Interventions for Moderate Malnutrition in Pregnancy

NCT ID: NCT02120599

Last Updated: 2016-11-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1867 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-03-31

Study Completion Date

2016-08-31

Brief Summary

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Malnutrition during pregnancy is more common in poor women in the developing world due to inadequate dietary intake combined with increased nutrient requirements; pregnancy risk is more consequential than among other demographic groups with increased risk of maternal and infant mortality and the lifelong effects of fetal malnutrition. The benefits of treating moderate malnutrition during pregnancy remain largely undocumented. This study tests the hypothesis that providing either a fortified flour or fortified paste-based supplementary food designed to replete the nutrient deficits during pregnancy will result in improved maternal nutritional recovery rates and higher infant birth weights and lengths. This study is a randomized, controlled clinical trial of 3 supplementary foods in 1800 moderately malnourished Malawian women who are pregnant. Subjects will receive one of 3 food rations: 1) a ready-to-use supplementary food formulated to deliver about 200% of the recommended daily allowance (RDA) of most micronutrients in pregnancy (RUSF-P), 2) corn soy blend with a multiple micronutrient tablet chosen to deliver about 200% of the RDA of most micronutrients (CSB-P) or 3), the standard of care which is a corn soy blend with supplementary iron and folic acid (CSB), delivering between 0-350% of the RDA. Subjects will receive the supplementary food until they recover from MAM. The outcome of the pregnancy and maternal nutritional status will be followed until 3 months after delivery.

Detailed Description

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Conditions

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Pregnancy Moderate Malnutrition

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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corn-soy-blend

This is the control group for the study, which will receive the Malawi standard of care. The treatment provided to women randomized to this arm of the study includes daily iron (60 mg) and folic acid (400 mcg) supplementation, along with 4 kg/2 weeks corn-soy blend (\~357 gm/d CSB).

Group Type ACTIVE_COMPARATOR

corn-soy blend

Intervention Type DIETARY_SUPPLEMENT

iron

Intervention Type DIETARY_SUPPLEMENT

folic acid

Intervention Type DIETARY_SUPPLEMENT

corn-soy-blend + multiple micronutrients

The treatment provided to women randomized to this arm of the study includes 200gm/d CSB along with a standard maternal multiple micronutrient tablet, which together provide a comparable amount of energy, protein and micronutrients to the ready-to-use supplemental food. The micronutrient supplement known as the United Nations Children's Emergency Fund (UNICEF) / World Health Organization (WHO) / United Nations University (UNU) international multiple micronutrient preparation (UNIMMAP) is widely available and has been used in many settings worldwide in pregnant women.

Group Type EXPERIMENTAL

corn-soy blend

Intervention Type DIETARY_SUPPLEMENT

UNIMMAP

Intervention Type DIETARY_SUPPLEMENT

ready-to-use supplementary food

RUSF-P (ready-to-use supplementary food) provides 750 kcal/d, 20 g protein/d, and 200% of RDA/d for most micronutrients during pregnancy (except for vitamins A, B3, folic acid, minerals iodine, magnesium, and calcium which will remain near 100%)

Group Type EXPERIMENTAL

ready-to-use supplementary food

Intervention Type DIETARY_SUPPLEMENT

Interventions

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ready-to-use supplementary food

Intervention Type DIETARY_SUPPLEMENT

corn-soy blend

Intervention Type DIETARY_SUPPLEMENT

iron

Intervention Type DIETARY_SUPPLEMENT

folic acid

Intervention Type DIETARY_SUPPLEMENT

UNIMMAP

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* Pregnant and consenting to study participation and HIV testing (if not already performed)
* mid-upper-arm circumference (MUAC) ≤ 23 cm
* planning to stay in the area and attend the clinic during pregnancy and for 3 months post partum

Exclusion Criteria

* Pregnancy complications such as gestational diabetes, pre-eclampsia, hypertension
* Severe anemia (Hg \<7.0 mg/dl)
* Severe malnutrition
* under 18 years of age
* over estimated 35 weeks of gestation
Minimum Eligible Age

14 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Washington University School of Medicine

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mark J Manary, MD

Role: STUDY_CHAIR

Washington University in St. Louis; University of Malawi

Peggy C Papathakis, PhD, RD

Role: STUDY_DIRECTOR

California Polytechnic State University-San Luis Obispo

Kenneth Maleta, MBBS PhD

Role: PRINCIPAL_INVESTIGATOR

University of Malawi

Chrissie Thakwalakwa

Role: PRINCIPAL_INVESTIGATOR

University of Malawi

Locations

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Blantyre District

Blantyre, , Malawi

Site Status

Chikwawa District

Chikwawa, , Malawi

Site Status

Countries

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Malawi

References

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Callaghan-Gillespie M, Schaffner AA, Garcia P, Fry J, Eckert R, Malek S, Trehan I, Thakwalakwa C, Maleta KM, Manary MJ, Papathakis PC. Trial of ready-to-use supplemental food and corn-soy blend in pregnant Malawian women with moderate malnutrition: a randomized controlled clinical trial. Am J Clin Nutr. 2017 Oct 1;106(4):1062-1069. doi: 10.3945/ajcn.117.157198.

Reference Type DERIVED
PMID: 28793991 (View on PubMed)

Other Identifiers

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201401112

Identifier Type: -

Identifier Source: org_study_id