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Meta-Analysis
. 2015 Oct;11(4):415-32.
doi: 10.1111/mcn.12183. Epub 2015 Apr 7.

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

Briony Stevens  1 , Petra Buettner  1 , Kerrianne Watt  1 , Alan Clough  1   2 , Julie Brimblecombe  3 , Jenni Judd  1   4   5
Affiliations
Meta-Analysis

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

Briony Stevens et al. Matern Child Nutr. 2015 Oct.

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 (1970-2015) 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 low- and 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.

Keywords: child growth; international child health nutrition; low-income countries; maternal nutrition; systematic review; underweight.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Summary of search for selected articles (modified from PRISMA flowchart).
Figure 2
Figure 2
EPHPP global ratings.
Figure 3
Figure 3
Effect of balanced protein energy supplementation on birthweight (n = 7).
Figure 4
Figure 4
Effect of balanced protein energy supplementation on birth length (n = 5).
Figure 5
Figure 5
Effect of balanced protein energy supplementation on birth head circumference (n = 3).
See this image and copyright information in PMC

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