Balanced Energy-Protein Supplementation Package in Lactating Women Increases Anthropometric Outcomes in Mothers and Infants: A Prospective IPD Meta-Analysis

Objectives: The Maternal Balanced Energy-Protein (BEP) Studies Harmonization Initiative, a collaboration of BEP trials in Africa and Asia, aimed to assess the effect of BEP given to lactating women on maternal and infant anthropometry. Methods: We conducted a one-stage prospective individual-participant data meta-analysis with 3 randomized controlled trials in Burkina Faso (MISAME-III), India (IMPRINT), and Pakistan (MumtaLW). Lactating mothers (13-45 yrs) and their infants (n=2,355 pairs) were randomized to BEP or control (standard of care, with iron and folic acid)) arms for 6 months postpartum; MumtaLW had an additional BEP intervention arm that gave one dose of azithromycin to infants. BEP supplements were 393-800 kcals, 15-21 g protein, and included multiple micronutrients (MMN). Maternal and infant weight, height/length, and mid-upper arm circumference (MUAC) were measured at enrollment (within 7 days of birth) and 6 months; maternal BMI and infant z-scores were calculated. We used multivariable mixed-effects linear regression models to examine the effect of BEP on outcomes, controlling for trial as a random effect and maternal age, education and BMI (baseline), baseline values for each outcome, and infant sex as fixed effects. Results: BEP package vs control resulted in a higher infant length-for-age z-score (LAZ; adjusted mean difference (AMD)=0.10; 95%CI: 0.03, 0.16), weight-for-age z-score (WAZ; AMD=0.13; 95%CI: 0.05, 0.21), and MUAC-for-age z-score (MUACZ; AMD=0.09; 95%CI: 0.01, 0.17) but no difference in weight-for-length z-score (AMD=0.07; 95%CI: -0.03, 0.16) and head circumference z-score (AMD=0.06; 95%CI: -0.03, 0.16). Also, BEP package vs control resulted in higher maternal BMI (AMD=0.47 kg/m2; 95%CI: 0.27, 0.66) and MUAC (AMD=0.41 cm; 95%CI: 0.29, 0.54). Results were similar when tested without the combined BEP and infant azithromycin intervention group. Conclusions: BEP supplementation with MMN compared to the standard of care during lactation in low-resource settings showed small increases in some infant and maternal anthropometry at 6 months. Funding Sources: Bill & Melinda Gates Foundation.