The Effect of Dadih Functional Bread for Nutritional Intake, Maternal Weight Gain During Pregnancy, and Outcomes: A Prospective Randomized Double-Blind Controlled Trial 

Introduction

The development of quality human resources is a mandated priority of national development. Good nutritional status is one of the determining factors for the success of human resource development. Pregnant women are among the nutritionally vulnerable groups requiring special attention due to the long-term consequences of malnutrition. If pregnant women experience malnutrition, it can impact fetal growth and development, increasing the risk of delivering low birth weight (LBW) babies or stunted children.¹ Stunting is a nutritional problem characterized by a child’s height being inappropriate for their age. Stunting assessment can be conducted by measuring the baby’s birth length. According to the minimum birth length standard, a child is considered to have short stature if the measurement result is < 47 cm.^2,3

The development of quality human resources is a mandated priority of national development. Good nutritional status is one of the determining factors for the success of human resource development. Pregnant women are among the nutritionally vulnerable groups requiring special attention due to the long-term consequences of malnutrition. If pregnant women experience malnutrition, it can impact fetal growth and development, increasing the risk of delivering low birth weight (LBW) babies or stunted children.¹ Stunting is a nutritional problem characterized by a child’s height being inappropriate for their age. Stunting assessment can be conducted by measuring the baby’s birth length. According to the minimum birth length standard, a child is considered to have short stature if the measurement result is < 47 cm.^2,3

The nutritional problems within Indonesian society remain significant. Based on the 2022 Indonesian Nutrition Status Survey (SSGI) and 2018 Riskesdas data, the prevalence of chronic energy deficiency (CED) in women of reproductive age (WRA) was 14.1%, while it was 17.3% in pregnant women. Additionally, the prevalence of anemia among pregnant women was 48.9%.⁴ Nutritional issues are caused by various factors. Direct causes include inadequate intake of nutritious food and frequent infections. Indirectly, inappropriate parenting, lack of knowledge, limited access to healthcare services, and socio-economic conditions also affect access to nutritious food and healthcare services. More than half of pregnant women have extremely low energy intake (<70% of the recommended energy adequacy level), and about half also have insufficient protein intake (<80% of the recommended adequacy level).^3,4 Efforts to improve health and nutritional status among pregnant women are also carried out through Integrated Antenatal Care (ANC). Based on 2013 and 2018 Riskesdas data, the coverage of ANC services for pregnant women (K4) has shown a tendency to increase, from 70% to 74.1%. However, to achieve the target of 100% coverage by 2024, as part of efforts to prevent low birth weight and stunting, the coverage of ANC services still needs improvement.⁵

The birth weight of a baby is greatly influenced by fetal growth during pregnancy up until birth. One of the main factors contributing to low birth weight (LBW) is the mother’s nutritional status or weight gain during pregnancy. A pregnant mother’s nutritional status can be affected by her nutrient intake, knowledge level, socioeconomic status, and dietary habits.⁶ One crucial aspect to consider regarding maternal nutrition is meeting the needs for macronutrients such as carbohydrates, proteins, and fats, as well as micronutrients like folic acid, iron, calcium, and others. These nutrients are essential to fulfill the needs of both the mother and the fetus during pregnancy and to support the fetus’s growth in the womb. Mothers who experience malnutrition can negatively impact the baby’s condition and increase the risk of LBW, intrauterine growth retardation (IUGR), and congenital abnormalities that may affect the child’s health and nutritional status in the future.⁷

A suitable step to improve maternal nutrition and weight during pregnancy as part of an effort to prevent low birth weight and stunting is through nutritional interventions within integrated antenatal care (ANC) services. These interventions include assessing nutritional status during pregnancy, measuring mid-upper arm circumference (MUAC), providing nutrition counselling, educating about healthy eating during pregnancy, and offering supplementary food during pregnancy.

Supplementary feeding (SF) using local food sources is one strategy to address nutritional problems in pregnant women. Local food-based SF activities are expected to promote sustainable food and nutritional self-sufficiency for families. Indonesia, as the third-largest country in terms of biodiversity, has at least 77 types of carbohydrate sources, 30 types of fish, 6 types of meat, 4 types of poultry, 4 types of eggs, 26 types of legumes, 389 types of fruits, 228 types of vegetables, and 110 types of spices and seasonings.^6–8

The recommended dietary allowance for pregnant women in Indonesia aged 19–49 years, based on Permenkes 28/2019, specifies energy needs as follows: an additional +180 kcal in the first trimester, and +300 kcal in both the second and third trimesters. Protein requirements increase by +1 grams in the first trimester, +10 grams in the second trimester, and +30 grams in the third trimester. Fat requirements remain consistent across all trimesters at +2.3 grams, while carbohydrate needs increase by +25 grams in the first trimester and +40 grams in both the second and third trimesters.⁹

The principle of providing supplementary food for pregnant women involves offering ready-to-eat, balanced meals or protein-rich snacks derived from animal sources. These meals should prioritize fresh ingredients (free from artificial preservatives) and limit the consumption of sugar, salt, and fat (SSF). Supplementary food serves as an additional source of nutrients rather than replacing main meals. This supplementary food is distributed over at least 120 days using a community empowerment approach and local food resources. It is typically provided through Posyandu (Integrated Health Service Posts), healthcare facilities, maternal health classes, or home visits by community volunteers or health cadres.¹⁰

Local food from West Sumatra plays a significant role as an alternative solution to address malnutrition and stunting. Commonly used local foods include legumes and cereals such as corn and red beans, which are nutritious, readily available, and versatile. These ingredients can be processed into various types of food during pregnancy, one example being bread.^11,12 Functional food diversification using composite flour made from legumes is an innovative breakthrough in supporting programs aimed at accelerating stunting reduction and preventing stunting risk in children under five. The composite flour, designed as an alternative carbohydrate source, can replace wheat flour.^13,14

Additionally, traditional West Sumatran food, Dadih, can serve as a nutritious food source. Dadih is widely produced in highland regions of West Sumatra with extensive buffalo and cattle farming, such as in Tanah Datar, Agam, and 50 Kota Regencies. Dadih is a fermented buffalo milk product stored in bamboo tubes for several weeks, which generates microbiota (probiotics) it contains from the lactic acid bacteria.^15–18 Consuming probiotics during pregnancy can improve pregnancy outcomes. Probiotics offer several health benefits, including improving gut microflora balance, aiding the fermentation of undigested food residues in the small intestine, modulating the immune system, supporting vitamin synthesis, producing folate, enhancing the nutritional value of food, and increasing weight gain by improving nutrient absorption and food intake.¹⁹ Probiotics are also beneficial in promoting weight gain in children.

This is supported by a study by Aslamzai et al. (2020), which demonstrated a significant effect of probiotic supplementation on the weight gain of newborns. Similarly, research by Wibowo et al. (2015) confirmed that consuming probiotics during pregnancy is a safe practice and contributes to healthier pregnancies.^20,21

Dadih contains numerous lactic acid bacteria (LAB) that act as probiotics, including Lactococcus lactis, Lactobacillus plantarum, Pediococcus pentosaceus, Lactobacillus casei, Enterococcus faecium, Lactobacillus pentosus, and others, which provide various health benefits. The LAB in dadih improves digestive health and is rich in iron, which can help prevent anemia in pregnant women.^22,23 Additionally, Dadih has been shown to promote increased birth weight and length, enhance appetite, prevent miscarriage, act as an antioxidant, lower cholesterol levels, control pathogenic bacteria, improve intestinal microflora, boost immunity, detoxify the body, prevent constipation, and support the production of vitamin B.¹⁴ The numerous benefits of functional bread and Dadih offer hope that pregnant women who consume functional bread combined with Dadih custard during pregnancy may deliver babies with birth weight and length that meet the national standards in Indonesia (>2500 grams and >47 cm).

Based on this background, the researchers are interested in examining the effects of providing dadih-based functional bread as supplementary food for pregnant women on their nutritional intake, weight gain during pregnancy, and the birth weight and length of their babies (outcomes) in West Sumatra Province.

Methods

Assessment of dietary intake

A qualified nutritionist obtained dietary intake data from participants either at their homes or at an integrated health service post. Dietary intake was assessed using a validated interviewer-administered 2×24-hour recall questionnaire.²⁴ All participant data were analyzed using the Indonesian Food Database and Nutrisurvey (EBISpro, Willstᾃtt, Germany) to estimate the total energy intake and macronutrient consumption. Figure 1 Consort flow diagram of study.

Figure 1. This is a figure of consort flow diagram of studies.

They should be listed as: (a) Assessed for eligibility; (b) Loss to follow up; (c) Maternal follow up; (d) Intervention and control group; (e) Outcome.⁴³

Results

Analyzing anthropometric pregnancy women

Based on the results in Table 3, there was an increase in weight among pregnant women in both the IG and CG groups during the consumption of Dadih-based functional bread. This difference is reflected in the mean weight gain across months 1 to 3, with values of 1.62, 2.09, and 5.04 kg, respectively ( Figure 2). In the third month, the difference in weight gain between the IG and CG groups was statistically significant, with p = 0.007. Similarly, the BMI values in the third month also showed a significant difference between the IG and CG groups, with p = 0.025.

Table 3. Anthropometric of pregnancy women (n = 143).

Anthropometric measurements (Weight gain and BMI gain) of pregnancy women	Groups		Mean Difference (Δ)	p Valuea
	IG (n = 77) (Mean ± SD)	CG (n = 66) (Mean ± SD)
Baseline of body weight (kg)	57.55 ± 11.17	56.62 ± 11.04	0.93	0.620
Month – 1 of body weight gain (kg)	59.94 ± 10.96	58.32 ± 11.09	1.62	0.381
Month – 2 of body weight gain (kg)	62.23 ± 11.54	60.14 ± 10.97	2.09	0.272
Month – 3 of body weight gain (kg)	66.28 ± 11.23	61.24 ± 10.51	5.04	0.007 *
Baseline of BMI (kg/cm2)	23.75 ± 4.11	23.77 ± 4.80	-0.02	0.979
Month – 1 of BMI gain (kg/m2)	24.76 ± 4.10	24.48 ± 4.85	0.68	0.707
Month – 2 of BMI gain (kg/m2)	25.69 ± 4.30	25.24 ± 4.82	0.45	0.554
Month – 3 of BMI gain (kg/m2)	27.39 ± 4.18	25.71 ± 4.63	1.68	0.025*

a Independent T-test was used to analyse the difference between variables of 2 groups. BMI: Body Mass Index; IG: Intervention Group; CG: Control Group.

* p < 0.05 (significant).

Figure 2. Plots of pregnancy women weight and BMI gain from baseline until 3-month;

(A) The difference plots of body weight gain IG and CG, (B) The difference plots of BMI gain IG and CG. BMI: Body Mass Index; IG: Intervention Group; CG: Control Group.⁴³

Analyzing anthropometric outcomes (newborn)

Based on the results in Table 4, there was a difference in the birth weight of infants between the IG group (3120.51 ± 503.43 grams) with a median (Q1–Q3) of 3100 (2200–4900) grams, and the CG group (3056.28 ± 439.91 grams) with a median (Q1–Q3) of 3000 (2300–4500) grams. The mean difference was 64.23 grams. However, statistical analysis showed that the difference in birth weight between the IG and CG groups ( Figure 3) was not significant (p = 0.422). Similarly, there was a difference in birth length between the IG group (48.55 ± 1.49 cm) with a median (Q1–Q3) of 48 (45–53) cm, and the CG group (48.16 ± 1.80 cm) with a median (Q1–Q3) of 48 (44–53) cm. Statistical analysis also indicated that the difference in birth length between the IG and CG groups was not significant (p = 0.165).

Table 4. Anthropometric of outcomes (newborn) (n = 143).

Anthropometric outcomes	IG (n = 77)		CG (n = 66)		Mean Difference (Δ)	p-valuea
	Mean ± SD	Median (Q1-Q3)	Mean ± SD	Median (Q1-Q3)
Weight (grams)	3120.51 ± 503.43	3100 (2200-4900)	3056.28 ± 439.91	3000 (2300-4500)	64.23	0.422
Length (cm)	48.55 ± 1.49	48 (45-53)	48.16 ± 1.80	48 (44-53)	0.39	0.165

a Independent T-test was used to analyse the difference between variables of 2 groups. BMI: Body Mass Index; IG: Intervention Group; CG: Control Group.

* p < 0.05 (significant).

Figure 3. Plots of weight and length of newborn (outcome);

(A) The difference plots of newborn’s weight IG and CG, (B) The difference plots of length’s newborn IG and CG. IG: Intervention Group; CG: Control Group.⁴³

Discussion

In Table 1, this study found that out of 143 pregnant women who met the initial criteria (second trimester), they were divided into two groups: 94.8% in the intervention group (IG) and 97.0% in the control group (CG) were Minangkabau. Pregnant women with a high school education made up 50.6% of IG and 42.4% of CG. Respondents working as housewife accounted for 79.2% in IG and 68.2% in CG. Family income in the IDR 2,000–3,000 range was reported by 49.4% of IG and 45.5% of CG. The most common parity in IG was multiparous (second or higher births), at 41.6%.

Education significantly influences a mother’s knowledge of pregnancy, which is a crucial factor in achieving better pregnancy outcomes. A higher level of knowledge can reduce the risk of nutritional deficiencies during pregnancy, which could otherwise affect newborn health. Mothers who do not work tend to have more time at home to meet their nutritional needs compared to working mothers.²⁵ The burden of work during pregnancy can negatively affect the fetus, as mothers may lack sufficient rest. Additionally, work-related stress can lead to adverse pregnancy outcomes, such as reduced appetite, resulting in inadequate nutritional intake that could affect both the mother and the baby’s birth weight.

Multiparity (second or higher births) was the most common parity. Parity refers to the number of births a woman has had, regardless of whether the infants were born alive or stillborn, excluding abortions. High parity (more than two births) poses risks for both the mother and the fetus. Repeated pregnancies and deliveries can cause vascular damage and reduce uterine elasticity, impairing the placenta’s ability to supply oxygen and nutrients. This increases the risk of low birth weight (LBW) and placental positioning abnormalities.²⁶ High parity also often leads to uterine scarring from previous pregnancies, which may result in inadequate blood flow to the placenta and disrupted nutrient transport to the fetus. A study by Wahyuningrum (2016) indicated that multiparous mothers have a higher risk of delivering LBW infants.

Based on the results in Table 2, there were no significant differences between the IG (Intervention Group) and CG (Control Group), indicating that all baseline data collected during the second trimester were equivalent. However, in the third trimester, significant differences were observed. The carbohydrate dietary intake in the IG was 320.40 (198.24–666.72) grams/day compared to 312.37 (137.87–556.85) grams/day in the CG (p = 0.019). Additionally, there were significant differences in fat dietary intake: 74.30 (25.53–245.47) grams/day in the IG and 62.85 (21.71–128.59) grams/day in the CG (p = 0.025). At the beginning of the study, dietary recall data revealed many pregnant women were experiencing energy and protein deficits. According to the 2014 Individual Food Consumption Survey, energy and protein deficiencies were common among pregnant women.^9,27 One of the policies of the Indonesian government, as outlined in Minister of Health Regulation No. 39 of 2016, is to provide nutritional interventions during the first 1,000 days of life and offer high-calorie, high-protein, and micronutrient-rich food to pregnant and postpartum mothers.^9,28

In addition to its broad health benefits, Dadih (fermented buffalo milk) offers specific nutritional advantages for pregnant women. Consuming Dadih as a dietary supplement can meet additional energy needs of 200–300 kcal/day and additional protein requirements of 1–1.7 grams per kg of body weight. Energy and protein deficiencies during pregnancy can lead to malnutrition, anemia, miscarriage, low birth weight (LBW), and intrauterine growth restriction (IUGR). Weekly consumption of Dadih recommended by Vinderolla (2000) in Purwati (2016) is approximately 300–400 grams. Probiotic foods like Dadih should be consumed regularly because the colonization of probiotic microbes is temporary and competes with pathogenic bacteria in the digestive tract.^14,21

Maternal nutrition is essential for providing energy for physical activity, regulating optimal body metabolism, and facilitating tissue formation and repair. The fetus derives nutrients from the mother via the placenta; thus, insufficient maternal nutrient intake can impair organ development and cell size, reduce placental size, and disrupt nutrient delivery to the fetus. Inadequate maternal nutrition also decreases blood volume and cardiac output, reducing blood flow and nutrient transport to the placenta, ultimately hindering fetal growth and increasing the risk of LBW. Fetal growth depends on maternal metabolism transferred through the placenta; hence, poor maternal nutrition correlates with lower birth weights.²⁹

Adequate fetal nutrition derived from the mother during pregnancy is critical to prevent growth faltering. This underscores the importance of ensuring sufficient maternal nutrient intake through dietary supplements.³⁰ One such supplement that fulfills energy, protein, and fat requirements is functional bread made from legume-based flours (corn and red bean flour) enriched with protein, fat, and probiotics from fermented buffalo milk (Dadih) prepared in bamboo tubes.¹⁸

A study by Shiddiq (2014) identified fetal nutritional status as a critical determinant of newborn birth weight, which is closely related to maternal nutritional status during pregnancy. Maternal nutritional deficiencies significantly impact maternal and fetal health. All nutrients required for fetal growth come from maternal food intake, which is stored as glycogen, protein, or excess fat. Increased maternal fat storage is associated with maternal weight gain.³⁰ This study aligns with research by Freedberg et al. (2018), which demonstrated that probiotic consumption from dietary sources affects maternal weight gain. This weight gain is closely linked to improved maternal nutritional status, which mediates fetal nutritional status at birth.³¹

Based on the results in Table 3, weight gain among pregnant women consuming functional bread with Dadih was observed in both the IG and CG. The mean differences in weight gain from months 1 to 3 were 1.62, 2.09, and 5.04 kg, respectively. In the third month, the difference in weight gain between IG and CG was statistically significant (p = 0.007). BMI values in the third month also showed significant differences between IG and CG (p = 0.025).

Dadih, a product of milk fermentation, has potential benefits for supporting maternal weight gain during pregnancy. According to WHO, consuming probiotics offers numerous health benefits, including maintaining immune homeostasis, inhibiting the growth of pathogenic bacteria, improving intestinal microflora balance, enhancing mineral absorption, aiding in lactose digestion, vitamin synthesis, and boosting interactions between the innate and adaptive immune systems. This reduces the risk of intestinal inflammation and infection and provides anti-inflammatory benefits by suppressing cytokine signaling. Probiotics can also promote nutrient absorption, increase food intake, prevent diarrhea or constipation, enhance the nutritional value of food, act as antimutagenic and anticarcinogenic agents, reduce cholesterol, and lower blood pressure.^2,16

Probiotics achieve these benefits through mechanisms such as producing lactic acid and inhibitory metabolites, stimulating the immune system, competing with pathogenic bacteria for nutrients, and lowering environmental pH. These processes protect and enhance the body’s condition, preventing pathogen colonization.³²

The mechanism of probiotics in regulating body weight is associated with their ability to enhance epithelial cell adhesion, reduce systemic inflammation, and improve insulin resistance. Probiotics also have the capacity to decrease intestinal permeability and promote the production of short-chain fatty acids (SCFAs). This process triggers the secretion of peptides such as glucagon-like peptide 1 (GLP-1), an incretin hormone that delays gastric emptying and stimulates insulin secretion, leading to increased glucose levels.³³ A diet low in fat, rich in unsaturated fatty acids, and containing specific probiotics like Dadih is believed to support gut microbiome health. Gut microbiota produces SCFAs such as acetate, propionate, and butyrate, which negatively correlate with maternal BMI. Increased maternal serum SCFA levels influence various metabolic changes, including maternal weight gain, glucose metabolism, and hormonal balance.³⁴ Furthermore, maternal gut microbiota, shaped by these factors, also impact the development of fetal microbiota in utero.³⁵

Maternal weight gain during pregnancy affects adiponectin levels in the body, which in turn influences fetal growth. Adiponectin is an adipokine secreted by adipose tissue, primarily responsible for regulating insulin sensitivity. In pregnant women, adiponectin reduces hepatic gluconeogenesis, enhances fatty acid oxidation and glucose utilization, increases insulin sensitivity in the liver and skeletal muscles, and decreases insulin signaling in the placenta. Adiponectin regulates fetal growth by modulating the nutrients present in maternal blood, the placenta, and umbilical cord blood. In overweight pregnant women, adiponectin levels decrease, leading to reduced insulin sensitivity and lower glucose absorption. As a result, maternal blood glucose levels rise, with excess glucose transferred to the fetus, contributing to increased fetal weight.³⁶

Decreased adiponectin levels are associated with increased levels of IGF-1, insulin, and leptin in the body.³⁶ Insulin-Like Growth Factor 1 (IGF-1), a polypeptide hormone produced by the liver in response to Growth Hormone (GH) stimuli, plays a crucial role in fetal growth and development during pregnancy. IGF-1 stimulates nutrient transporters in the placenta, including glucose, protein, and fatty acid transporters. Additionally, IGF-1 enhances calcium and phosphate absorption in the maternal body, which are subsequently transferred to the fetus via the placenta. In cases where mothers have poor nutritional status, IGF-1 levels decrease, disrupting nutrient transport to the fetus, thereby impairing fetal growth and development.³⁷

The effect of supplementation also influences weight gain in pregnant women. This is closely related to the improvement in maternal nutritional status, which mediates the impact on birth weight. Such conditions are supported by studies conducted by various researchers, including Freedberg et al. (2019), who explained that each kilogram of maternal weight gain during the first, second, and third trimesters was statistically associated with significant increases in infant birth weight by 18.0 grams, 32.8 grams, and 17.0 grams, respectively. They concluded that the study indicates a specific pattern of maternal weight gain, particularly during the second trimester, which is associated with infant birth weight. Regardless of the relationship between birth weight and variables such as pre-pregnancy weight, age, height, and maternal parity, fetal growth and development remain key pregnancy outcomes.³¹

According to Helmizar (2017), Dadih can serve as a dietary supplement for pregnant women due to its high nutritional value and the presence of lactic acid bacteria (LAB) with probiotic potential. Acceptance of Dadih was higher among pregnant women already accustomed to consuming it before pregnancy, and the combination of zinc supplementation further enhanced its acceptance. Meeting the nutritional needs of pregnant women and the probiotic content in Dadih offer potential benefits for pregnancy outcomes.³⁸

Table 4 shows that the difference in infant birth weights between the intervention group (IG) and the control group (CG) was not statistically significant (p = 0.422). Similarly, the statistical results for differences in infant birth length between IG and CG also did not show significance (p = 0.165). One factor influencing the results of this study was the insufficient maternal weight gain compared to the target and unmet macronutrient intake in alignment with the dietary reference intake Recommended Dietary Allowance (RDA) for pregnant women. In general, mothers experienced significant weight gain, but this increase often occurred before pregnancy. Furthermore, some mothers were underweighting before becoming pregnant.

This study aligns with Luoto R. (2016), which showed that probiotic supplementation during pregnancy did not significantly affect infant birth weight. This outcome might be due to other factors influencing birth weight, such as maternal pre-pregnancy BMI, smoking habits before pregnancy, educational level, gestational diabetes, the baby’s gender, and breastfeeding duration.³⁹

A literature review by Wang C.C., et al. (2020) also indicated that probiotic administration had limited impact on infant birth weight and length. The mechanism of probiotics in regulating body weight involves enhancing molecular adhesion in epithelial cells, reducing systemic inflammation and insulin resistance, and promoting SCFA production. These SCFAs stimulate the secretion of glucagon-like peptide 1 (GLP-1), a hormone that triggers insulin secretion and delays gastric emptying, leading to increased glucose levels in the body. However, in this study, probiotic supplementation during pregnancy did not affect infant birth weight or length, possibly because the probiotics used included only one or two strains, and the intervention lasted approximately six weeks.³³

Helmizar (2018) investigated the potential of Dadih from West Sumatra to improve the nutritional status of pregnant women and found a slight, albeit not highly significant, impact of Dadih consumption on infant birth weight. This study used a Dadih dosage of 100 grams per pregnant woman, while the present study provided only 30 grams. Differences in Dadih dosage can influence its nutritional content, and the provision of only 30 grams in this study was associated with the lack of significant effects on infant birth weight.³⁸

Although the differences in infant birth weight and length were not statistically significant, there was a mean difference between IG and CG. Mothers consuming functional Dadih bread (IG) gave birth to heavier babies than the control group (CG), with a mean difference of 64.23 grams. Similarly, the birth length of babies in the IG group was greater than that in the CG group, with a mean difference of 0.39 cm. Studies have shown that colonization of the gut microbiota during pregnancy has long-term effects on the condition of the offspring. While in the womb, the fetus lives in a relatively sterile environment, and the maternal gut microbiota’s metabolites influence fetal growth and brain development through the placenta.⁴⁰ The placenta plays a critical role in fetal growth and development, especially under adverse conditions such as malnutrition. The placenta can undergo autophagy to provide essential energy and nutrients for fetal development.⁴¹

This study aligns with Lechtig et al. (2017), who observed a difference in infant birth weight of 105.9 grams among mothers receiving dietary supplementation for more than 13 weeks, compared to only 102 grams for those supplemented for less than 13 weeks relative to the control group. Although the statistical results did not show significant differences, supplementation tended to reduce the prevalence of low birth weight.⁴²

Conclusions

The study emphasized the cultural and nutritional advantages of incorporating traditional Minangkabau foods into modern dietary practices. This randomized, double-blind, controlled trial assessed the impact of functional bread made from Dadih, enriched with local nutritional value, on pregnant women. It highlighted the bread’s role in supporting maternal health during pregnancy while recommending further research to explore its broader implications for neonatal outcomes, particularly in preventing conditions such as low birth weight and stunting.

The investigation into Dadih Functional Bread as a traditional Minangkabau complementary food demonstrated its potential to improve nutritional intake and maternal weight gain during pregnancy. Findings suggest that supplementing this bread significantly enhances maternal nutritional status without adverse effects. However, although it positively influences maternal weight gain, its effect on birth outcomes, such as neonatal birth weight and length, appears to be limited.

Limitation

This study has several limitations that should be considered. Although it employed a rigorous randomized double-blind controlled trial design, dietary variations outside the intervention period could not be fully controlled. These variations may have influenced maternal nutritional intake and weight gain during pregnancy, potentially affecting the study outcomes. Additionally, the intervention was only provided for three months until delivery, which may limit the ability to observe its full effects on maternal and fetal nutritional status. Future studies are recommended to initiate the intervention from the first trimester to better assess its long-term impact on maternal health and pregnancy outcomes.

Ethical considerations

The study received review and approval from the Scientific Research Committee and Ethics Board of the Faculty of Medicine, Andalas University (ethical clearance number: 945/UN.16.2/KEP-FK/2022), approval date: 22 September 2022 and was conducted in compliance with Andalas University’s regulations for human research. Written informed consent for participation and publication of the patient’s details was obtained from the patients. The study was done after the explanation of its importance and the objectives of the study to the participants. Only subjects who clearly agreed were enrolled and those who refused after the explanation were excluded. The research followed clinical randomized trial protocols and is registered on ClinicalTrials.gov with the identifier, trial registration: NCT05712629, registration date: 2023-01-03. accessible at https://classic.clinicaltrials.gov/ct2/show/NCT05712629.