Effect of Energy Dense Biscuits in Undernourished Women on Birth Weight of Their Neonates

NCT ID: NCT02294240

Last Updated: 2016-01-11

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

224 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-09-30

Study Completion Date

2016-03-31

Brief Summary

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A nutrition trial which is based on the evidence that multivitamins \& micro nutrients provided during pregnancy in malnourished women will improve neonatal birth weight. There will be two arms. Arm one will provide energy dense biscuits to pregnant women with BMI \<20 \& gestational age less than 14 weeks. The other arm with same criteria will be provided with wheat flour, oil, iron \& folic acid. Neonatal birth weight is the primary outcome of interest but maternal weight gain, maternal hemoglobin \& ferritin levels and palatability of biscuits will also be assessed.

Detailed Description

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It has been realized that micronutrient deficiencies are a major determinant of intra-uterine growth retardation (IUGR) so multiple trials using micronutrient supplementation during pregnancy have been done \& shown a positive effect on birth weight.UNICEF/WHO/United Nations University(UNU) designed a new multiple micro nutrient supplement for pregnant and lactating women-the UNICEF/WHO/UNU international multiple micro nutrient preparation (UNIMMAP)-that provides the Recommended Dietary Allowance (RDA) of 15 vitamins and minerals. The benefit of this supplementation over routinely prescribed iron and folic supplementation has been proven in multiple trials. Evidence has shown reduction in low birth newborns.

This randomized controlled trial will compare the effect of calories and multiple micro nutrients provided in energy dense biscuits manufactured by EBM to malnourished pregnant women seen by AKU's Department of Paediatrics and Child Health at their Ali Akbar Shah Goth and Ibrahim Hyderi, compared to food supplementation ration of wheat and oil, plus iron and folic acid tablet supplementation.

Arm 1: Dietary supplementation with EBM biscuits containing multiple vitamins and calcium in the recommended allowance (RDA) for pregnant women Arm 2: Supplementation with Wheat flour and oil, iron and folic acid All undernourished pregnant females identified before 14 weeks of gestation through our surveillance system will be offered enrollment.

First contact: First meeting will be on enrollment. Patients will be randomized into any one of the arm. After randomization Weight, height, MUAC and BMI will be recorded. Samples for Ferritin \& hemoglobin will be drawn. In Arm 1 participant will be supplied with energy dense biscuits while in arm 2 will be provided with Wheat flour and oil after every two weeks.

End of each trimester: In second(20-22 week) \& third trimester(33-35 week) weight, MUAC \& BMI will be recorded. Supplementation will be given according to the Arm. Samples will also be drawn for Ferritin \& hemoglobin on third visit. Also at the third trimester visit palatability, accessibility and compliance with biscuits will be assessed by filling a preformed questionnaire.

Follow up of the newborn: Follow up of the newborn will be done within 48 hours. Length, weight, fronto-occipital circumference and MUAC will be recorded.

Conditions

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Birth Weight

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Arm One

Energy dense biscuits will be provided throughout pregnancy after enrolment

Group Type EXPERIMENTAL

Energy dense biscuits

Intervention Type DIETARY_SUPPLEMENT

Energy dense biscuits will be provided

Arm Two

Wheat Flour,oil, iron and folic acid will be provided fortnightly throughout pregnancy after enrolment

Group Type PLACEBO_COMPARATOR

Wheat Flour, oil, iron & Folic acid

Intervention Type OTHER

Wheat flour, oil, iron and folic acid will be provided

Interventions

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Energy dense biscuits

Energy dense biscuits will be provided

Intervention Type DIETARY_SUPPLEMENT

Wheat Flour, oil, iron & Folic acid

Wheat flour, oil, iron and folic acid will be provided

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

All pregnant females with gestational age ≤14 weeks and Body mass index(BMI) \<18.5

Exclusion Criteria

Pregnant females with underlying chronic illness (cardiovascular disease, diabetes, renal disease, and hypertension)

Pregnant females with history of multiple abortions ( two or more abortions)

Pregnant females identified as having twin/triplet pregnancies

Pregnant females not consenting to participate

Pregnant females who are already enrolled in any other study that may interfere with the results of this study
Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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English Biscuit Manufacturers

UNKNOWN

Sponsor Role collaborator

Aga Khan University

OTHER

Sponsor Role lead

Responsible Party

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Dr Faraz Naz Qamar

Assistant professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Farah N Qamar

Role: PRINCIPAL_INVESTIGATOR

Aga Khan University

Locations

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Ali Akbar Shah

Karachi, Sindh, Pakistan

Site Status

Ibrahim Hyderi

Karachi, Sindh, Pakistan

Site Status

Countries

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Pakistan

References

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de Onis M, Blossner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries. Eur J Clin Nutr. 1998 Jan;52 Suppl 1:S5-15.

Reference Type BACKGROUND
PMID: 9511014 (View on PubMed)

Kawai K, Spiegelman D, Shankar AH, Fawzi WW. Maternal multiple micronutrient supplementation and pregnancy outcomes in developing countries: meta-analysis and meta-regression. Bull World Health Organ. 2011 Jun 1;89(6):402-411B. doi: 10.2471/BLT.10.083758. Epub 2011 Mar 21.

Reference Type BACKGROUND
PMID: 21673856 (View on PubMed)

Roberfroid D, Huybregts L, Lanou H, Henry MC, Meda N, Menten J, Kolsteren P; MISAME Study Group. Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso. Am J Clin Nutr. 2008 Nov;88(5):1330-40. doi: 10.3945/ajcn.2008.26296.

Reference Type BACKGROUND
PMID: 18996870 (View on PubMed)

Berghella V. Prevention of recurrent fetal growth restriction. Obstet Gynecol. 2007 Oct;110(4):904-12. doi: 10.1097/01.AOG.0000267203.55718.aa.

Reference Type BACKGROUND
PMID: 17906027 (View on PubMed)

Ramakrishnan U, Grant FK, Goldenberg T, Bui V, Imdad A, Bhutta ZA. Effect of multiple micronutrient supplementation on pregnancy and infant outcomes: a systematic review. Paediatr Perinat Epidemiol. 2012 Jul;26 Suppl 1:153-67. doi: 10.1111/j.1365-3016.2012.01276.x.

Reference Type BACKGROUND
PMID: 22742608 (View on PubMed)

Osrin D, Vaidya A, Shrestha Y, Baniya RB, Manandhar DS, Adhikari RK, Filteau S, Tomkins A, Costello AM. Effects of antenatal multiple micronutrient supplementation on birthweight and gestational duration in Nepal: double-blind, randomised controlled trial. Lancet. 2005 Mar 12-18;365(9463):955-62. doi: 10.1016/S0140-6736(05)71084-9.

Reference Type BACKGROUND
PMID: 15766997 (View on PubMed)

Gupta P, Ray M, Dua T, Radhakrishnan G, Kumar R, Sachdev HP. Multimicronutrient supplementation for undernourished pregnant women and the birth size of their offspring: a double-blind, randomized, placebo-controlled trial. Arch Pediatr Adolesc Med. 2007 Jan;161(1):58-64. doi: 10.1001/archpedi.161.1.58.

Reference Type BACKGROUND
PMID: 17199068 (View on PubMed)

Jehan I, Harris H, Salat S, Zeb A, Mobeen N, Pasha O, McClure EM, Moore J, Wright LL, Goldenberg RL. Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Bull World Health Organ. 2009 Feb;87(2):130-8. doi: 10.2471/blt.08.050963.

Reference Type BACKGROUND
PMID: 19274365 (View on PubMed)

Imdad A, Bhutta ZA. Effect of balanced protein energy supplementation during pregnancy on birth outcomes. BMC Public Health. 2011 Apr 13;11 Suppl 3(Suppl 3):S17. doi: 10.1186/1471-2458-11-S3-S17.

Reference Type BACKGROUND
PMID: 21501434 (View on PubMed)

Kramer MS, Kakuma R. Energy and protein intake in pregnancy. Cochrane Database Syst Rev. 2003;(4):CD000032. doi: 10.1002/14651858.CD000032.

Reference Type BACKGROUND
PMID: 14583907 (View on PubMed)

Other Identifiers

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PED 3009

Identifier Type: -

Identifier Source: org_study_id

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