Impact of targeted food supplementation on pregnancy weight gain and birth weight in rural Bangladesh: an assessment of the Bangladesh Integrated Nutrition Program (BINP).

Objectives: To assess whether the Bangladesh Integrated Nutrition Programme (BINP) correctly identified which pregnant women should be enrolled in the food supplementation programme, whether supplementation commenced on time and was taken on a regular basis. A second objective was to determine whether food supplementation led to enhanced pregnancy weight gain and reduction in the prevalence of low birth weight.

Design: A one-year community-based longitudinal study.

Setting: A rural union of Bhaluka Upazila, Mymensingh, located 110 km north-west of Dhaka City, the capital of Bangladesh.ParticipantsA total of 1104 normotensive, non-smoking pregnant women who attended Community Nutrition Centres were studied from first presentation at the centre until child delivery.

Results: Pregnant women who had a BMI of <18.5 kg/m(2) on first presentation should have been selected for supplementary feeding (2512 kJ (600 kcal)/d for six days per week) starting at month 4 (16 weeks) of pregnancy. However, of the 526 women who had BMI < 18.5 kg/m(2), only 335 received supplementation; so the failure rate was 36.3 %. In addition, of those receiving supplementation, only 193 women (36.7 % of 526 women) commenced supplementation at the correct time, of whom thirty-two (9.6 % of 335 women) received supplementation for the correct number of days (100 % days). There were no significant differences in mean weight gain between BMI < 18.5 kg/m(2) supplemented or non-supplemented groups or between the equivalent groups with BMI > or = 18.5 kg/m(2). Weight gain was inversely related to initial weight, so lighter women gained relatively more weight during their pregnancy than heavier women. The mean birth weight in the supplemented and non-supplemented groups was 2.63 kg and 2.72 kg, respectively. Mothers with BMI < 18.5 kg/m(2) who were or were not supplemented had almost equal percentages of low-birth-weight babies (21 % and 22 %, respectively).

Conclusion: The study raises doubt about the efficiency of the BINP to correctly target food supplementation to pregnant women. It also shows that food supplementation does not lead to enhanced pregnancy weight gain nor does it provide any evidence of a reduction in prevalence of low birth weight.