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Session: Milk to Meals: Feeding From Birth to Childhood (Oral 5)

(OR05-07-23) The Effect of Balanced Energy-Protein Supplementation Provided to Lactating Women on Maternal and Infant Outcomes: A Prospectively Planned IPD Meta-Analysis

Sunday, July 23, 2023
9:12 AM – 9:24 AM ET
Location:  Constitution B
ECRAC
Disclosure(s):
Mihaela A. Ciulei, PhD, MS: No relevant financial relationship(s) with ineligible companies to disclose.
Objectives: The high prevalence of infant stunting and maternal undernourishment in low- and middle-income countries poses a significant public health threat, but the WHO only recommends protein (BEP) supplementation to underweight (BMI < 18.5 kg/m2) pregnant women. In this preliminary study, the Maternal BEP Studies Harmonization Initiative aimed to assess the effect of BEP given to lactating mothers on length-for-age z-scores (LAZ) and identify effect modifiers.

Methods: This prospective individual participant data (IPD) meta-analysis included 4 randomized controlled trials in Burkina Faso (MISAME-III), India (IMPRINT), Nepal (MINT), and Pakistan (Mumta). To date, data are available for the IMPRINT and Mumta trials (n=1,773). Lactating mothers (13-49 yrs) and their infants were randomized into BEP (mothers only) or control groups at baseline for 6 months. Maternal BEP intervention consisted of prepared meals and snacks (600 kcals and 20 g protein) and a multiple micronutrient supplement (MMS) in IMPRINT and a micronutrient fortified food product (560 kcals and 16 g protein) with/without infant azithromycin in Mumta. The effect of maternal BEP intervention vs standard of care (iron and folic acid) was tested with linear regression. Multivariable analyses included baseline characteristics (maternal age, BMI, LAZ at baseline, and infant sex). Effect modifiers considered were maternal underweight, infant sex, and infant LAZ < -2 at baseline (≤7 days from birth).

Results: BEP intervention vs control improved LAZ at 6 months (adjusted mean difference (MD)=0.08; 95% CI: 0.00-0.16). There was no effect modification by maternal underweight (MD=-0.18; 95% CI: -0.47-0.11), infant sex (MD=0.09; 95% CI: -0.02-0.30), or low baseline LAZ (MD=-0.01; 95% CI: -0.23-0.20).

Conclusions: These preliminary IPD meta-analysis results indicate that maternal BEP with MMS provision vs standard of care during lactation showed a small improvement in infant LAZ at 6 months in low-resource settings.

Funding Sources: Bill & Melinda Gates Foundation