Date of Award


Degree Name

MS in Nutrition


Food Science and Nutrition


College of Agriculture, Food, and Environmental Sciences


Peggy Papathakis

Advisor Department

Food Science and Nutrition

Advisor College

College of Agriculture, Food, and Environmental Sciences


Background: Maternal malnutrition in developing countries is associated with adverse pregnancy and birth outcomes. Malnourished mothers are often faced with additional risk factors as a circumstance of poverty. Supplementary nutrition can improve the outcomes of both mother and infant. Identifying maternal nutritional and socioeconomic risk factors is critical for developing effective interventions.

Objective: A secondary analysis to evaluate maternal risk factors associated with poor birth outcomes including pregnancy loss, low birth weight, stunting, and preterm delivery among moderately malnourished pregnant women in Sierra Leone. Maternal risk factors in the analysis are age, education, parity, BMI, MUAC, gestational weight gain, and recent exposure to malaria infection.

Methods: Pregnant women were enrolled into a randomized controlled trial when presenting with a MUAC ≤ 23cm (N=1475). Demographic information was collected and women were randomly assigned two receive either a ready-to-use supplementary food (RUSF) or a corn-soy blended flour with an iron and folic acid supplement (CSB +IFA). Anthropometric measurements of height, weight, MUAC, and fundal height were measured every two weeks during pregnancy. Upon delivery the infant was measured for length, weight, MUAC, and head circumference and the mother was measured for MUAC. Infant outcomes of interest included stunting (length-for-age z-score

Results: The mean age of enrolled pregnant women was 21.2 years with a mean BMI of 19.78 kg/m2. A total of 33.2% had never attended school. Controlling for weeks on treatment and BMI at enrollment, mothers receiving the RUSF treatment gained a mean 0.49 kg (p2 produced infants that were significantly smaller than women with a BMI ≥ 18.5 kg/cm2 . Similarly, infants born to women with a MUAC(p=0.004) and had a 0.26 cm smaller MUAC (p=0.008) compared to women with a MUAC ≤23. Additionally, for every one unit decrease in maternal MUAC, women has 1.2 greater odds of preterm delivery (p=0.022). Also, women with adequate weekly weight gain gave birth to infants with a 0.37 cm greater mean length (p=0.012), 7.0 g greater mean weight (p=0.030), and 0.08 cm greater mean MUAC (p=0.045) than women with inadequate weight gain. No association was found between recent exposure to malaria at enrollment and poor infant outcomes.

Conclusion: In resource poor settings like Sierra Leone with high rates of maternal malnutrition and a high burden of stunting, LBW, and preterm delivery, use of RUSF improved maternal nutritional status but did not impact infant outcomes. The youngest adolescents had the most adverse infant outcomes. Education did not have the expected outcome, indicating other risk factors in this population may play a greater role in infant outcomes. Maternal risk factors of malnutrition such as BMI2and MUACpregnancy, women should be encouraged to gain adequate weight. Young primiparous adolescent are at the highest risk and interventions to postpone motherhood should be priority.