Low Birth Weight is More Common in Food Insecure Pregnant Malawian Women with Moderate Malnutrition
Authors: Quon Sarah , Papathakis Peggy , Schaffner Andrew , Finfer Erica , Bell Lauren , Peace Bryanna , Varni Marissa , Gates Elaina , Tolleshaug Cammie , Manary Mark 
Published: June 2021

AimTo determine if food insecurity for pregnant women with moderate malnutrition (MAM) affects gestational weight gain, infant weight and length.MethodsThis randomized controlled trial enrolled 1872 pregnant women with MAM, defined as mid‐upper arm circumference (MUAC) between 20.6 and 23.0 cm. Women aged 16 to 45 years enrolled at approximately 24 weeks gestation. Household Food Insecurity Access Scale (HFIAS) survey was obtained at enrollment. Women returned every two weeks for measurements and received supplemental foods; each provided ~900 kcals, 35 g protein, and ~2 times the recommended dietary allowance for micronutrients daily. HFIAS score was determined by adding each subject's responses to 9 questions with numerical values (0 = no, 1 = rarely, 2 = sometimes, 3 = often); sum of scores range from 0 to 27. The subjects were categorized by their severity of food insecurity (secure, mild, moderate, or severe) according to Food and Nutrition Technical Assistance (FANTA III) guidelines. Maternal anthropometric measurements (weight, height, MUAC) were taken at enrollment, during follow‐up, and at delivery; hemoglobin was measured at enrollment. Infant measurements (head circumference, length, weight, MUAC) were taken at birth, 6 weeks, and 3 months; z‐scores were calculated to determine low birth weight (LBW) and stunting. Maternal and infant measurements were compared independently against HFIAS categories and questions.ResultsMean sum of HFIAS scores was 10.0 ± 0.05. Most mothers (1318 or 70.4%) were severely food insecure [95 (5.1%) food secure, 81 (4.3%) mildly and 377 (20.2%) moderately food insecure]. Gestational weight gain before delivery, low weekly maternal weight gain, BMI and MUAC were not different by HFIAS category. There was a trend towards less anemia in the most food insecure group (78.5%, 75.3%, 75.1%, 69.8% in secure, mild, moderate and severe, respectively; p = 0.07). LBW was more common in the severely food insecure group (27.0%, 20.9%, 22.7%, 30.4% in secure, mild, moderate, and severe; p=0.0289); there was a trend toward worse birth stunting in the secure group (28.6%, 25.0%, 18.6%, 25.6% in secure, mild, moderate, and severe; p=0.07). Birth length was slightly different amongst groups (46.9 cm, 47.1 cm, 47.4 cm, and 46.9 cm in secure, mild, moderate, and severe; p=0.047). There was no difference between HFIAS category and infant birth MUAC, weight, or head circumference. Infant measures at 6 weeks were no different by HFIAS category, however, infant weight at 3 months was lowest in the severely food insecure families (5.52 kg, 5.60 kg, 5.64 kg, 5.49 kg in secure, mild, moderate, and severe, respectively; p=0.043).ConclusionThe majority of pregnant women with MAM were severely food insecure. Maternal anthropometric measures were not significantly different by HFIAS group. Although all mothers received food and micronutrient supplements during part of pregnancy, low birth weight infants were more common from severely food insecure mothers. The impact of food insecurity during pregnancy continued to impact infant weight at three months.Support or Funding InformationUSAID (FHI360), USAID Feed the Future (Peanut and Micotoxin Innovation Lab), Cal Poly San Luis Obispo Agriculture Research Initiative, US Dairy Export Council, Dairy Research Initiative