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

Enju Liu; Dongqing Wang; Anne M Darling; Nandita Perumal; Molin Wang; Tahmeed Ahmed; Parul Christian; Kathryn G Dewey; Gilberto Kac; Stephen Kennedy; Vishak Subramoney; Brittany Briggs; Wafaie W Fawzi; members of the GWG Pooling Project Consortium

doi:10.1093/ajcn/nqac259

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

Am J Clin Nutr. 2022 Dec 19;116(6):1864-1876. doi: 10.1093/ajcn/nqac259.

Authors

Enju Liu^{1

2}, Dongqing Wang^{3

4}, Anne M Darling³, Nandita Perumal³, Molin Wang^{5

6}, Tahmeed Ahmed⁷, Parul Christian⁸, Kathryn G Dewey⁹, Gilberto Kac¹⁰, Stephen Kennedy¹¹, Vishak Subramoney^{12

13}, Brittany Briggs¹⁴, Wafaie W Fawzi^{3

5

15}; members of the GWG Pooling Project Consortium

Collaborators

members of the GWG Pooling Project Consortium:
Seth Adu-Afarwuah, Abu Ahmed Shamim, Shams Arifeen, Per Ashorn, Ulla Ashorn, Zulfiqar A Bhutta, Yue Cheng, Anthony M Costello, Henrik Friis, Exnevia Gomo, Rebecca Grais, Ousmane Guindo, Lieven Huybregts, Sheila Isanaka, Keith P West, Patrick Kolsteren, Nancy F Krebs, Carl Lachat, Anna Lartey, Steven C LeClerq, Kenneth Maleta, Dharma S Manandhar, Reynaldo Martorell, Susana L Matias, Elizabeth M McClure, K Michael Hambidge, Sophie E Moore, Malay Kanti Mridha, David Osrin, Andrea B Pembe, Andrew M Prentice, Usha Ramakrishnan, Juan Rivera, Sajid Soofi, Kerry Schulze, Willy Urassa, Lee Wu, Lingxia Zeng, Zhonghai Zhu

Affiliations

¹ Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA.
² Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
³ Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA.
⁴ Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA.
⁵ Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA.
⁶ Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA.
⁷ Nutrition & Clinical Services, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
⁸ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁹ Department of Nutrition, University of California, Davis, Davis, CA, USA.
¹⁰ Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
¹¹ Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom.
¹² Certara Canada, Montreal, Quebec, Canada.
¹³ DVPL Tech.
¹⁴ Certara USA, Inc. on behalf of the Bill & Melinda Gates Foundation, Seattle, WA, USA.
¹⁵ Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA.

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: We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs.

Methods: A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage 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: MMSs resulted in a greater percentage 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 g; P < 0.01) than among those in the control arm. Women who received MMSs 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 LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: -0.38%, 3.40%; P = 0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG.

Conclusions: Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.

Keywords: gestational weight gain; low- and middle-income countries; meta-analysis; multiple micronutrient supplements; randomized controlled trials; small-quantity lipid-based nutrient supplements.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index
Developing Countries
Female
Folic Acid
Gestational Weight Gain*
Humans
Iron
Pregnancy
Pregnancy Outcome
Vitamins

Substances

Vitamins
Folic Acid
Iron

Abstract

Publication types

MeSH terms

Substances

Grants and funding