title: Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomised controlled trial .
abstract: OBJECTIVE
  To test the efficacy in terms of birth weight and infant survival of a diet supplement programme in pregnant African women through a primary healthcare system.
  
  
  METHODS
  5 year controlled trial of all pregnant women in 28 villages randomised to daily supplementation with high energy groundnut biscuits (4.3 MJ/day) for about 20 weeks before delivery (intervention) or after delivery (control).
  
  
  METHODS
  Rural Gambia.
  
  
  METHODS
  Chronically undernourished women (twin bearers excluded), yielding 2047 singleton live births and 35 stillbirths.
  
  
  METHODS
  Birth weight; prevalence of low birth weight (< 2500 g); head circumference; birth length; gestational age; prevalence of stillbirths; neonatal and postneonatal mortality.
  
  
  RESULTS
  Supplementation increased weight gain in pregnancy and significantly increased birth weight, particularly during the nutritionally debilitating hungry season (June to October). Weight gain increased by 201 g (P < 0.001) in the hungry season, by 94 g (P < 0.01) in the harvest season (November to May), and by 136 g (P < 0.001) over the whole year. The odds ratio for low birthweight babies in supplemented women was 0.61 (95% confidence interval 0.47 to 0.79, P < 0.001). Head circumference was significantly increased (P < 0.01), but by only 3.1 mm. Birth length and duration of gestation were not affected. Supplementation significantly reduced perinatal mortality: the odds ratio was 0.47 (0.23 to 0.99, P < 0.05) for stillbirths and 0.54 (0.35 to 0.85, P < 0.01) for all deaths in first week of life. Mortality after 7 days was unaffected.
  
  
  CONCLUSIONS
  Prenatal dietary supplementation reduced retardation in intrauterine growth when effectively targeted at genuinely at-risk mothers. This was associated with a substantial reduction in the prevalence of stillbirths and in early neonatal mortality. The intervention can be successfully delivered through a primary healthcare system.
authors.affiliation: MRC Dunn Nutrition Unit, Keneba, Gambia, West Africa.
authors.forename: S M
authors.initials: SM
authors.lastname: Ceesay
authors.forename: A M
authors.initials: AM
authors.lastname: Prentice
authors.forename: T J
authors.initials: TJ
authors.lastname: Cole
authors.forename: F
authors.initials: F
authors.lastname: Foord
authors.forename: L T
authors.initials: LT
authors.lastname: Weaver
authors.forename: E M
authors.initials: EM
authors.lastname: Poskitt
authors.forename: R G
authors.initials: RG
authors.lastname: Whitehead
mesh_terms: D001724:Birth Weight / Q000502:physiology*; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D009748:Nutrition Disorders / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011295:Prenatal Care; D011446:Prospective Studies; D012423:Rural Health / Q000706:statistics & numerical data*; D012621:Seasons; D015430:Weight Gain / Q000502:physiology