Wang Dongqing, Partap Uttara, Liu Enju, Costa Janaína Calu, Cliffer Ilana R, Wang Molin, Nookala Sudeer Kumar, Subramoney Vishak, Briggs Brittany, Ahmed Imran, Argaw Alemayehu, Ariff Shabina, Bhandari Nita, Chowdhury Ranadip, Erchick Daniel, García-Guerra Armando, Ghaffarpour Masoumah, Hanley-Cook Giles, Huybregts Lieven, Jehan Fyezah, Kaseb Fatemeh, Krebs Nancy F, Lachat Carl, Lama Tsering Pema, Manandhar Dharma S, McClure Elizabeth M, Moore Sophie E, Muhammad Ameer, Neufeld Lynnette M, Prentice Andrew M, Quezada-Sánchez Amado D, Roberfroid Dominique, Saville Naomi M, Shafiq Yasir, Shrestha Bhim P, Sonko Bakary, Soofi Sajid, Taneja Sunita, Tielsch James M, Toe Laéticia Céline, Valaei Naser, Fawzi Wafaie W
Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, United States of America.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.
PLoS Med. 2025 Feb 3;22(2):e1004523. doi: 10.1371/journal.pmed.1004523. eCollection 2025 Feb.
Understanding the effects of balanced energy and protein (BEP) supplements on gestational weight gain (GWG) and how the effects differ depending on maternal characteristics and the nutritional composition of the supplements will inform the implementation of prenatal BEP interventions.
Individual participant data from 11 randomized controlled trials of prenatal BEP supplements (N = 12,549, with 5,693 in the BEP arm and 6,856 in the comparison arm) in low- and middle-income countries were used. The primary outcomes included GWG adequacy (%) and the estimated total GWG at delivery as continuous outcomes, and severely inadequate (<70% adequacy), inadequate GWG (<90% adequacy), and excessive GWG (>125% adequacy) as binary outcomes; all variables were calculated based on the Institute of Medicine recommendations. Linear and log-binomial models were used to estimate study-specific mean differences or risk ratios (RRs), respectively, with 95% confidence intervals (CIs) of the effects of prenatal BEP on the GWG outcomes. The study-specific estimates were pooled using meta-analyses. Subgroup analyses were conducted by individual characteristics. Subgroup analyses and meta-regression were conducted for study-level characteristics. Compared to the comparison group, prenatal BEP led to a 6% greater GWG percent adequacy (95% CI: 2.18, 9.56; p = 0.002), a 0.59 kg greater estimated total GWG at delivery (95% CI, 0.12, 1.05; p = 0.014), a 10% lower risk of severely inadequate GWG (RR: 0.90; 95% CI: 0.83, 0.99; p = 0.025), and a 7% lower risk of inadequate GWG (RR: 0.93; 95% CI: 0.89, 0.97; p = 0.001). The effects of prenatal BEP on GWG outcomes were stronger in studies with a targeted approach, where BEP supplements were provided to participants in the intervention arm under specific criteria such as low body mass index or low GWG, compared to studies with an untargeted approach, where BEP supplements were provided to all participants allocated to the intervention arm.
Prenatal BEP supplements are effective in increasing GWG and reducing the risk of inadequate weight gain during pregnancy. BEP supplementation targeted toward pregnant women with undernutrition may be a promising approach to delivering the supplements.
了解能量和蛋白质平衡（BEP）补充剂对孕期体重增加（GWG）的影响，以及这些影响如何因孕产妇特征和补充剂的营养成分而异，将为产前BEP干预措施的实施提供依据。
使用了来自低收入和中等收入国家的11项产前BEP补充剂随机对照试验的个体参与者数据（N = 12549，BEP组5693人，对照组6856人）。主要结局包括GWG充足率（%）和分娩时估计的总GWG作为连续结局，以及严重不足（<70%充足率）、GWG不足（<90%充足率）和GWG过度（>125%充足率）作为二元结局；所有变量均根据医学研究所的建议计算。分别使用线性模型和对数二项模型估计特定研究的平均差异或风险比（RR），以及产前BEP对GWG结局影响的95%置信区间（CI）。使用荟萃分析汇总特定研究的估计值。按个体特征进行亚组分析。对研究水平特征进行亚组分析和荟萃回归。与对照组相比，产前BEP使GWG充足率提高了6%（95%CI：2.18，9.56；p = 0.002），分娩时估计的总GWG增加了0.59kg（95%CI，0.12，1.05；p = 0.014），严重不足GWG的风险降低了10%（RR：0.90；95%CI：0.83，0.99；p = 0.025），GWG不足的风险降低了7%（RR：0.93；95%CI：0.89，0.97；p = 0.001）。与采用非针对性方法的研究相比，在采用针对性方法的研究中，即根据低体重指数或低GWG等特定标准向干预组参与者提供BEP补充剂，产前BEP对GWG结局的影响更强，在非针对性方法的研究中，BEP补充剂提供给分配到干预组的所有参与者。
产前BEP补充剂可有效增加GWG并降低孕期体重增加不足的风险。针对营养不良孕妇的BEP补充可能是一种有前景的补充剂给药方法。
