Provision of Supplementary Food to Pregnant Malawian Women with Moderate Acute Malnutrition Improves Gestational Weight Gain and Reduces Low Birth Weight
Authors: Papathakis Peggy , Schaffner Andrew , Garcia Patsy , Eckert Rachael , Fry Jocelyn , Malek Shirin , Trehan Indi , Thakwalakwa Chrissie , Maleta Ken , Manary Mark 
Published: June 2021

AimTo determine whether a ready‐to‐use supplementary food (RUSF) for pregnant women with moderate acute malnutrition (MAM) will improve maternal recovery from MAM and infant birth weight and length.MethodsThis randomized controlled clinical trial in southern Malawi enrolled 1872 pregnant women with MAM, defined as mid‐upper arm circumference (MUAC) between 20.6 cm and 23.0 cm. Women received RUSF, corn soy blend (CSB+) plus a multiple micronutrient antenatal supplement (UNIMMAP), or CSB+ plus iron and folic acid (IFA), the standard of care. Study foods provided approximately 900 kcal and 35 g protein daily. Women returned every 2 weeks for health checks and received their two‐week supply of treatment food until they either had a MUAC of >23.0 cm or delivered their baby. Treatment comparisons and duration effects were made utilizing ordinary least squares and logistic regression for continuous and categorical outcomes respectively.ResultsOn average, women were enrolled at 24 weeks gestation, with a BMI of 19.7 kg/m2 (range 15.24–24.05), and MUAC of 22.3 cm (range 20.2–23); nearly half were primaparous. Slightly less than 10% of mothers were HIV‐positive. Mothers in the RUSF and IFA groups had the highest mean gestational weight gain during treatment (3.1 kg, 2.8 kg, 2.9 kg in RUSF, UNIMMAP, IFA, respectively, p=0.0118). Recovery from MAM was not significantly different between the three groups (36.7%, 35.3%, and 32.1% for RUSF, UNIMMAP, IFA, respectively, p=0.26). There were no differences in any infant outcomes except for the rate of low birth weight (LBW), with the RUSF and IFA groups having the lowest rate (25.6% and 26.9%, respectively, vs. 32.8% in UNIMMAP group; p=0.0311). On average, infants across all treatment groups were small with mean birth z‐scores for length‐for‐age and weight‐for‐age near −1.3. When comparing birth outcomes from mothers who received any treatment for less than weeks to those receiving full treatment, longer treatment resulted in higher birth weight (2.7 kg vs 2.6, p=0.01) and less LBW (27.6% vs 36.7%, p=0.04). Using regression modeling, each additional week of treatment was associated with a 0.03 cm increase in infant birth length and a 221 g increase in gestational weight gain.ConclusionsThe RUSF and CSB+ with IFA treatments improved gestational weight gain during treatment more than CSB+ with UNIMMAP. Infant weights, lengths and head circumferences were similar regardless of treatment, but LBW was less frequent in the RUSF and CSB+ with IFA groups. In pregnant women with MAM, food and micronutrient supplementation is more effective when started earlier in pregnancy.Support or Funding InformationUSAID (FHI 360), USAID Feed the Future (Peanut and Mycotoxin Innovation Lab), Cal Poly San Luis Obispo Agricultural Research Initiative, U.S. Dairy Export Council, Dairy Research Initiative, Sackler Institute & Hickey Family Foundation