Cited Here

  1. de Onis M, Blossner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries. Eur J Clin Nutr. 1998;52(Suppl 1):S5–15.
  2. Ashworth A. Effects of intrauterine growth retardation on mortality and morbidity in infants and young children. Eur J Clin Nutr. 1998;52(Suppl 1):S34–41. discussion S41-32. 
  3. Prada JA, Tsang RC. Biological mechanisms of environmentally induced causes of IUGR. Eur J Clin Nutr. 1998;52(Suppl 1):S21–27. discussion S27-28.
  4. Scholl TO. Maternal nutrition before and during pregnancy. Nestle Nutr Workshop Ser Pediatr Program. 2008;61:79–89.
  5. de Onis M, Villar J, Gulmezoglu M. Nutritional interventions to prevent intrauterine growth retardation: evidence from randomized controlled trials. Eur J Clin Nutr. 1998;52(Suppl 1):S83–93.
  6. Kramer MS, Kakuma R. Energy and protein intake in pregnancy. Cochrane Dbase Syst Rev. 2003. 4:CD000032.
  7. WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee: Technical Report Series No. 854. Geneva: World Health Organization; 1995. pp. 121–160.

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