(P24-036-24) Effect of a Prenatal Balanced Energy-Protein (BEP) Supplement on Gestational Weight Gain in Rural Ethiopia

Objectives: To examine the effect of a prenatal balanced energy protein supplement (BEP) on gestational weight gain in rural Amhara, Ethiopia.

Methods: We conducted a pragmatic, factorial cluster randomised clinical effectiveness study among pregnant women enrolled < 24 weeks gestation in Amhara, Ethiopia. Twelve rural health centers were randomized to provide routine care (including iron and folic acid), or an enhanced nutrition package (ENP) that included iodized salt and, among women with mid-upper arm circumference (MUAC) < 23 cm, a daily micronutrient-fortified BEP. Gestational weight gain (GWG) was calculated overall and as a rate (kg/wk) from enrollment to the last antenatal care (ANC) visit. Mixed effects linear regression was used to estimate intervention impact on GWG, adjusting for enrollment weight and gestational age (GA) and imbalanced baseline covariates.

Results: From August 2020 to December 2021, 2399 pregnant women were enrolled, and pregnancy follow-up ended in June 2022.  In the ENP arm (n=1,204), at enrollment, the mean GA was 16.9 wks (sd 5.3), maternal weight was 51.2 (6.6) kg, and 28.5% had a MUAC < 23 cm.  In the routine care arm (1,188), the mean enrollment GA was 16.7 (sd 5.4) wks, maternal weight 51.8 (6.9) kg, and 28.9% had a MUAC < 23 cm. Women in the intervention arm eligible for BEP consumed on average 74 (sd 55) days (52% of eligible days).  Among women with MUAC < 23 cm, in the intervention arm the total GWG and GWG rate were 5.8 kg (sd 3.2) and 0.30 kg/wk (sd 0.15), and in the routine care arm the GWG was 5.5 kg (sd 3.2) and GWG rate 0.30 kg/wk (sd 0.17).  GWG and GWG rate were not higher in the BEP intervention arm compared to the control (GWG: β=0.31 kg [95%CI: -0.07,  0.68]; p=0.11; GWG rate β=0.011 kg/wk [95%CI: -0.027, 0.049], p=0.54). Among women with >50% BEP adherence, the mean GWG was 5.9 kg(3.2) and GWG rate was 0.32 (0.15)kg/week. GWG was greater among women with higher BEP adherence compared to the control arm (GWG β=0.41 kg [95%CI: 0.02, 0.81], p=0.04; GWG rate β=0.022 kg/wk [95%CI: -0.015, 0.059], p=0.21).

Conclusions: Among undernourished pregnant women in Ethiopia, the BEP supplementation arm did not have higher maternal GWG than the routine care arm, although GWG was greater among those with high BEP adherence. The effectiveness of the intervention may have been hampered by low adherence to the supplement.

Funding Sources: Bill and Melinda Gates Foundation