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Meta-Analysis
. 2025 Jan-Dec:21:17455057251335366.
doi: 10.1177/17455057251335366. Epub 2025 Apr 30.

Effect of balanced protein-energy supplementation given to pregnant women on birth outcomes: A systematic review and meta-analysis

Aliha Iftikhar  1 , Hafsa Azam  1 , Mariam Ahmed  1 , Aliza Asad  1 , Amber Noorani  1 , Maaha Shabbir  1 , Kanza Aftab  1
Affiliations
Meta-Analysis

Effect of balanced protein-energy supplementation given to pregnant women on birth outcomes: A systematic review and meta-analysis

Aliha Iftikhar et al. Womens Health (Lond). 2025 Jan-Dec.

Abstract

Background: There is an increased demand for nutrition during pregnancy to improve fetal growth and development. Several dietary interventions have been recommended to pregnant women to meet their maternal needs. Using a larger sample size, we aim to assess the effect of balanced protein-energy supplementation given to pregnant women on birth outcomes.

Objective: To evaluate the effect of balanced protein-energy supplementation given to pregnant women on birth outcomes.

Design: Search included PubMed, Cochrane Central, and Embase from initiation till 20 March 2023 to select relevant studies examining perinatal factors associated with balanced protein-energy supplementation. Mean differences (MD) and risk ratios (RRs) with a 95% confidence interval (CI) were calculated using Review Manager.

Data sources and methods: Randomized controlled trials and observational studies were included. Out of 218,720 studies initially identified, 24 met the inclusion criteria, involving pregnant women who received balanced protein-energy supplementation and reported outcomes related to perinatal death, birthweight, length, or head circumference.

Results: Meta-analysis of pooled studies revealed that balanced protein supplementation had a significant effect on birthweight (g) (MD: 62.67, CI: 27.92-97.43), low birth weight (LBW) (RR: 0.73, CI: 0.57-0.95), birth length (MD: 0.20, CI: 0.10-0.30), and small-for-gestational-age (SGA) babies (RR: 0.74, CI: 0.59-0.93) and had no significant effect on the birth head circumference (MD: 0.05, CI: -0.09 to 0.20), perinatal death (RR: 0.83, CI: 0.50-1.37), and preterm birth (RR: 0.86, CI: 0.68-1.08).

Conclusion: Balanced protein-energy supplementation is an effective intervention for birth length, birth weight, risk of LBW, and SGA births, particularly in women who are undernourished.

Keywords: balanced protein–energy supplementation; birth outcome; birthweight; meta-analysis; pregnant women.

Plain language summary

Looking at the effects of giving pregnant women a balanced combination of protein energy supplements on the results of their pregnancy outcomes, by reviewing and analyzing data from several previous studies.Introduction: During pregnancy, there is a greater need for good nutrition to help the baby grow and develop properly. Different dietary supplements have been recommended for pregnant women to meet their increased nutritional requirements. This study aimed to evaluate the effects of providing a balanced combination of protein and energy supplements to pregnant women on birth outcomes.Methods: The researchers searched various databases to find relevant studies that looked at the relationship between balanced protein–energy supplements during pregnancy and factors like infant birth weight, length, head size, and risk of complications. They evaluated the quality of the studies and used statistical analysis to combine the results.Results: The analysis of the 24 studies, involving over 11,000 pregnant women, found that balanced protein–energy supplements had these effects: Increased average birth weight Reduced the risk of low birth weight Increased average birth length Reduced the risk of babies being small for their gestational age However, the supplements did not have a significant effect on: Birth head circumference Risk of perinatal death Risk of preterm birth.Conclusion: Providing a balanced combination of protein and energy supplements to pregnant women, especially those who are undernourished, can be an effective way to improve certain birth outcomes, like increasing birth weight and length.

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Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of the systematic review process.
Figure 2.
Figure 2.
Analysis of comparison: balanced protein–energy supplementation versus control, outcome: birth weight.
Figure 3.
Figure 3.
Analysis of comparison: balanced protein–energy supplementation versus control, outcome: low birth weight (<2500).
Figure 4.
Figure 4.
Analysis of comparison: balanced protein–energy supplementation versus control, outcome: birth length.
Figure 5.
Figure 5.
Analysis of comparison: balanced protein–energy supplementation versus control, outcome: birth head circumference.
Figure 6.
Figure 6.
Subgroup analysis of balanced protein–energy supplementation in adequately nourished women versus malnourished women. Outcome: birth head circumference.
Figure 7.
Figure 7.
Analysis of comparison: balanced protein–energy supplementation versus control, outcome: perinatal death.
Figure 8.
Figure 8.
Subgroup analysis of balanced protein–energy supplementation in adequately nourished women versus malnourished women. Outcome: perinatal death.
Figure 9.
Figure 9.
Analysis of comparison: balanced protein–energy supplementation versus control, outcome: small-for-gestational-age baby.
Figure 10.
Figure 10.
Subgroup analysis of balanced protein–energy supplementation in adequately nourished women versus malnourished women. Outcome: small-for-gestational-age baby.
Figure 11.
Figure 11.
Analysis of comparison: balanced protein–energy supplementation versus control, outcome: preterm birth.
Figure 12.
Figure 12.
Subgroup analysis of balanced protein–energy supplementation in adequately nourished women versus malnourished women. Outcome: preterm birth.
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