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A score of ��moderate�� means further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate, and a score of ��low�� means that further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. A score of ��very low quality�� means that we are very uncertain about the estimate.28 Figure?1 shows the results of literature search. We identified 5606 titles from searches conducted on all databases. After screening the titles and abstracts, 24 studies were identified that addressed protein-energy supplementation during pregnancy. A total of 16 interventional studies were chosen for data extraction to conduct meta-analyses.21�C23,25,29�C40Table?1 presents the characteristics of included studies. Nine studies were excluded and the reasons IOX1 supplier for exclusion are provided in Table?2. Eight of the included studies were from www.selleckchem.com/products/incb28060.html developing countries30�C32,34,35,37,38,40 and eight were from developed countries.21�C23,25,29,33,36,39 In 10 of the included studies, women were undernourished (as defined by authors) and/or were at risk of delivering a LBW baby.23,25,29,31,34�C36,38,39,41 Sixteen studies reported data on birthweight and the pooled estimate showed that babies born to women who received balanced protein-energy supplementation had a higher birthweight compared with controls (MD 73 [95% CI 30, 117]) (Figure?2). There was a substantial heterogeneity in the pooled data (I2?=?80%) and thus the random-effects models were used. A subgroup analysis based on nutritional status of the mothers showed that balanced protein-energy supplementation was more effective in malnourished women (MD 100 [95% CI 53, 147]) than adequately nourished women (MD 37 [95% CI ?34, 99]). Data on the incidence of LBW (birthweight Oxygenase was heterogeneity in the pooled data (I2?=?52%). Pooled results from nine studies reporting data on the prevalence of small-for-gestational age showed a reduction of 34% in the intervention compared with the control (RR 0.66 [95% CI 0.49, 0.89]) (Figure?4). As the pooled estimate had significant heterogeneity (I2?=?87%), random-effects models were used. The risk of stillbirth in the intervention group was 38% lower based on pooled data from three studies (RR 0.62 [95% CI 0.40, 0.98]) (Figure?5). Balanced protein-energy supplementation had virtually no effect on preterm birth rates (Figure?6). Table?3 shows summary estimates of some of the other maternal and neonatal outcomes.