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

Maternal undernutrition and iron deficiency anemia (IDA) remain major public health challenges in Ethiopia, contributing to adverse pregnancy outcomes and poor maternal health. Amaranth, a nutrient-dense pseudocereal, has demonstrated potential to improve maternal nutritional status, yet evidence from rigorous trials is limited. To evaluate the effect of amaranth grain flatbread on maternal anthropometric indicators - mid-upper arm circumference (MUAC), body mass index (BMI), and gestational weight change (GWG) - as proxies for overall nutritional status among pregnant women in Hawela Lida district, Southern Ethiopia.

A parallel-group, two-arm cluster randomized controlled trial was conducted from September 2024 to February 2025. Pregnant women with mild-to-moderate anemia, residing in Hawela Lida district for at least six months, were enrolled before 12 weeks of gestation and randomly allocated to receive either 200 g/day of amaranth-chickpea flatbread (intervention, n = 153) or maize flatbread (control, n = 153) for six months. Anthropometric measurements (MUAC, GWG, BMI) were collected at baseline and endline. Multilevel linear regression models adjusted for individual- and community-level covariates were used to estimate intervention effects.