Rethinking balanced food supplementation for pregnant women: time to move beyond energy and protein

The term "balanced energy and protein (BEP)" supplementation during pregnancy arose from research conducted >40 y ago, and has been defined as food supplements with <25% of energy from protein. BEP supplementation is recommended for undernourished populations by the World Health Organization, although the evidence base for this includes highly heterogeneous products and comparison groups. In this perspective, we briefly outline limitations in the evidence base for BEP supplementation and argue that the term diverts attention away from other important elements of "balance," such as healthy fats and carbohydrates. We articulate the need to carefully consider the goals of food supplementation during pregnancy, the biological mechanisms underlying effects on key outcomes, the desirability of flexibility in approaches, cost considerations, and the needs of the entire household in the context of food insecurity. We conclude that it is time to redefine the concept of balanced food supplementation for pregnant women, clarify objectives and terminology, and conduct further research relevant to the current global context.