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The role of Polyvinylpyrrolidone (PVP) on human gametogenesis and embryonic development has been investigated in clinical setting. PVP is routinely used in sperm handling during intracytoplasmic sperm injection (ICSI) procedure. However, the controversies about its harmful effects on embryonic cells has been debated in recent years. Some reported that PVP decreases the membrane integrity and chromatin stability and strongly affects the fine structure of spermatozoa, such as axonemal tubules, fibrous sheath, and accessory fibres. However, others claimed that PVP delayed the onset of calcium oscillations in the oocyte in ICSI setting. Therefore, PVP affects the decondensation of male pronuclear formation after sperm injection. Also, it has been reported that after injection of conventional 10%PVP to embryos, PVP solution remained in the embryos and suppressed development of these embryos. Recent studies indicated that with a decrease in PVP concentration, embryo development increased and morphokinetics improved in ICSI cycles. Also, low concentration of PVP decreased the rate of apoptosis when compared to 10%PVP. In this review, the irreversible effects of PVP on sperm and embryonic chromosomal aberrant were reported. In conclusion, it is recommended to use the low concentration of PVP in conventional ICSI programme to limit its damage on fertilization processes as well as embryo development.
In eukaryotes, conserved Rag-family GTPases are crucial for TOR signaling, integrating nutrient sensing with cellular growth. However, their functions in filamentous fungal pathogens are poorly understood. Here, we demonstrate that MoGtr1 and MoGtr2, the Rag GTPase homologs, form a functional heterodimer in Magnaporthe oryzae. Phenotypic analyses reveal that the ΔMogtr1 mutant exhibits severe defects in autophagy, asexual reproduction, vacuolar homeostasis, and virulence. In contrast, the ΔMogtr2 mutant is primarily impaired in autophagy. The ΔMogtr1/2 double mutant shows additive defects in autophagy and mild attenuation in asexual reproduction and pathogenicity. Critically, MoGtr1 acts as an important GTP-dependent molecular switch. The GTP-bound form of MoGtr1 activates TOR signaling, maintains basal autophagy, and confers tolerance to hydrogen peroxide, whereas its GDP-bound form inhibits TOR, promotes autophagy, and increases sensitivity to hydrogen peroxide. Thus, MoGtr1 serves as a master regulator of development and infection, while MoGtr2 fine-tunes autophagy. Our study elucidates the divergent roles of Gtr homologs in a major fungal pathogen and proposes new strategies for disease intervention.
Clonality, the process of vegetative reproduction through belowground organs (rhizomes, stolons), occurs in about half of all plant species. It influences key ecological and evolutionary phenomena, including effective population size, meiosis frequency and genet longevity, which may affect diversification rates. This study investigates how clonality impacts diversification in angiosperms by comparing clonal, mixed and non-clonal genera. Using genus-level phylogeny and data on clonal status of 16,465 species across 2997 genera, we estimated speciation and net diversification rates for each genus with MoM, DR and BAMM. Our results reveal lower diversification rates in clonal genera in non-phylogenetic models, consistent with the hypothesis that clonality constrains diversification. This effect weakens when accounting for phylogenetic non-independence but remains significant overall. We show that monocots show a slightly stronger effect of clonality on diversification than eudicots. Our findings suggest that clonality may limit long-term diversification in angiosperms, influencing evolutionary dynamics where clonal reproduction predominates.
Meiosis is a key stage in the sexual reproduction of eukaryotes. It ensures the continuity of genetic information from generation to generation, while also generating the necessary genetic diversity for the survival and evolution of species. Meiotic progression is often compromised in hybrids between related subspecies, resulting in hybrid sterility and irreversible reproductive isolation. However, most genetic studies to date have not focused on the meiotic phenotypes of hybrid sterility and their molecular mechanisms. This review examines the genetic architecture, as well as the meiotic and molecular phenotypes, of hybrid sterility in the house mouse (Mus musculus) and other mammals. House mice subspecies provide the most widely understood mammalian model of hybrid sterility because of their recent evolutionary divergence, powerful genetic tools and comprehensive cytology of individual meiotic stages. We emphasize the potential impact of meiotic surveillance mechanisms, checkpoint pathways, particularly those leading to the meiotic sex chromosome inactivation and we draw parallels between intraspecific genic and chromosomal sterility and intersubspecific hybrid sterility. Finally, we review the Prdm9-Mir465 incompatibility system, the only vertebrate hybrid sterility model for which the three major genetic components necessary and sufficient to recreate the hybrid sterility genome have been identified. This three-part genetic architecture links Prdm9-dependent meiotic recombination hotspot activation, heterosubspecific homolog pairing, and microRNA-mediated meiotic checkpoint regulation to spermatogenic arrest and male sterility. MiR-465 is apparently the first microRNA which functions as a guardian of the pachytene checkpoint.
Aedes aegypti mosquitoes are the primary vector of several pathogens including dengue, Zika, and chikungunya viruses. Within an hour after an initial insemination, female Ae. aegypti are generally refractory to subsequent inseminations, a response that was first attributed in the 1960's to the effects of seminal fluid molecules (SFMs). Yet, despite the importance of this discovery, the actual molecules responsible for long-term female insemination refractoriness have remained unknown for 60 years. In a previous study, we identified adipokinetic hormone (AKH) precursor protein as an SFM in Ae. albopictus. AKH is a well-studied insect neuropeptide that impacts phenotypes including those related to metabolism, locomotion, and reproduction. In this study, we investigated whether AKH is an SFM in Ae. aegypti and whether it impacts female re-insemination patterns. We first established that AKH is produced and has enriched expression in the male reproductive tract. We then found that AKH is transferred to females during mating, and is, therefore, an SFM. Next, we generated an AKH-null line which allowed us to demonstrate that seminal fluid AKH contributes to long-term insemination refractoriness of females. Together, our findings (i) are the first to identify one of the seminal fluid proteins that influence long-term insemination refractoriness in Ae. aegypti and (ii) demonstrate a novel expression pattern and function for the well-studied, multi-functional adipokinetic hormone. These results lay the groundwork for understanding the evolution and mode of action of novel seminal fluid proteins as well as for investigating novel pathways or approaches for mosquito control.
Climate-driven changes in floral resource quantity, timing, and nutritional quality can modulate access to essential nutrients for bees, with consequences for development, reproduction, physiology, and sensitivity to other stressors. Although most nutritionally focused research has centred on managed social bees, most bee species are solitary or non-eusocial and therefore experience nutritional landscapes in fundamentally different ways. Here, we examine how sociality and life-history strategy shapes sensitivity to nutritional stress under climate change, and how climate-driven nutritional change could alter the costs and benefits of social behaviours. We argue that social organisation, nesting strategy, diet breadth, foraging range, body size, and colony demography shape exposure to nutritional stress, the capacity to respond to nutritional stress, and its interactions with other stressors. Integrating nutritional ecology with life-history theory will therefore be essential for improving predictions of bee vulnerability and designing conservation strategies that support a broad range of bee taxa.
Women with systemic lupus erythematosus (SLE) are at increased risk of adverse maternal and fetal outcomes, particularly when pregnancy occurs during periods of active disease. Effective contraception is therefore essential, yet data on sexual activity and contraceptive practices among women with SLE in Nigeria are limited. A cross-sectional survey was conducted between April and July 2025 among women aged 18-48 years with rheumatologist-diagnosed SLE in Nigeria. Participants were recruited through rheumatology clinics and an online survey platform. Information obtained included sociodemographic characteristics, disease duration, disease activity assessed using the Mexican SLE Disease Activity Index, sexual activity, reproductive intentions, contraceptive use, and perceived risk of unintended pregnancy. Descriptive statistics were used, and Kendall's tau-b assessed the association between sexual activity and disease activity. Eighty-five women were analyzed. The mean age was 35.0 ± 7.7 years, and the median disease duration was 50 months (interquartile range: 22-108). Fifty-eight participants (68.2%) were sexually active. Among these, 39 (67.2%) reported using contraception, although only 19 (48.7%) used it consistently. Barrier methods, predominantly condoms, were the most commonly used (31.1%). Most contraceptive users (74.4%) did not intend pregnancy within the next 12 months. Sexual activity was inversely associated with disease activity (Kendall's tau-b = -0.184, P = 0.048). Despite low perceived risk, 23.2% reported at least one episode of unintended pregnancy risk in the preceding year. This study demonstrates that women with SLE in Nigeria remain sexually active and, despite their strong pregnancy avoidance intentions, frequently rely on barrier methods and inconsistently use contraception. These patterns closely mirror global experience and highlight the urgent need to integrate structured, disease-specific contraceptive counseling into routine SLE care in Nigeria to reduce potentially unintended pregnancy and associated maternal-fetal risks. Résumé Contexte:Les femmes atteintes de lupus érythémateux systémique (LES) présentent un risque accru de complications maternelles et fœtales, en particulier lorsque la grossesse survient pendant les poussées de la maladie. Une contraception efficace est donc essentielle, mais les données sur l’activité sexuelle et les pratiques contraceptives chez les femmes atteintes de LES au Nigéria sont limitées.Méthodes:Une enquête transversale a été menée entre avril et juillet 2025 auprès de femmes âgées de 18 à 48 ans ayant reçu un diagnostic de LES par un rhumatologue au Nigéria. Les participantes ont été recrutées dans des cliniques de rhumatologie et via une plateforme d’enquête en ligne. Les informations recueillies portaient sur les caractéristiques sociodémographiques, la durée de la maladie, l’activité de la maladie évaluée à l’aide de l’indice mexicain d’activité du LES, l’activité sexuelle, les intentions reproductives, l’utilisation de contraceptifs et le risque perçu de grossesse non désirée. Des statistiques descriptives ont été utilisées et le coefficient tau-b de Kendall a permis d’évaluer l’association entre l’activité sexuelle et l’activité de la maladie.Résultats:Quatre-vingt-cinq femmes ont été analysées. L’âge moyen était de 35,0 ± 7,7 ans et la durée médiane de la maladie de 50 mois (intervalle interquartile: 22–108). Cinquante-huit participants (68,2 %) étaient sexuellement actifs. Parmi eux, 39 (67,2 %) ont déclaré utiliser une contraception, mais seulement 19 (48,7 %) l’utilisaient de façon régulière. Les méthodes barrières, principalement les préservatifs, étaient les plus fréquemment utilisées (31,1 %). La plupart des utilisatrices de contraception (74,4 %) n’envisageaient pas de grossesse dans les 12 mois suivants. L’activité sexuelle était inversement corrélée à l’activité de la maladie (tau-b de Kendall = −0,184, P = 0,048). Malgré une faible perception du risque, 23,2 % ont rapporté au moins un épisode de risque de grossesse non désirée au cours de l’année précédente.Conclusion:Cette étude démontre que les femmes atteintes de LED au Nigéria restent sexuellement actives et, malgré leur volonté d’éviter une grossesse, ont fréquemment recours à des méthodes barrières et utilisent la contraception de façon irrégulière. Ces tendances reflètent fidèlement les observations mondiales et soulignent l’urgence d’intégrer un accompagnement contraceptif structuré et adapté à la maladie dans la prise en charge courante du LED au Nigéria afin de réduire les grossesses non désirées et les risques materno-fœtaux associés.
Prolonged time to pregnancy, increased need for fertility treatment, and increased pregnancy loss have been reported in women with asthma. However, it is unknown whether uterine inflammatory cells negatively affects fertility in this group. We explored whether women with asthma undergoing fertility treatment have increased inflammatory cells in the endometrium compared to women without asthma. Thirty women with and without asthma (1:1) undergoing fertility treatment were included in this explorative observational study. Asthma was defined by symptoms and a positive bronchial challenge test. Participants underwent questionnaires, fractional exhaled nitric oxide measurement, blood sampling, spirometry, methacholine challenge, induced sputum, and 2/3D ultrasound scan of the uterus followed by endometrial biopsy near ovulation. Endometrial biopsies revealed no significant differences in inflammatory cell types between women with asthma versus women without asthma. Women with asthma had higher airway responsiveness, atopy, IgE, and eosinophil counts, as expected, but similar reproductive history and treatment characteristics. No differences were observed in plasma cells/mm2 (median(IQR) 0.15(0.14-0.65); 0.33(0.21-0.92), ns), mast cells/mm2 (median(IQR) 2.99(1.31-3.47); 3.72(3.25-9.57), ns) nor CD3+ or CD20+ lymphocytes or eosinophils. Biomarker analysis across tissues showed no significant association with asthma after multiple testing correction. This exploratory study found no evidence of differences in endometrial inflammatory cells between infertile women with and without asthma. However, the small sample size limits statistical power and a Type II error cannot be excluded.
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Reproductive efficiency in Nellore heifers is fundamental to the profitability and sustainability of beef production in tropical regions, where environmental stress can cause genotype-environment (G×E) interactions that affect fertility. Using 200,258 and 299,885 phenotypic records for heifer early pregnancy (HP) and heifer rebreeding (HR), respectively, we investigated the genetic basis of reproductive plasticity via single-step genomic reaction norms across a continuous environmental gradient (EG) defined from yearling weight records as a proxy for environmental quality. Genomic analyses included 22,556 animals (21,456 females and 1,100 sires) with genotypes imputed to 409,617 single-nucleotide polymorphisms (SNPs). We then performed genome-wide association analyses of the reaction norm intercept (genetic merit) and slope (environmental sensitivity), followed by multi-trait summary analyses and Bayesian fine-mapping of significant loci using imputed whole-genome sequence variants within ±100 kb windows around lead SNPs. Heritability for both traits increased with environmental quality, indicating environment-dependent expression of genetic variance. Genetic correlations for HP and HR across the environmental gradient ranged from 0.15 to 0.98, supporting substantial G×E interactions and reranking between low and high environmental conditions. Multi-trait analyses of reaction norm parameters identified 482 significant signals for the intercept and 700 for the slope. Intercept-associated loci were enriched for lipid metabolism, embryonic development, estrous regulation, and hypothalamic-pituitary signaling, whereas slope-associated loci highlighted endocrine signaling, metabolic plasticity, and neuroendocrine feedback responsive to contrasting post-weaning nutritional and management conditions captured by the EG. Fine-mapping refined associations to 146 (intercept) and 149 (slope) putative loci for HP, and 117 (intercept) and 167 (slope) for HR, supported by high posterior probabilities and Bayes factors. Candidate variants mapped to endocrine and metabolic regulators, including IGF1, LEP, GHRL, GNRHR, KISS1, MAPK3, PLAG1, INSR, and LHCGR. G × E interactions play a key role in shaping the genetic architecture of reproductive efficiency in Nellore heifers. Integrating reaction norm, multi-trait GWAS, and fine-mapping highlighted loci, affecting both genetic merit and environmental sensitivity of fertility, providing targets to select more resilient Nellore females for tropical systems.
This study aimed to explore the associations between assisted reproductive technology (ART) modality and chorionicity in monozygotic twinning pregnancies following single blastocyst frozen-thawed embryo transfer. This retrospective cohort study analyzed 30,121 single embryo transfer cycles from January 2013 to December 2022 but focused on 251 monozygotic twinning pregnancies following single blastocyst frozen-thawed embryo transfer, including 144 monochorionic diamniotic (MCDA) twins and 107 dichorionic diamniotic (DCDA) twins. Regression analysis was performed to determine the risk factors for the subtypes of monozygotic twinning pregnancies after ART. Pregnancy complications and neonatal outcomes of the MCDA and DCDA groups were compared, and subgroup analyses among the in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and preimplantation genetic testing (PGT) groups were performed. The overall monozygotic twinning rate was 1.97%, without a significant difference between D5/6 and D3 embryos in frozen cycles (1.95% vs. 1.56%, p = 0.55). IVF and ICSI were associated with a lower incidence of MCDA twins than observed in the PGT group (IVF: adjusted odds ratio [aOR] = 0.40, p = 0.009; ICSI: aOR = 0.38, p = 0.011). The incidence rates of specific severe complications in MCDA twins, such as twin‒twin transfusion syndrome, selective intrauterine growth restriction, and twin anemia polycythemia sequence, were 2.78%, 2.78%, and 0.69%, respectively. No significant differences were observed in other adverse pregnancy or neonatal outcomes among the MCDA, DCDA, and ART modalities. PGT may be associated with an increased incidence of MCDA twins following single blastocyst frozen-thawed embryo transfer. The incidence of specific maternal-fetal complications for MCDA twins, such as twin‒twin transfusion syndrome and selective intrauterine growth restriction, remains noteworthy. However, the occurrence rates of other adverse pregnancy complications and neonatal outcomes of MCDA twins and DCDA twins are comparable.
Sickle cell hemoglobinopathy is not merely a genetic disorder but a deeply embedded socio-cultural phenomenon in the remote regions of Odisha. Drawing on long-term ethnographic fieldwork in Koraput and surrounding districts, this study explores the lived experiences of individuals with sickle cell trait (SCT) and sickle cell disease (SCD), focusing on social discrimination, medical uncertainty, and healthcare accessibility. The findings reveal reluctance toward screening, particularly among unmarried women, due to fears of marital exclusion and family stigma. Misconceptions about SCT, including beliefs that it can appear or disappear over time, further reinforce social anxiety and misinformation. Inconsistencies in diagnosis, limited genetic counselling, geographic isolation, and economic insecurity exacerbate these challenges. The study also examines women's caregiving roles, therapeutic pluralism involving traditional healers, and youth perspectives on reproductive futures. By foregrounding the social consequences of carrier status alongside disease, the article challenges assumptions that SCT is negligible. These findings highlight the need for culturally sensitive genetic education, decentralized health services, and community-based interventions, contributing to a holistic understanding of sickle cell hemoglobinopathy within medical anthropology.
Toxoplasmosis can cause reproductive losses in livestock species such as goats and sheep. However, the impact of this parasitic infection in mares remains poorly investigated, reflecting the neglect of this pathogen in equine production. The present study aimed to conduct a serological survey in 100 mares from farms enrolled in embryo transfer (ET) programs in Northeastern Brazil, report the first molecular detection of Toxoplasma gondii in the placenta and aborted fetus of a mare in the country, and evaluate potential risk factors associated with infection. Anti-T. gondii IgG antibodies were detected using the indirect fluorescent antibody assay (IFA) with a cutoff of 1:64, followed by serial titration. Placentas and fetal organs from three mares from a farm with an abortion outbreak were also analyzed by PCR targeting the 18S rRNA gene of the family Sarcocystidae and the 529-bp repetitive element of T. gondii. A total of 31% of mares were seropositive (95% CI: 22.3-40.9), and both the fetus and placenta from one mare tested positive for the 18S rRNA gene and the 529-bp RE. The presence of cats on the farms and a history of abortion were identified as factors associated with seropositivity. These findings provide novel evidence contributing to the understanding of T. gondii infection in equine production systems.
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To evaluate the cost-effectiveness of including embryos derived from atypically-pronucleated zygotes (APZs) in IVF cycles with preimplantation genetic testing for aneuploidy (PGT-A), compared with standard use of only typically fertilised (2PN) embryos. Model-based cost-effectiveness analysis using retrospective clinical data. Data were derived from two clinical embryology datasets from a private IVF centre in Italy, comprising 8,334 intracytoplasmic sperm injection (ICSI) cycles with PGT-A (2015-2022) and 826 ICSI cycles with time-lapse monitoring (2013-2020). A decision-tree model compared two IVF strategies over up to two treatment cycles: (1) standard selection of euploid blastocysts derived exclusively from 2PN zygotes and (2) inclusion of PGT-A-confirmed euploid blastocysts derived from APZs (1PN or ≥3PN) in addition to 2PN embryos. The primary effectiveness outcome was the probability of achieving at least one live birth per treatment pathway, and costs reflected patient out-of-pocket expenses. Incremental cost-effectiveness ratios (ICERs) were calculated against a patient-derived willingness-to-pay (WTP) threshold of €422.25 per 1% absolute increase in live-birth probability. Deterministic (±20% parameter variation) and probabilistic (10,000 Monte Carlo simulations) sensitivity analyses evaluated parameter uncertainty and the robustness and transferability of results across clinical and economic settings, with subgroup analyses by maternal age and embryo availability. Inclusion of APZ-derived euploid blastocysts increased cumulative live-birth probability from 0.7294 to 0.7436 (absolute increase 1.42%) while marginally reducing mean treatment cost (€12,737.92 vs €12,749.49), resulting in a cost saving of €11.57 per couple. Across all sensitivity analyses and subgroups, the APZ-inclusive strategy consistently demonstrated higher effectiveness with lower costs or favourable ICERs, remaining economically dominant or cost-effective within the predefined WTP threshold. Notably, higher treatment costs further enhanced the relative cost-effectiveness of APZ utilisation by increasing the economic value of incremental gains in live-birth probability. Inclusion of PGT-A-confirmed euploid APZ-derived blastocysts improves IVF live-birth outcomes at lower or comparable cost and remains cost-effective across diverse clinical and economic scenarios. This is particularly relevant in healthcare systems with higher IVF and PGT-A costs, supporting routine integration of APZ-derived embryos as a generalisable and economically efficient approach.
To examine whether use of preimplantation genetic testing for aneuploidy (PGT-A) among donor oocyte recipients is associated with the number of embryo transfers (ETs) required to achieve a live birth, or time to live birth. Retrospective cohort study. Recipients at a large, academic-affiliated practice who underwent donor oocyte in vitro fertilization (IVF) from 2016 to 2024 and achieved at least one live birth were included. Cycles utilizing fresh or frozen donor oocytes and resulting in fresh or frozen single ETs were eligible for analysis. Patients who did and did not use PGT-A were compared. The primary outcome was the number of ETs required to achieve first live birth. Secondary outcomes were days from days from first ET until first live birth, days from fertilization until first live birth, live birth rate after first ET, and rate of spontaneous abortion per patient and per ET. The study included 629 patients who underwent 927 ETs. 312 patients (479 ETs) used PGT-A and 317 patients (448 ETs) did not use PGT-A. On Cox proportional hazards model, no difference was found between study groups regarding number of ETs needed to achieve first live birth (hazard ratio (HR) 0.89, CI 95% [0.73-1.09]). There was also no difference between groups regarding number of days from first ET to first live birth (HR 0.93, CI 95% [0.77-1.13]) and number of days from fertilization to first live birth (HR 1.07, CI 95% [0.83-1.36]). No association was found between PGT-A group and live birth rate for the first ET (aOR 1.29, CI 95% [0.91-1.84]), or rate of spontaneous abortion per patient (aOR 1.08, CI 95% [0.52-2.27]) or per ET (aOR 1.23, CI 95% [0.61-2.49]). Donor oocyte recipients can be counseled that PGT-A use does not appear to be associated with number of transfers needed to achieve live birth or with time to live birth.
Attachment theory was built on heterosexual, biologically related mother-infant dyads, leaving caregiving in sexual minority parent families peripheral to the field. This PRISMA 2020 systematic review synthesized empirical work applying attachment measures to lesbian mother and gay father families. Searches of PsycINFO, PubMed, Scopus, and Web of Science from inception to 28 February 2026 yielded 15 reports (8 cross-sectional, 6 longitudinal, 1 case study; from 12 studies) sampling families formed via donor insemination, gestational surrogacy, and adoption. Across measures, designs, and developmental periods, children of lesbian and gay parents did not differ from peers in attachment security or classification distributions; in adoptive gay father families, security exceeded comparison samples. Intergenerational transmission from parental coherence of mind to sensitive caregiving and child security operated as expected, regardless of within-couple biological relatedness. Caregiving role, reflective functioning, and minority stress were key moderators. It proposes five theoretical advancements and a 10-year research agenda.
Suboptimal gestational weight gain (GWG) is associated with adverse pregnancy outcomes; however, evidence on the impact of nutritional interventions on GWG in low-income settings remains limited OBJECTIVE: To examine the effectiveness of an enhanced nutrition package (ENP), including a balanced energy protein (BEP) supplement, on GWG compared to routine care. We conducted a pragmatic cluster-randomized effectiveness study among pregnant women <24 weeks' gestation in rural Amhara, Ethiopia. Twelve health centers were randomized to provide either ENP, including a daily BEP supplement for women with mid-upper arm circumference (MUAC) ≤23 cm or routine care. GWG and GWG rate (kg/week) were calculated from enrollment to late pregnancy weight measurement. Intention-to-treat (ITT), cluster-level analysis, compared GWG outcomes between study arms. Primary analyses were restricted to women with observed 3rd trimester weights. Secondary dose-response analysis within the ENP arm examined associations between BEP consumption duration and GWG outcomes. A total of 2392 women were enrolled and randomized (n=1210 ENP; n=1189 routine care), with 2170 followed up until birth. In the ENP arm, 37% were eligible for BEP supplementation. ITT analysis showed no differences between arms in GWG rate (diff= -0.006 kg/week; 95%CI: -0.042, 0.030) or observed GWG (diff= 0.009 kg; 95%CI: -0.687, 0.706). Among BEP-eligible women, GWG outcomes also did not differ between arms (ΔGWG rate= 0.006 kg/week; 95%CI: -0.027, 0.030); observed ΔGWG= 0.201 kg (95%CI: -0.443, 0.845). In dose-response analysis within the ENP arm, women consuming BEP for 61-90 and >90 days had a higher GWG rate (61-90 days: 0.46 kg/wk, 95% CI: 0.003 to 0.090); >90 days: 0.059 kg/week; 95%CI:0.018 to 0.099) and observed GWG (61-90 days: 0.895 kg, 95% CI 0.004 to 1.786 kg; >90 days: 1.206 kg, 95%CI: 0.331, 2.081) compared to those consuming BEP for <30 days. The ENP package, including BEP, did not improve GWG compared to routine care in this pragmatic study in the Ethiopian health system. Longer duration of prenatal BEP adherence (at least 60 days) may benefit GWG and GWG rates among undernourished women. ISRCTN15116516.