Balanced protein–energy supplementation can improve the nutritional status of pregnant women and birthweight. The cost of prenatal supplementation is often beyond the reach of mothers in low-income countries. In this study of undernourished pregnant women, the aim was to develop an affordable, locally produced, balanced protein–energy food-based supplement and test its acceptance. A small business enterprise was established. With a commitment to local-level applied research, a balanced protein–energy supplement was developed using locally available, affordable, and preferred foods. A 30-day acceptability study was conducted among 10 pregnant women between September and October 2012 in a rural district of northern Bangladesh. A questionnaire was administered at days 15 and 30 to assess women’s perceptions and experience regarding compliance, organoleptic qualities, as well as personal and community attitudes toward the supplement and study. The primary outcome was compliance. All 10 women completed the 15- and 30-day questionnaires. The supplement was redeveloped at day 15 based on feedback from the follow-up survey and formal and informal feedback. By day 30, women consumed an average of 29.7 packets of the supplement of the 30 packets received. We concluded that the redeveloped locally produced food-based supplement was well accepted by pregnant women. Study findings have contributed toward the design of an efficacy trial currently underway.