title: The effect of balanced protein energy supplementation in undernourished pregnant women and child physical growth in low- and middle-income countries: a systematic review and meta-analysis.
abstract: The beneficial effect of balanced protein energy supplementation during pregnancy on subsequent child growth is unclear and may depend upon the mother entering pregnancy adequately nourished or undernourished. Systematic reviews to-date have included studies from high-, middle- and low-income countries. However, the effect of balanced protein energy supplementation should not be generalised. This review assesses the effect of balanced protein energy supplementation in undernourished pregnant women from low- and middle-income countries on child growth. A systematic review of articles published in English (1970-2015) was conducted via MEDLINE, Scopus, the Cochrane Register and hand searching. Only peer-reviewed experimental studies analysing the effects of balanced protein energy supplementation in undernourished pregnant women from low- and middle-income countries with measures of physical growth as the primary outcome were included. Two reviewers independently assessed full-text articles against inclusion criteria. Validity of eligible studies was ascertained using the Quality Assessment Tool for Quantitative Studies (EPHPP QAT). In total, seven studies met the inclusion criteria. All studies reported on birthweight, five on birth length, three on birth head circumference, and one on longer-term growth. Standardised mean differences were calculated using a random-effects meta-analysis. Balanced protein energy supplementation significantly improved birthweight (seven randomised controlled trials, n = 2367; d = 0.20, 95% confidence interval, 0.03-0.38, P = 0.02). No significant benefit was observed on birth length or birth head circumference. Impact of intervention could not be determined for longer-term physical growth due to limited evidence. Additional research is required in low- and middle-income countries to identify impacts on longer-term infant growth.
authors: School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia.
authors: Briony
authors: B
authors: Stevens
authors: School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia.
authors: Petra
authors: P
authors: Buettner
authors: School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia.
authors: Kerrianne
authors: K
authors: Watt
authors: School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia.|Anton Breinl Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia.
authors: Alan
authors: A
authors: Clough
authors: School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
authors: Julie
authors: J
authors: Brimblecombe
authors: School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia.|Australian Institute of Tropical Health and Medicine, Townsville, Queensland, Australia.|Menzies School of Health Research, Darwin, Northern Territory, Australia.
authors: Jenni
authors: J
authors: Judd
mesh_terms: D001724:Birth Weight; D002657:Child Development / Q000502:physiology*; D003906:Developing Countries; D004044:Dietary Proteins / Q000008:administration & dosage*; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D002149:Energy Intake / Q000502:physiology; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D039382:Maternal Nutritional Physiological Phenomena; D011203:Poverty; D011247:Pregnancy
chemical_list: D004044:Dietary Proteins
keywords: child growth; international child health nutrition; low-income countries; maternal nutrition; systematic review; underweight