| Title: |
The effect of prenatal balanced energy and protein supplementation on small vulnerable newborn types in low- and middle-income countries: A systematic review and meta-analysis of individual participant data. |
| Authors: |
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; Dailey-Chwalibóg, Trenton; Hanley-Cook, Giles T; Huybregts, Lieven; Jehan, Fyezah; Krebs, Nancy F; Lachat, Carl; Manandhar, Dharma S; McClure, Elizabeth M; Moore, Sophie E; Muhammad, Ameer; Nisar, Muhammad Imran; Prentice, Andrew M; Roberfroid, Dominique; Saville, Naomi M; Shafiq, Yasir; Shrestha, Bhim P; Sonko, Bakary; Soofi, Sajid; Taneja, Sunita; Toe, Laéticia Céline; Fawzi, Wafaie W |
| Publisher Information: |
Public Library of Science |
| Publication Year: |
2026 |
| Collection: |
London School of Hygiene & Tropical Medicine: LSHTM Research Online |
| Description: |
BACKGROUND: Small vulnerable newborn (SVN) types, defined by combinations of being born too soon or too small, have distinct determinants, health consequences, and prevention strategies. The effects of prenatal balanced energy and protein (BEP) supplementation on SVN types remain unknown. METHODS AND FINDINGS: We conducted a systematic review and meta-analysis of individual participant data from eight randomized controlled trials of prenatal BEP supplements (N = 10,252, with 5,164 in the BEP arm and 5,088 in the control arm) in low- and middle-income countries were used. The control arms varied across studies and included context-specific standards of care, iron and folic acid supplements, or multiple micronutrient supplements. Newborns were classified into 10 groups through the combinations of preterm birth, small for gestational age (SGA) birth, and low birthweight (LBW), such as term-appropriate-for-gestational-age (AGA)-nonLBW, preterm-SGA-LBW, preterm-large-for-gestational-age-LBW, term-SGA-LBW, preterm-AGA-nonLBW, and other permutations. Newborns were also analyzed using a four-group categorization that included term-nonSGA, preterm-nonSGA, term-SGA, and preterm-SGA. Log-binomial models were used to estimate study-specific risk ratios (RRs), which were pooled using meta-analyses. Subgroup analyses were conducted by maternal age, parity, gestational age at enrollment, early pregnancy body mass index, and maternal anemia status. In the 10-group categorization of SVNs, on average, prenatal BEP supplementation led to a 30% lower risk of preterm-SGA-LBW (RR: 0.70; 95% CI [0.53, 0.91]; P = 0.009), a 25% lower risk of preterm-AGA-LBW (RR: 0.75; 95% CI [0.60, 0.93]; P = 0.009), and a 20% lower risk of term-SGA-LBW (RR: 0.80; 95% CI [0.72, 0.90]; P < 0.001). In the four-group categorization, prenatal BEP supplementation led to a 31% lower risk of preterm-SGA (RR: 0.69; 95% CI [0.52, 0.91]; P = 0.008) and a 12% lower risk of term-SGA (RR: 0.88; 95% CI [0.81, 0.96]; P = 0.005). The protective effect of prenatal ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| ISSN: |
1549-1277 |
| Relation: |
https://researchonline.lshtm.ac.uk/id/eprint/4680771/1/Wang-etal-2026-The-effect-of-prenatal-balanced.pdf; Wang, DongqingORCID logo; Partap, UttaraORCID logo; Liu, EnjuORCID logo; Costa, Janaína Calu; Cliffer, Ilana R; Wang, MolinORCID logo; Nookala, Sudeer KumarORCID logo; Subramoney, Vishak; Briggs, BrittanyORCID logo; Ahmed, ImranORCID logo; +25 more.Argaw, AlemayehuORCID logo; Ariff, Shabina; Bhandari, NitaORCID logo; Chowdhury, RanadipORCID logo; Dailey-Chwalibóg, TrentonORCID logo; Hanley-Cook, Giles TORCID logo; Huybregts, LievenORCID logo; Jehan, FyezahORCID logo; Krebs, Nancy F; Lachat, Carl; Manandhar, Dharma SORCID logo; McClure, Elizabeth M; Moore, Sophie EORCID logo; Muhammad, AmeerORCID logo; Nisar, Muhammad ImranORCID logo; Prentice, Andrew M ORCID logo; Roberfroid, DominiqueORCID logo; Saville, Naomi MORCID logo; Shafiq, YasirORCID logo; Shrestha, Bhim P; Sonko, BakaryORCID logo; Soofi, SajidORCID logo; Taneja, SunitaORCID logo; Toe, Laéticia CélineORCID logo; and Fawzi, Wafaie WORCID logo (2026) The effect of prenatal balanced energy and protein supplementation on small vulnerable newborn types in low- and middle-income countries: A systematic review and meta-analysis of individual participant data. PLoS medicine, 23 (2). e1004716. ISSN 1549-1277 DOI:10.1371/journal.pmed.1004716 |
| DOI: |
10.1371/journal.pmed.1004716 |
| Availability: |
https://researchonline.lshtm.ac.uk/id/eprint/4680771/; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004716; https://doi.org/10.1371/journal.pmed.1004716 |
| Rights: |
cc_by_4 |
| Accession Number: |
edsbas.F69494B1 |
| Database: |
BASE |