Low cost local food supplements could improve maternal and birth outcomes: a pilot randomized controlled trial

ObjectivesMaternal nutrition plays a crucial role in influencing fetal growth and birth outcomes. The government of Indonesia has provided a manufactured fortified food supplementation program for undernourished pregnant mothers. We hypothesized a low-cost local food supplementation (LFS) would improve maternal and birth outcomes compared with government food supplementation (GFS). MethodsWe conducted a randomized control trial. We enrolled 54 pregnant mothers with MUAC<23.5cm who were assigned into two groups. The intervention group received LFS and multiple micronutrient supplements (MMS). The control group received the GFS and iron and folic acid supplements (IFA). LFS was a balanced energy protein food supplement made from nuts and fish. LFS and GFS contained approximately 500kcal energy and 10grams protein. We compared the effectiveness of these two interventions using logistic and linear regression. ResultsAt the baseline, the two groups had similar characteristics. After 60 days of treatment, mothers in the LFS group were 2.28 folds more likely to increase MUAC (RR 2.28; 95%CI 1.58,3.27, p<0.001) and 4.73 folds to increase gestational weight (RR 4.73; 95%CI 1.37,16.3, p=0.015) than were mothers in the GFS group. For birth outcomes, in the LFS group had reduction of birthweight <3000grams (RR 0.15; 95%CI 0.023,0.98; p=0.048), short birth length (RR 0.068; 95%CI 0.005,0.93; p=0.044), and cesarean delivery (RR 0.11; 95%CI 0.022,0.61, p=011) as compared to the GFS group. Conclusions for PracticeLocal foods and MMS supplementation can improve maternal and birth outcomes. Therefore, local food supplements can be considered for food supplementation programs to undernourished pregnant mothers. Significance StatementO_ST_ABSWhat is already known on this subject?C_ST_ABSBalanced protein-energy foods fortified with multiple micronutrients supplements has been known as an effective intervention to improve birth length and birth weight for underweight pregnant women. What this study adds?The provision of balanced energy protein of local foods supplements combined with multiple micronutrients supplements pills, showed the reduction on birth weight < 3000grams and short birth length. Surprisingly could reduce cesarean deliveries, and furthermore could give a chance to produce local food supplements by micro and small enterprises in community setting. Future studies should be conducted using better research design and embeded in the food and stunting reduction system.