Prenatal fortified balanced energy—Protein supplementation and birth outcomes in rural Burkina Faso: A randomized controlled efficacy trial
Background: Providing balanced energy–protein (BEP) supplements is a promising intervention to improve birth outcomes in low- and middle-income countries (LMICs); however, evidence is limited. We aimed to assess the efficacy of fortified BEP supplementation during pregnancy to improve birth outcomes...
| Autores principales: | , , , , , |
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| Formato: | Journal Article |
| Lenguaje: | Inglés |
| Publicado: |
2022
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| Materias: | |
| Acceso en línea: | https://hdl.handle.net/10568/141336 |
| _version_ | 1855541853706780672 |
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| author | de Kok, Brenda Toe, Laeticia Celine Hanley-Cook, Giles T. Argaw, Alemayehu Ouédraogo, Moctar Huybregts, Lieven |
| author_browse | Argaw, Alemayehu Hanley-Cook, Giles T. Huybregts, Lieven Ouédraogo, Moctar Toe, Laeticia Celine de Kok, Brenda |
| author_facet | de Kok, Brenda Toe, Laeticia Celine Hanley-Cook, Giles T. Argaw, Alemayehu Ouédraogo, Moctar Huybregts, Lieven |
| author_sort | de Kok, Brenda |
| collection | Repository of Agricultural Research Outputs (CGSpace) |
| description | Background: Providing balanced energy–protein (BEP) supplements is a promising intervention to improve birth outcomes in low- and middle-income countries (LMICs); however, evidence is limited. We aimed to assess the efficacy of fortified BEP supplementation during pregnancy to improve birth outcomes, as compared to iron–folic acid (IFA) tablets, the standard of care. Methods and findings: We conducted an individually randomized controlled efficacy trial (MIcronutriments pour la SAnté de la Mère et de l’Enfant [MISAME]-III) in 6 health center catchment areas in rural Burkina Faso. Pregnant women, aged 15 to 40 years with gestational age (GA) <21 completed weeks, were randomly assigned to receive either fortified BEP supplements and IFA (intervention) or IFA (control). Supplements were provided during home visits, and intake was supervised on a daily basis by trained village-based project workers. The primary outcome was prevalence of small-for-gestational age (SGA) and secondary outcomes included large-for-gestational age (LGA), low birth weight (LBW), preterm birth (PTB), gestational duration, birth weight, birth length, Rohrer’s ponderal index, head circumference, thoracic circumference, arm circumference, fetal loss, and stillbirth. Statistical analyses followed the intention-to-treat (ITT) principle. From October 2019 to December 2020, 1,897 pregnant women were randomized (960 control and 937 intervention). The last child was born in August 2021, and birth anthropometry was analyzed from 1,708 pregnancies (872 control and 836 intervention). A total of 22 women were lost to follow-up in the control group and 27 women in the intervention group. BEP supplementation led to a mean 3.1 percentage points (pp) reduction in SGA with a 95% confidence interval (CI) of −7.39 to 1.16 (P = 0.151), indicating a wide range of plausible true treatment efficacy. Adjusting for prognostic factors of SGA, and conducting complete cases (1,659/1,708, 97%) and per-protocol analysis among women with an observed BEP adherence ≥75% (1,481/1,708, 87%), did not change the results. The intervention significantly improved the duration of gestation (+0.20 weeks, 95% CI 0.05 to 0.36, P = 0.010), birth weight (50.1 g, 8.11 to 92.0, P = 0.019), birth length (0.20 cm, 0.01 to 0.40, P = 0.044), thoracic circumference (0.20 cm, 0.04 to 0.37, P = 0.016), arm circumference (0.86 mm, 0.11 to 1.62, P = 0.025), and decreased LBW prevalence (−3.95 pp, −6.83 to −1.06, P = 0.007) as secondary outcomes measures. No differences in serious adverse events [SAEs; fetal loss (21 control and 26 intervention) and stillbirth (16 control and 17 intervention)] between the study groups were found. Key limitations are the nonblinded administration of supplements and the lack of information on other prognostic factors (e.g., infection, inflammation, stress, and physical activity) to determine to which extent these might have influenced the effect on nutrient availability and birth outcomes. Conclusions: The MISAME-III trial did not provide evidence that fortified BEP supplementation is efficacious in reducing SGA prevalence. However, the intervention had a small positive effect on other birth outcomes. Additional maternal and biochemical outcomes need to be investigated to provide further evidence on the overall clinical relevance of BEP supplementation. |
| format | Journal Article |
| id | CGSpace141336 |
| institution | CGIAR Consortium |
| language | Inglés |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| record_format | dspace |
| spelling | CGSpace1413362025-10-26T13:01:11Z Prenatal fortified balanced energy—Protein supplementation and birth outcomes in rural Burkina Faso: A randomized controlled efficacy trial de Kok, Brenda Toe, Laeticia Celine Hanley-Cook, Giles T. Argaw, Alemayehu Ouédraogo, Moctar Huybregts, Lieven randomized controlled trials supplements protein content rural areas perinatal period Background: Providing balanced energy–protein (BEP) supplements is a promising intervention to improve birth outcomes in low- and middle-income countries (LMICs); however, evidence is limited. We aimed to assess the efficacy of fortified BEP supplementation during pregnancy to improve birth outcomes, as compared to iron–folic acid (IFA) tablets, the standard of care. Methods and findings: We conducted an individually randomized controlled efficacy trial (MIcronutriments pour la SAnté de la Mère et de l’Enfant [MISAME]-III) in 6 health center catchment areas in rural Burkina Faso. Pregnant women, aged 15 to 40 years with gestational age (GA) <21 completed weeks, were randomly assigned to receive either fortified BEP supplements and IFA (intervention) or IFA (control). Supplements were provided during home visits, and intake was supervised on a daily basis by trained village-based project workers. The primary outcome was prevalence of small-for-gestational age (SGA) and secondary outcomes included large-for-gestational age (LGA), low birth weight (LBW), preterm birth (PTB), gestational duration, birth weight, birth length, Rohrer’s ponderal index, head circumference, thoracic circumference, arm circumference, fetal loss, and stillbirth. Statistical analyses followed the intention-to-treat (ITT) principle. From October 2019 to December 2020, 1,897 pregnant women were randomized (960 control and 937 intervention). The last child was born in August 2021, and birth anthropometry was analyzed from 1,708 pregnancies (872 control and 836 intervention). A total of 22 women were lost to follow-up in the control group and 27 women in the intervention group. BEP supplementation led to a mean 3.1 percentage points (pp) reduction in SGA with a 95% confidence interval (CI) of −7.39 to 1.16 (P = 0.151), indicating a wide range of plausible true treatment efficacy. Adjusting for prognostic factors of SGA, and conducting complete cases (1,659/1,708, 97%) and per-protocol analysis among women with an observed BEP adherence ≥75% (1,481/1,708, 87%), did not change the results. The intervention significantly improved the duration of gestation (+0.20 weeks, 95% CI 0.05 to 0.36, P = 0.010), birth weight (50.1 g, 8.11 to 92.0, P = 0.019), birth length (0.20 cm, 0.01 to 0.40, P = 0.044), thoracic circumference (0.20 cm, 0.04 to 0.37, P = 0.016), arm circumference (0.86 mm, 0.11 to 1.62, P = 0.025), and decreased LBW prevalence (−3.95 pp, −6.83 to −1.06, P = 0.007) as secondary outcomes measures. No differences in serious adverse events [SAEs; fetal loss (21 control and 26 intervention) and stillbirth (16 control and 17 intervention)] between the study groups were found. Key limitations are the nonblinded administration of supplements and the lack of information on other prognostic factors (e.g., infection, inflammation, stress, and physical activity) to determine to which extent these might have influenced the effect on nutrient availability and birth outcomes. Conclusions: The MISAME-III trial did not provide evidence that fortified BEP supplementation is efficacious in reducing SGA prevalence. However, the intervention had a small positive effect on other birth outcomes. Additional maternal and biochemical outcomes need to be investigated to provide further evidence on the overall clinical relevance of BEP supplementation. 2022-05-13 2024-04-12T13:37:43Z 2024-04-12T13:37:43Z Journal Article https://hdl.handle.net/10568/141336 en Open Access de Kok, Brenda; Toe, Laeticia Celine; Hanley-Cook, Giles; Argaw, Alemayehu; Ouédraogo, Moctar; Huybregts, Lieven; et al. 2022. Prenatal fortified balanced energy—Protein supplementation and birth outcomes in rural Burkina Faso: A randomized controlled efficacy trial. PLoS Med 19(5): e1004002. https://doi.org/10.1371/journal.pmed.1004002 |
| spellingShingle | randomized controlled trials supplements protein content rural areas perinatal period de Kok, Brenda Toe, Laeticia Celine Hanley-Cook, Giles T. Argaw, Alemayehu Ouédraogo, Moctar Huybregts, Lieven Prenatal fortified balanced energy—Protein supplementation and birth outcomes in rural Burkina Faso: A randomized controlled efficacy trial |
| title | Prenatal fortified balanced energy—Protein supplementation and birth outcomes in rural Burkina Faso: A randomized controlled efficacy trial |
| title_full | Prenatal fortified balanced energy—Protein supplementation and birth outcomes in rural Burkina Faso: A randomized controlled efficacy trial |
| title_fullStr | Prenatal fortified balanced energy—Protein supplementation and birth outcomes in rural Burkina Faso: A randomized controlled efficacy trial |
| title_full_unstemmed | Prenatal fortified balanced energy—Protein supplementation and birth outcomes in rural Burkina Faso: A randomized controlled efficacy trial |
| title_short | Prenatal fortified balanced energy—Protein supplementation and birth outcomes in rural Burkina Faso: A randomized controlled efficacy trial |
| title_sort | prenatal fortified balanced energy protein supplementation and birth outcomes in rural burkina faso a randomized controlled efficacy trial |
| topic | randomized controlled trials supplements protein content rural areas perinatal period |
| url | https://hdl.handle.net/10568/141336 |
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