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Prenatal fortified balanced energy-protein supplementation and birth outcomes in rural Burkina Faso : a randomized controlled efficacy trial

(2022) PLOS MEDICINE. 19(5).
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Abstract
Background Anemia and suboptimal gestational weight gain (GWG) are associated with adverse maternal and birth outcomes. Limited research indicates that balanced energy-protein (BEP) supplements reduce the incidence of inadequate GWG. Objectives We assessed the efficacy of a micronutrient-fortified BEP supplement on the secondary outcomes of anemia, GWG, GWG rate, and GWG in relation to the Institute of Medicine (IOM)'s recommendations, as compared with an iron-folic acid (IFA) tablet. Methods We conducted a randomized controlled trial in Burkina Faso, among pregnant women (15-40 y old) enrolled at <21 weeks of gestation. Women received either BEP and IFA (intervention) or IFA (control). Hemoglobin (g/dL) concentrations were measured at baseline and the third antenatal care visit (ANC), whereas maternal weight was measured at baseline and all subsequent similar to 7-weekly ANCs. GWG (kg) was calculated as a woman's last weight measurement (at similar to 36 weeks of gestation) minus weight at enrollment, whereas GWG rate (kg/wk) was GWG divided by the time between the first and last weight measurements. GWG adequacy (%) was computed as GWG divided by the IOM's recommendation. Binary outcomes included severely inadequate, inadequate, and excessive GWG. Statistical analyses followed the intention-to-treat principle. Linear regression and probability models were fitted for the continuous and binary outcomes, respectively, adjusting for baseline measurements. Results Women in the BEP group tended to have higher, but nonsignificantly different, GWG (0.28 kg; 95% CI: -0.05, 0.58 kg; P = 0.099). Furthermore, there were no significant differences in prenatal anemia prevalence, GWG rate, GWG adequacy, or incidence of inadequate or excessive GWG. Findings were robust to model adjustments and complete case and per protocol analyses. Conclusions This trial does not provide evidence that fortified BEP supplementation reduces maternal anemia or increases GWG, as compared with IFA. In conjunction with the small, but positive, effects of maternal BEP supplementation on birth outcomes, our findings warrant the investigation of additional biochemical and postnatal outcomes. This trial was registered at clinicaltrials.gov as NCT03533712.
Keywords
anemia, balanced energy-protein, Burkina Faso, gestational weight gain, iron-folic acid, multiple micronutrients, randomized controlled trial, MULTIPLE MICRONUTRIENT SUPPLEMENTATION, BIRTH-WEIGHT, BODY-COMPOSITION, FETAL-GROWTH, FOLIC-ACID, IRON, FOOD, MULTIVITAMIN, IMPROVE

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MLA
de Kok, Brenda, et al. “Prenatal Fortified Balanced Energy-Protein Supplementation and Birth Outcomes in Rural Burkina Faso : A Randomized Controlled Efficacy Trial.” PLOS MEDICINE, vol. 19, no. 5, 2022, doi:10.1371/journal.pmed.1004002.
APA
de Kok, B., Toe, L. C., Hanley-Cook, G., Argaw, A., Ouédraogo, M., Compaoré, A., … Lachat, C. (2022). Prenatal fortified balanced energy-protein supplementation and birth outcomes in rural Burkina Faso : a randomized controlled efficacy trial. PLOS MEDICINE, 19(5). https://doi.org/10.1371/journal.pmed.1004002
Chicago author-date
Kok, Brenda de, Laeticia Celine Toe, Giles Hanley-Cook, Alemayehu Argaw, Moctar Ouédraogo, Anderson Compaoré, Katrien Vanslambrouck, et al. 2022. “Prenatal Fortified Balanced Energy-Protein Supplementation and Birth Outcomes in Rural Burkina Faso : A Randomized Controlled Efficacy Trial.” PLOS MEDICINE 19 (5). https://doi.org/10.1371/journal.pmed.1004002.
Chicago author-date (all authors)
de Kok, Brenda, Laeticia Celine Toe, Giles Hanley-Cook, Alemayehu Argaw, Moctar Ouédraogo, Anderson Compaoré, Katrien Vanslambrouck, Trenton Dailey-Chwalibóg, Rasmané Ganaba, Patrick Kolsteren, Lieven Huybregts, and Carl Lachat. 2022. “Prenatal Fortified Balanced Energy-Protein Supplementation and Birth Outcomes in Rural Burkina Faso : A Randomized Controlled Efficacy Trial.” PLOS MEDICINE 19 (5). doi:10.1371/journal.pmed.1004002.
Vancouver
1.
de Kok B, Toe LC, Hanley-Cook G, Argaw A, Ouédraogo M, Compaoré A, et al. Prenatal fortified balanced energy-protein supplementation and birth outcomes in rural Burkina Faso : a randomized controlled efficacy trial. PLOS MEDICINE. 2022;19(5).
IEEE
[1]
B. de Kok et al., “Prenatal fortified balanced energy-protein supplementation and birth outcomes in rural Burkina Faso : a randomized controlled efficacy trial,” PLOS MEDICINE, vol. 19, no. 5, 2022.
@article{8753824,
  abstract     = {{Background Anemia and suboptimal gestational weight gain (GWG) are associated with adverse maternal and birth outcomes. Limited research indicates that balanced energy-protein (BEP) supplements reduce the incidence of inadequate GWG. Objectives We assessed the efficacy of a micronutrient-fortified BEP supplement on the secondary outcomes of anemia, GWG, GWG rate, and GWG in relation to the Institute of Medicine (IOM)'s recommendations, as compared with an iron-folic acid (IFA) tablet. Methods We conducted a randomized controlled trial in Burkina Faso, among pregnant women (15-40 y old) enrolled at <21 weeks of gestation. Women received either BEP and IFA (intervention) or IFA (control). Hemoglobin (g/dL) concentrations were measured at baseline and the third antenatal care visit (ANC), whereas maternal weight was measured at baseline and all subsequent similar to 7-weekly ANCs. GWG (kg) was calculated as a woman's last weight measurement (at similar to 36 weeks of gestation) minus weight at enrollment, whereas GWG rate (kg/wk) was GWG divided by the time between the first and last weight measurements. GWG adequacy (%) was computed as GWG divided by the IOM's recommendation. Binary outcomes included severely inadequate, inadequate, and excessive GWG. Statistical analyses followed the intention-to-treat principle. Linear regression and probability models were fitted for the continuous and binary outcomes, respectively, adjusting for baseline measurements. Results Women in the BEP group tended to have higher, but nonsignificantly different, GWG (0.28 kg; 95% CI: -0.05, 0.58 kg; P = 0.099). Furthermore, there were no significant differences in prenatal anemia prevalence, GWG rate, GWG adequacy, or incidence of inadequate or excessive GWG. Findings were robust to model adjustments and complete case and per protocol analyses. Conclusions This trial does not provide evidence that fortified BEP supplementation reduces maternal anemia or increases GWG, as compared with IFA. In conjunction with the small, but positive, effects of maternal BEP supplementation on birth outcomes, our findings warrant the investigation of additional biochemical and postnatal outcomes. This trial was registered at clinicaltrials.gov as NCT03533712.}},
  articleno    = {{e1004002}},
  author       = {{de Kok, Brenda and Toe, Laeticia Celine and Hanley-Cook, Giles and Argaw, Alemayehu and Ouédraogo, Moctar and Compaoré, Anderson and Vanslambrouck, Katrien and Dailey-Chwalibóg, Trenton and Ganaba, Rasmané and Kolsteren, Patrick and Huybregts, Lieven and Lachat, Carl}},
  issn         = {{1549-1277}},
  journal      = {{PLOS MEDICINE}},
  keywords     = {{anemia,balanced energy-protein,Burkina Faso,gestational weight gain,iron-folic acid,multiple micronutrients,randomized controlled trial,MULTIPLE MICRONUTRIENT SUPPLEMENTATION,BIRTH-WEIGHT,BODY-COMPOSITION,FETAL-GROWTH,FOLIC-ACID,IRON,FOOD,MULTIVITAMIN,IMPROVE}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{20}},
  title        = {{Prenatal fortified balanced energy-protein supplementation and birth outcomes in rural Burkina Faso : a randomized controlled efficacy trial}},
  url          = {{http://dx.doi.org/10.1371/journal.pmed.1004002}},
  volume       = {{19}},
  year         = {{2022}},
}

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