Leaf concentrate fortification of antenatal protein-calorie snacks improves pregnancy outcomes.
Ready-to-eat (RTE) snacks are routinely distributed to pregnant women in India. These provide protein and calories but are low in micronutrients. We investigated whether RTE snacks fortified with leaf concentrate (LC) could improve pregnancy outcomes, including maternal haemoglobin (Hb) concentrations and infants' birthweight. This randomized controlled two-arm trial was conducted over 18 months: control (sRTE) group received standard 120 g RTE snack (102 g wheat flour, 18 g soya flour); intervention (lcRTE) group received the same snack fortified with 7 g LC. The study was conducted in Jaipur, Rajasthan, India. One hundred and five pregnant women aged 18-35 years were studied. Among the 105 women randomized to the two arms of the trial, 2 (1.9%) were severely anaemic (Hb ≤ 6.0 g/dL); 55 (53.4%) were moderately anaemic (Hb 6.0-8.0 g/dL); 34 (33.0%) were mildly anaemic (Hb 8.6-10.9 g/dL); and 12 (11.7%) were not anaemic (Hb ≥ 11.0 g/dL). In the final month of pregnancy, 83.0% (39/47) of women in the sRTE group had Hb ≤ 8.5 g/dL compared to 37.8% (17/45) in the lcRTE group (p<0.001). After adjustment for age and baseline Hb concentration, the difference in Hb concentrations due to LC fortification was 0.94 g/dL (95% CI 6.8-12.0; p<0.001). Mean live birthweight in the lcRTE group was 2,695 g (SD 325 g) compared to 2,545 g (297 g) in the sRTE group (p=0.02). The lcRTE snacks increased infants' birthweight by 133.7 g (95% CI 7.3-260.2; p=0.04) compared to sRTE snacks. Leaf concentrate fortification of antenatal protein-calorie snacks in a low-income setting in India protected against declining maternal haemoglobin concentrations and increased infants' birthweight when compared with unfortified snacks. These findings require replication in a larger trial.
Department of Foods and Nutrition, University of Rajasthan, Jaipur, India.
Anjna
A
Magon
School of Social & Community Medicine, University of Bristol, UK.
Simon M
SM
Collin
Department of Foods and Nutrition, University of Rajasthan, Jaipur, India.
Pallavi
P
Joshi
Association pour la Promotion des Extraits Foliaires en Nutrition (APEF), Nozet, F-51230, Connantre, France.
Glyn
G
Davys Late
Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, United Arab Emirates.
Amita
A
Attlee
Department of Foods and Nutrition, University of Rajasthan, Jaipur, India.
Beena
B
Mathur
D018798:Anemia, Iron-Deficiency / Q000517:prevention & control*; D001724:Birth Weight; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007194:India; D007231:Infant, Newborn; D010936:Plant Extracts / Q000008:administration & dosage*; D018515:Plant Leaves / Q000737:chemistry; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011256:Pregnancy Outcome; D062410:Snacks; D055815:Young Adult
D010936:Plant Extracts
Anaemia; Birthweight; India; Leaf concentrate; Pregnancy