EFFECTS ON BIRTH-WEIGHT AND PERINATAL-MORTALITY OF MATERNAL DIETARY-SUPPLEMENTS IN RURAL GAMBIA - 5-YEAR RANDOMIZED CONTROLLED TRIAL

Objective: To test the efficacy in terms of birth weight and infant su rvival of a diet supplement programme in pregnant African women throug h a primary healthcare system. Design: 5 year controlled trial of all pregnant women in 28 villages randomised to daily supplementation with high energy groundnut biscuits (4.3MJ/day) for about 20 weeks before delivery (intervention) or after delivery (control). Setting: Rural Ga mbia Subjects: Chronically undernourished women (twin bearers excluded ), yielding 2047 singleton live births and 35 stillbirths. Main outcom e measures: Birth weight; prevalence of low birth weight (<2500 g); he ad circumference; birth length; gestational age; prevalence of stillbi rths; neonatal and postneonatal mortality. Results: Supplementation in creased weight gain in pregnancy and significantly increased birthweig ht, particularly during the nutritionally debilitating hungry season ( June to October). Weight gain increased by 201 g (P<0.001) in the hung ry season, by 94 g (P<0.01) in the harvest season (November to May), a nd by 136 g (P<0.001) over the whole year The odds ratio for low birth weight babies in supplemented women was 0.61 (95% confidence interval 0.47 to 0.79, P<0.001). Head circumference was significantly Increased (P<0.01), but by only 3.1 mm. Birth length and duration of gestation were not affected. Supplementation significantly reduced perinatal mor tality: the odds ratio was 0.47 (0.23 to 0.99, P<0.05) for stillbirths and 0.54 (0.35 to 0.85, P<0.01) for all deaths in first week of life. Mortality after 7 days was unaffected. Conclusion: Prenatal dietary s upplementation reduced retardation in intrauterine growth when effecti vely targeted at genuinely at-risk mothers. This was associated with a substantial reduction in the prevalence of stillbirths and in early n eonatal mortality. The intervention can be successfully delivered thro ugh a primary healthcare system.