Background: Adolescent childbearing and maternal malnutrition are common in low- and middle-income countries and are associated with increased risk for poor maternal and infant outcomes. Adolescent pregnancy compounded with moderate malnutrition exacerbates outcomes common to both individually. Supplementary foods may be a way to improve outcomes in malnourished adolescent pregnant women. Objective: To retrospectively assess maternal and infant outcomes in moderately malnourished pregnant young adolescents (16-17 YO), older adolescents (18-19 YO), and adults (≥20 YO) in response to one of three nutritional interventions and in a pooled treatment group analysis, and to assess differences in infant outcomes by infant gender. Methods: Height, weight, MUAC, and FH were measured in pregnant women with MUAC >20.6 cm and < 23.0 cm at baseline (N=1828) every 2 weeks over the course of enrollment while receiving either: 1) macro- and micronutrient fortified, peanut-based, ready-to-use supplementary food (RUSF), 2) corn-soy blended flour with a prenatal multiple micronutrient supplement (CSB-UNIMMAP), or 3) corn-soy blended flour with iron and folic acid (CSB-IFA). Each provided approximately double the RDA of most micronutrients, 900 kcal/day and 33-36 g/day protein. Postpartum maternal and infant measurements were taken at delivery, and after 6 and 12 weeks. Maternal age at enrollment variable was transformed from a continuous variable into a categorical variable; young adolescent (16-17 YO), older adolescent (18-19 YO), and adults (≥20 YO). General linear models with normal errors were used to compare: 1. Adolescent maternal and infant outcomes by intervention, 2. Adolescent maternal and infant outcomes by maternal age within each intervention group, 3. Maternal and infant outcomes in a pooled treatment analysis by maternal age, 4. Interaction effects between maternal age and intervention, 5. Infant outcomes by infant gender. If differences between groups were detected, they were tested using the Tukey HSD test (response) or the likelihood ratio-based odds ratios (categorical). Odds ratios were measured using effects likelihood ratio tests via logistic regression. Response variables included in the analyses were BMI and fundal height at enrollment. Results: There were 297 young adolescents, 582 older adolescents, and 949 adults enrolled. Adolescents enrolled in the study at a younger gestational age than the adult mothers. Upon enrollment, BMI was greater and FH was smaller in the adolescent mothers than adults. At delivery, adolescent mothers had gained less weight on treatment, delivered with a lower final MUAC and FH, had increased odds of delivering extremely prematurely, and the greatest odds for delivering before recovery from malnutrition (MUAC ≥23.0 cm). Infants of young adolescent mothers were inferior anthropometrically to infants of the older mothers and had greatest odds of being underweight and stunted through 12 weeks of age. Young adolescents had the greatest odds for delivering LBW infants compared to the adults. Catch up growth was observed in the infants of older adolescents by 12 weeks of age; however, no catch up was observed for the infants of young adolescents. No one intervention was more helpful than another in determining maternal and infant outcomes of the adolescent mothers, and male infants had greater odds of being underweight and stunted at 6 and 12 weeks of age. Conclusions: Although adolescents did not appear to have characteristics of more severe clinical malnutrition, such as lower BMI, lower maternal height, and increased rates of HIV at baseline, maternal and infant outcomes were worse for the adolescent mothers compared to the older, more mature mothers. Adolescents gained less weight during pregnancy and delivered smaller infants that were unable to catch up linearly and with weight gain. Pregnant adolescents, particularly young adolescents, are a high-risk population and public health efforts should be made to delay the age of first pregnancy.

Background: Malnutrition can affect the body composition changes that occur in healthy pregnancy, resulting in adverse effects to both the mother and infant. Supplementary foods with high quality protein may result in more favorable changes in lean mass and fat mass in pregnant malnourished women. Objective: To retrospectively assess changes in body composition in moderately malnourished pregnant Malawian women in response to one of three nutritional interventions. Methods: Height, weight, MUAC, and TSF were measured in pregnant women with MUAC >20.6 cm and19) were compared using ANOVA. If differences were detected, differences between groups were tested using the Tukey HSD test (continuous) or Chi-squared test (categorical). Longitudinal changes were also measured using mixed model analysis of variance. Results: At baseline, women had small MUACs and low fat stores, but high muscle mass. Overall, women had significantly larger MUACs at the end of follow up than at baseline, except in adolescents in CSB-IFA and CSB-UNIMMAP. Women overall had significantly larger AMA at the end of enrollment than at baseline, with mature women in the RUSF group experiencing the largest increase compared to adolescents in RUSF and all women in CSB-UNIMMAP and CSB-IFA. On average, AMA was between the 50th-75th percentiles compared to women in the western world, indicating maintenance of muscle mass despite moderate malnutrition. TSF and AFA were both low in all age groups, falling below the 5th percentile for mature women and below the 10th percentile in adolescents compared to women in the Western world. There was no difference in birth weight across intervention groups. Among births that occurred during the rainy season, every cm of MUAC at the end of enrollment resulted in a 0.29 cm greater birth length. Conclusions: Overall, women improved their nutritional status but did not recover from moderate malnutrition over the course of enrollment. MUAC and BMI were the strongest predictors of birth weight, highlighting the contribution of overall nutritional status to birth outcomes. Women had high muscle mass relative to fat stores, with women in the RUSF group experiencing the largest accrual in muscle. More accurate and objective methods to measure body composition could provide greater detail about changes in body composition over the course of pregnancy in response to supplementary foods.

Background: Multiple micronutrient deficiencies are prevalent in pregnant women in developing countries and can result in adverse effects to both the mother and infant. Multiple micronutrient supplements or supplementary foods may be a way to combat micronutrient deficiencies. Objective: To assess change in micronutrient and protein levels in moderately malnourished pregnant Malawian women after receiving one of three nutritional interventions. Methods: Serum retinol, 25-hydroxyvitamin D, ferritin, vitamin B12, folate, zinc, albumin and C-reactive protein concentrations were measured in pregnant women with MUAC >20.6 cm and Results: Baseline micronutrient concentrations indicated high rates of deficiency in zinc (29-39%) and albumin (37-46%), and marginal status of retinol (26-37%) and vitamin D (31-32%). Adjusted mean changes in vitamin B12 concentrations from week 0 to week 10 were -17.1, -36.1, and -52.9 pg/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.007). Adjusted mean changes in vitamin D concentrations from week 0 to week 10 were 6.1, 3.1, and 1.7 ng/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.007). Adjusted mean changes in folate concentrations from week 0 to week 10 were 2.2, 1.7, and 4.0 ng/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.37 for effect of treatment; p=0.06 for the interaction effect of time*treatment). Changes in ferritin, zinc, albumin, retinol, and CRP were not significantly different between treatment groups. Conclusions: Deficiencies in zinc and albumin, and marginal status of vitamin D and retinol, are common among this population of moderately malnourished pregnant Malawian women. Significant changes in vitamin D and vitamin B12were observed from week 0 to week 10, with the RUSF group having the greatest improvements compared to the CSB-UNIMMAP and CSB-IFA treatments.