Amaranth Flatbread Improved Maternal Nutrition Measures in Ethiopian Trial

Pregnant women who ate amaranth-chickpea flatbread during a six-month cluster-randomized controlled trial in Southern Ethiopia had better maternal anthropometric measures than women assigned to maize flatbread. The trial, conducted among women with mild-to-moderate anemia, found higher mid-upper arm circumference, body mass index and gestational weight gain in the amaranth group. The parallel-group, two-arm trial took place in Hawela Lida district from September 2024 to February 2025.

Researchers enrolled 306 pregnant women who had lived in the district for at least six months, with all participants entering the study before 12 weeks of gestation. Participants were randomly allocated to receive either 200 grams per day of amaranth-chickpea flatbread or maize flatbread for six months. Investigators measured mid-upper arm circumference, body mass index and gestational weight change at baseline and at the end of the intervention.

These anthropometric measures served as proxies for overall nutritional status during pregnancy. The analysis used multilevel linear regression models that adjusted for individual- and community-level covariates to estimate the effect of the dietary intervention. Of the 306 enrolled participants, 293 completed the study, corresponding to a completion rate of 95.8%.

At the endline assessment, mean mid-upper arm circumference was 26.1 ± 1.2 centimeters in the amaranth-chickpea group, compared with 24.3 ± 1.4 centimeters in the maize group. The adjusted estimate for the difference was 1.72 centimeters, with a 95% confidence interval of 1.48–1.96. Body mass index followed the same pattern.

Women in the intervention group had a mean body mass index of 23.8 ± 1.5 kilograms per square meter, whereas those in the control group had a mean of 21.9 ± 1.6 kilograms per square meter. The adjusted effect estimate was 1.89 kilograms per square meter, with a 95% confidence interval of 1.62–2.16. Gestational weight gain was also greater in the amaranth-chickpea group.

Participants assigned to the intervention gained an average of 8.4 ± 1.2 kilograms during the study period, compared with 6.1 ± 1.4 kilograms among those assigned to maize flatbread. The adjusted estimate was 2.23 kilograms, with a 95% confidence interval of 1.92–2.54. The direction of the nutritional improvements was consistent across subgroups, and no serious adverse events were reported.

Sensitivity analyses that categorized maternal nutritional status produced results consistent with the primary analyses, which the researchers interpreted as supporting the robustness and public health relevance of the intervention effects. Overall, the trial found that daily amaranth-chickpea flatbread produced better maternal anthropometric indicators than maize flatbread over six months among pregnant women with mild-to-moderate anemia in one Southern Ethiopian district.

Subject of Research: Effects of amaranth-chickpea flatbread on maternal anthropometric measures during pregnancy in Southern Ethiopia

Article Title: Effect of amaranth flatbread on maternal anthropometry during pregnancy: Evidence from a cluster-randomized controlled trial in Southern Ethiopia

Article References: Yoseph, A., Mussie, L., Belayneh, M., & Guillen-Grima, F. (2026). Effect of amaranth flatbread on maternal anthropometry during pregnancy: Evidence from a cluster-randomized controlled trial in Southern Ethiopia. PLOS One, 21(10), e0360480. https://doi.org/10.1371/journal.pone.0360480

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360480

Keywords: amaranth flatbread, maternal nutrition, pregnancy, anthropometry, cluster-randomized trial, anemia, Ethiopia, gestational weight gain, mid-upper arm circumference, body mass index, Effect, amaranth