Nutritious Supplemental Foods for Pregnant Women from Food Insecure Settings: Types, Nutritional Composition, and Relationships to Health Outcomes

Abstract

There is growing evidence that the provision of nutritious supplemental foods to undernourished pregnant women can improve maternal and infant outcomes. However, comparing and synthesizing the evidence base is complicated by differences in interventions and products and the use of ambiguous terminology. We aimed to define 2 common types of nutritious supplemental foods used in pregnancy, balanced energy-protein (BEP) supplements and lipid-based nutrient supplements (LNS), and to review the evidence supporting each via a narrative review of systematic reviews and meta-analyses (SRMAs). Information about the nutritional composition of the food supplements and their effects on maternal and infant outcomes was abstracted. Five SRMAs (n = 20 trials) evaluated the effect of BEP compared with no BEP/control (comparison group commonly received iron and folic acid [IFA]). BEP foods/products ranged in calories (118-1017 kcals), protein (3-50 g), fat (6-57 g), and micronutrient content. Overall, maternal BEP improved birth weight and reduced the risk of stillbirth and small for gestational age when compared with no BEP/control in pregnancy. Three SRMAs (n = 5 trials) evaluated the effect of LNS compared with IFA or multiple micronutrients (MMNs). The LNS interventions comprised small- and large-quantity LNS that ranged in calories (118-746 kcals), protein (3-21 g), fat (10-53 g), and micronutrient content. LNS compared with IFA increased pregnancy duration, birth weight, and birth length and reduced the risk of small for gestational age and infant stunting; however, no beneficial effect of LNS was identified when compared with MMN. Despite heterogeneity in the nutritional composition of BEP supplements, the evidence suggests that in nutritionally at-risk populations, these products may improve birth outcomes in pregnant women. The evidence is limited but promising when LNS is compared with IFA in improving maternal and infant outcomes. Overall, BEP, compared with MMN or LNS, are key areas that have not been studied and deserve attention.

Keywords: BEP; LNS; balanced energy-protein; birth outcomes; lipid-based nutrient supplement; maternal outcomes; narrative review; pregnancy; women.

FIGURE 1

Nutritious supplemental foods used in pregnancy. Aside from 2 studies [34,38] that provided <250 kcals in BEP food/product, the total energy per day for medium-quantity and large-quantity LNS overlap with most of the BEP foods/products given in research trials; LNS products overlap in energy from protein with BEP; BEP food/products should provide <50% of energy from fats. BEP, balanced energy-protein; EAR, estimated average requirement; LNS, lipid-based nutrient supplement; MN, micronutrient; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children. Small-quantity-LNS [13,44,45,55], medium-quantity-LNS [13,47], large-quantity-LNS [31,46,13]; food-based supplementation [[20], [21], [22], [23],25], commercially produced supplement [[26], [27], [28], [29], [30], [31], [32], [33],[35], [36], [37]], supplemental food tokens or vouchers [38,39], recommended BEP formulation [10].