For research purposes you can measure MUAC as often as you like as this is non-invasive.  In terms of a targeted supplementary feeding program, women early in pregnancy may not qualify (MUAC< 23.1 cm), but will often first qualify around 22 weeks, so it is important to continue measurements of these women when they become malnourished.  I would enroll anyone who presents as malnourished to allow for this work to be operationized.

Hello Colleague

I do not fully understand your question but in case you want to do anthropometric measurements of breastfeeding women (BW) after their infant has reached the age of 6 months you can use BMI again, instead of MUAC. Once a BW has given birth and provided breastmilk for 6 months, BMI is a good measurement and you can regard her as if she is an adult without specific physiological conditions. And as you know, we use BMI for adults to identify malnutrition.  I did not understand fully my colleague's suggestion regarding 22 weeks, but as you probably know from many studies, pregnant women who have a MUAC <23 cm have a high likelihood to give birth to a low birth weight child. The sooner they are identified the better, and the sooner their nutritional status and potential underlying ill-health conditions are identified and improved/treated, the better.

What I meant about 22 weeks is that we see pregnant women sequentially from very early in gestation and as the baby gets bigger, the mother's arm gets smaller.  The we find 22 weeks to  be a common point when mother's MUAC decreases to < 23.1 cm as he fetus approaches 3rd trimester

Excellent initiative, and here you go my reflections:

1. Extending follow-up post discharge is a brilliant strategy, particularly for breastfeeding women (BW). This could involve using BMI after six months postpartum, as suggested by Mija Ververs. BMI, while not perfect, offers a practical approach for assessing adult malnutrition when MUAC may no longer be appropriate. Additionally, try to include qualitative research to understand barriers and facilitators to continued program participation post-discharge.

2. Super fantastic to establish whether interventions (SNF, cash, or vouchers) lead to sustained recovery beyond program participation, one exchange article from Yemen published in ENN tried to answer this and found a link between CVA and nutritional improvement: 
   https://www.ennonline.net/fex/68/yemencashtransfers

   3. Finally, try to investigate cost-effectiveness of the three arms (SNF, cash, or vouchers) to inform future program scaling.

    

    

   thank you and all the best 

    

Hello, sounds like a great study. This may sound a little cynical, but isn't the main aim of interventions for undernourished mothers to reduce the risk of low birth weight and wasting in the infant? Maybe you should consider infant outcomes at birth and 6 months as your main outcome when supporting PBW rather than "recovery" in the mother..  ?