Increased birthweight after prenatal dietary supplementation of rural African women

Birthweight data from 197 rural Gambian women who received an energy-dense prenatal dietary supplement over a 4-y period (net intake = 430 kcal/d) was compared with data from 182 women from 4 baseline years. Preintervention birthweights averaged 2944 +/- 43 (SEM) g when women were in positive energy balance during the dry harvest season (pregnancy weight gain greater than 1200 g/mo). Birthweights decreased to 2808 +/- 41 g (p less than 0.01) in the wet season when food shortages and agricultural work caused negative energy balance (weight gain less than 500 g/mo). There were no detectable secular trends in the baseline data. Supplementation was ineffective during the dry season but highly effective during the wet season: +225 +/- 56 g, p less than 0.001 (unadjusted) or +200 +/- 53 g, p less than 0.001 (adjusted for sex, season, and parity) by between-child multiple regression analysis; +231 +/- 65 g, p less than 0.001 by within-mother analysis. The proportion of low-birthweight babies (less than 2501 g) decreased from 23.7–7.5%, p less than 0.002. The observed threshold effect emphasizes the importance of selective targeting of interventions to truly at-risk groups. Birthweight data from 197 rural Gambian women who received an energy-dense prenatal dietary supplement over a 4 year period (net intake = 430 kcal/day) was compared with data from 182 women from 4 baseline years. Preintervention birthweights averaged 2944 +or- 43 (SEM) grams when women were in positive energy balance during the dry harvest season (pregnancy weight gain 1200 gram/month). Birthweights decreased 2808 +or- 41 grams (p0.01) in the wet season when food shortages and agricultural work caused negative energy balance (weight gain 500 grams/month). There were no detectable secular trends in the baseline data. Supplementation was ineffective during the dry season but highly effective during the wet season: +225 +or- 56 frams, p0.001 (unadjusted) or +200 +or- 53 grams, p0.001 (adjusted for sex, season, and parity) by between-child multiple regression analysis; +231 +or- 65 grams, p0.001 by within-mother analysis. The proportion of babies of low birthweight (2501 grams) decreased from 23.7 to 7.5%, p0.002. The observed threshold effect emphasizes the importance of selective targeting of interventions to truly at-risk groups.