Summary
This four-arm randomised controlled trial in Pakistan evaluated whether balanced energy-protein supplementation (BEP) during pregnancy, with or without azithromycin or choline/nicotinamide, improves birth outcomes in undernourished pregnant women. Compared to controls, BEP plus azithromycin increased birth weight by 104 g and reduced early neonatal mortality to 14.0 per 1000 live births (versus 31.7 in controls), whilst BEP plus choline/nicotinamide showed a non-significant 58 g birth weight increase and a reduction in neonatal mortality to 21.3 per 1000 live births. The authors conclude that synergistic combinations of nutritional and pharmacological interventions may offer benefits beyond supplementation alone in this setting.
Regional applicability
The study was conducted in Pakistan with pregnant women experiencing undernutrition, a context differing substantially from United Kingdom maternal nutrition patterns and healthcare provision. Findings may have limited direct applicability to UK antenatal practice, although the underlying mechanisms linking maternal nutritional status to birth outcomes are universal; transferability would depend on whether UK subpopulations with comparable undernutrition exist and whether UK guidelines would endorse routine azithromycin use in pregnancy.
Key measures
Birth weight (grams), early neonatal mortality (per 1000 live births), infant anthropometric measurements within 72 hours of birth
Outcomes reported
Birth weight and early neonatal mortality in infants born to pregnant women receiving balanced energy-protein supplementation alone or combined with azithromycin or choline/nicotinamide.
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