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Meta-Analysis
. 2025 Feb 3;22(2):e1004523.
doi: 10.1371/journal.pmed.1004523. eCollection 2025 Feb.

The effect of prenatal balanced energy and protein supplementation on gestational weight gain: An individual participant data meta-analysis in low- and middle-income countries

Dongqing Wang  1 , Uttara Partap  2 , Enju Liu  3   4 , Janaína Calu Costa  2 , Ilana R Cliffer  2 , Molin Wang  5   6 , Sudeer Kumar Nookala  7 , Vishak Subramoney  8 , Brittany Briggs  9 , Imran Ahmed  10 , Alemayehu Argaw  11 , Shabina Ariff  10 , Nita Bhandari  12 , Ranadip Chowdhury  12 , Daniel Erchick  13 , Armando García-Guerra  14   15 , Masoumah Ghaffarpour  16 , Giles Hanley-Cook  11 , Lieven Huybregts  11   17 , Fyezah Jehan  18 , Fatemeh Kaseb  19 , Nancy F Krebs  20 , Carl Lachat  11 , Tsering Pema Lama  21 , Dharma S Manandhar  22 , Elizabeth M McClure  23 , Sophie E Moore  24   25 , Ameer Muhammad  26 , Lynnette M Neufeld  27 , Andrew M Prentice  25 , Amado D Quezada-Sánchez  15   28 , Dominique Roberfroid  29 , Naomi M Saville  30 , Yasir Shafiq  31   32   33 , Bhim P Shrestha  22 , Bakary Sonko  25 , Sajid Soofi  10 , Sunita Taneja  12 , James M Tielsch  34 , Laéticia Céline Toe  11   35 , Naser Valaei  16 , Wafaie W Fawzi  2   5   36
Affiliations
Meta-Analysis

The effect of prenatal balanced energy and protein supplementation on gestational weight gain: An individual participant data meta-analysis in low- and middle-income countries

Dongqing Wang et al. PLoS Med. .

Abstract

Background: Understanding the effects of balanced energy and protein (BEP) supplements on gestational weight gain (GWG) and how the effects differ depending on maternal characteristics and the nutritional composition of the supplements will inform the implementation of prenatal BEP interventions.

Methods and findings: Individual participant data from 11 randomized controlled trials of prenatal BEP supplements (N = 12,549, with 5,693 in the BEP arm and 6,856 in the comparison arm) in low- and middle-income countries were used. The primary outcomes included GWG adequacy (%) and the estimated total GWG at delivery as continuous outcomes, and severely inadequate (<70% adequacy), inadequate GWG (<90% adequacy), and excessive GWG (>125% adequacy) as binary outcomes; all variables were calculated based on the Institute of Medicine recommendations. Linear and log-binomial models were used to estimate study-specific mean differences or risk ratios (RRs), respectively, with 95% confidence intervals (CIs) of the effects of prenatal BEP on the GWG outcomes. The study-specific estimates were pooled using meta-analyses. Subgroup analyses were conducted by individual characteristics. Subgroup analyses and meta-regression were conducted for study-level characteristics. Compared to the comparison group, prenatal BEP led to a 6% greater GWG percent adequacy (95% CI: 2.18, 9.56; p = 0.002), a 0.59 kg greater estimated total GWG at delivery (95% CI, 0.12, 1.05; p = 0.014), a 10% lower risk of severely inadequate GWG (RR: 0.90; 95% CI: 0.83, 0.99; p = 0.025), and a 7% lower risk of inadequate GWG (RR: 0.93; 95% CI: 0.89, 0.97; p = 0.001). The effects of prenatal BEP on GWG outcomes were stronger in studies with a targeted approach, where BEP supplements were provided to participants in the intervention arm under specific criteria such as low body mass index or low GWG, compared to studies with an untargeted approach, where BEP supplements were provided to all participants allocated to the intervention arm.

Conclusions: Prenatal BEP supplements are effective in increasing GWG and reducing the risk of inadequate weight gain during pregnancy. BEP supplementation targeted toward pregnant women with undernutrition may be a promising approach to delivering the supplements.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Forest plot for the effect of prenatal BEP supplements on GWG percent adequacy at the last gestational weight measurement.
BEP, balanced energy and protein; CI, confidence interval; GWG, gestational weight gain.
Fig 2
Fig 2. Forest plot for the effect of prenatal BEP supplements on the estimated total GWG at delivery (kilograms).
BEP, balanced energy and protein; CI, confidence interval; GWG, gestational weight gain.
Fig 3
Fig 3. Forest plot for the effect of prenatal BEP supplements on severely inadequate GWG at the last gestational weight measurement.
BEP, balanced energy and protein; CI, confidence interval; GWG, gestational weight gain.
Fig 4
Fig 4. Forest plot for the effect of prenatal BEP supplements on inadequate GWG at the last gestational weight measurement.
BEP, balanced energy and protein; CI, confidence interval; GWG, gestational weight gain.
Fig 5
Fig 5. Forest plot for the effect of prenatal BEP supplements on excessive GWG at the last gestational weight measurement.
BEP, balanced energy and protein; CI, confidence interval; GWG, gestational weight gain.
See this image and copyright information in PMC

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