Antenatal supplementation with folic acid + iron + zinc improves linear growth and reduces peripheral adiposity in school-age children in rural Nepal

Stewart, Christine P; Christian, Parul; LeClerq, Steven C.; West, Keith P.; Khatry, Subarna K.

doi:10.3945/ajcn.2008.27368

Cited by 89 publications

(88 citation statements)

References 40 publications

(50 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11,12 In another trial in Nepal, there was no difference in height between school-age children prenatally supplemented with MMN compared with folic acid. 13 Few studies evaluated the combined effect of prenatal food supplements and MMN on postnatal outcomes. In Bangladesh, food rations combined with micronutrients tablets given in early gestation resulted in a reduced proportion of stunting from early infancy up to 54 months for boys and a higher infant mortality.…”

mentioning

confidence: 99%

Prenatal Nutrient Supplementation and Postnatal Growth in a Developing Nation: An RCT

et al. 2014

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT: Prenatal lipid-based nutrient supplementation has been demonstrated to increase birth length. However, the impact of this intervention on infant growth and morbidity is unknown. WHAT THIS STUDY ADDS:Infants from mothers who were given prenatal lipid-based nutrient supplements showed decelerated linear growth. The gain in length at birth related to prenatal lipidbased nutrient supplementation was not sustained during infancy. abstract BACKGROUND AND OBJECTIVES: Prenatal lipid-based nutrient supplements (LNS) have been shown to improve birth anthropometry. However, little is known about the effects of such supplements on infant health. We hypothesized that prenatal LNS compared with multiple micronutrient supplement for pregnant and lactating women would improve survival, growth, and morbidity during infancy. METHODS:Infants' weight, length, head, chest, and mid-upper arm circumferences were measured during monthly home visits from birth to 12 months of age in the Micronutriments et Santé de la Mère et de l'Enfant-2 trial. Differences in stunting and wasting episodes between study arms were assessed by Cox regression for recurrent event models. Morbidity signs during the 2 weeks before the visits and death cases were also assessed by multilevel analysis accounting for repeated individual measurements.RESULTS: Infant length-for-age growth (-0.033 z score/month; 95% confidence interval: -0.601 to -0.006; P = .018) for the LNS group was inferior to that of the control group. We did not find evidence of significant difference in mortality or morbidity between groups. CONCLUSIONS:The previously reported positive effect of prenatal LNS on birth length was not sustained during the postnatal phase. Prenatal LNS does not appear to make a long-lasting difference in child linear growth. Pediatrics 2014;133:e1001-e1008 Size at birth and growth in early infancy are important indicators of early childhood survival and health. Newborns with small birth size, reflecting poor intrauterine nutrition and/or prematurity, have an increased riskofinfant mortality and morbidity, 1 impaired child cognitive development, 2 and adverse health outcomes in adulthood. 3 Poor infant growth is associated with higher mortality and neurocognitive delays. 4,5 Stunted growth during the first 2 years is also associated with shorter adult height, reduced economic productivity, and decreased reproductive performance. 5 In 2011, an estimated 165 million children aged ,5 years worldwide had stunted growth, with the majority residing in Asia and sub-Saharan Africa. 6 Prenatal multiple micronutrient (MMN) 7 and balanced energy and protein 8 supplementation result in a significant reduction in small-for-gestational age births (9% and 31%, respectively). However, the results of such interventions on postnatal growth yielded more dispersed results. In 2 prenatal multiple MMN trials in Burkina Faso and Vietnam, the rate of stunting was reduced during infancy 9 and at 2 years, 10 although no difference was seen at 2.5 years in the ...

show abstract

mentioning

confidence: 99%

Prenatal Nutrient Supplementation and Postnatal Growth in a Developing Nation: An RCT

et al. 2014

View full text Add to dashboard Cite

show abstract

“…A total of 1316 women were eligible for inclusion in the substudy and 1165 agreed to provide a blood sample. From 2006 to 2008, the surviving children born during the trial were revisited and assessed during a series of household visits, the methods of which have been described elsewhere (14,15). Children were asked to fast overnight and a team of phlebotomists traveled to the households early in the morning to collect blood and urine specimens.…”

Section: Methodsmentioning

confidence: 99%

Low Maternal Vitamin B-12 Status Is Associated with Offspring Insulin Resistance Regardless of Antenatal Micronutrient Supplementation in Rural Nepal,

Stewart

Christian

Schulze

et al. 2011

The Journal of Nutrition

Self Cite

110

View full text Add to dashboard Cite

Questions have been raised about potentially negative effects of antenatal folic acid use in populations with a high prevalence of vitamin B-12 deficiency. Our objective was to examine the association between maternal folate and vitamin B-12 status in pregnancy on offspring insulin resistance and examine whether the effects of maternal micronutrient supplementation varied by baseline maternal folate and/or vitamin B-12 status. Pregnant women were cluster randomized to receive daily supplements containing vitamin A alone or with folic acid, folic acid+iron, folic acid+iron+zinc, or a multiple micronutrient. In a subsample (n = 1132), micronutrient status biomarkers were analyzed at baseline and late pregnancy. Children born to the women who participated in the trial were visited at 6-8 y of age. Fasting plasma glucose and insulin were used to estimate insulin resistance using the homeostasis model assessment (HOMA-IR). Children whose mothers were deficient in vitamin B-12 (<148 pmol/L, 27%) during early pregnancy had a 26.7% increase in HOMA-IR (P = 0.02), but there was no association with maternal folate status. Among children born to women who were vitamin B-12 deficient at baseline, the percent difference in HOMA-IR compared to the control group was 15.1% (95% CI: -35.9, 106.4), 4.9% (-41.6, 88.5), 3.3% (-38.4, 73.5), and 18.1% (-29.0, 96.7) in the folic acid, folic acid-iron, folic acid-iron-zinc, and multiple micronutrient supplementation groups, respectively, none of which were significant. Maternal vitamin B-12 deficiency is associated with an elevated risk of insulin resistance, but supplementation with folic acid or other micronutrients led to no significant change in insulin resistance in school-aged offspring.

show abstract

“…17 Stewart et al found that children born to women who received daily IFA combined with zinc supplementation during pregnancy had greater postnatal linear growth (0.65 cm) at 7.5 years of age than control groups. 19 In contrast, Vadiya et al found that children born to women who took daily antenatal MMN had an increase of 204 g …”

Section: Bmj Global Healthmentioning

confidence: 93%

“…However, this is unlikely as the study was randomised and extensive measurement of confounders was undertaken. Eight other trials of antenatal/prenatal micronutrient supplementation have assessed growth in childhood; [16][17][18][19][20][21][22][23] however, findings are inconsistent and none of these studies assessed intermittent supplementation regimens, where the total dose of iron given during pregnancy is significantly lower than in daily regimens. Two of these trials showed an improvement in growth outcomes in children born to mothers who took daily IFA compared with daily MMN or placebo.…”

Section: Bmj Global Healthmentioning

confidence: 99%

Effect of low-dose versus higher-dose antenatal iron supplementation on child health outcomes at 36 months of age in Viet Nam: longitudinal follow-up of a cluster randomised controlled trial

et al. 2017

View full text Add to dashboard Cite

IntroductionIntermittent iron-folic acid supplementation (IFA) is currently recommended for pregnant women in populations where anaemia prevalence among pregnant women is <20% or if daily iron is not acceptable. The effect of providing lower doses of antenatal elemental iron through intermittent regimes on longer-term health outcomes in childhood is unclear.MethodsA prospective cohort study conducted between May 2012 and May 2014 in Viet Nam among children of 36 months of age, born to women previously enrolled in a cluster randomised controlled trial of antenatal micronutrient supplementation (daily IFA (60 mg elemental iron) vs twice-weekly IFA (60 mg elemental iron) vs twice-weekly multiple micronutrient (MMN) supplementation (60 mg elemental iron)). Primary outcomes were height-for-age z-scores (HAZ), according to WHO growth standards and cognitive composite scores (Bayley Scales of Infant and Toddler Development, third edition) at 36 months of age.ResultsA total of 1017 children born to mothers enrolled in the cluster randomised trial were assessed at 36 months of age. Adjusted mean differences (MDs) in HAZ were –0.14 (95% CI –0.28 to –0.01) and –0.15 (95% CI –0.29 to –0.01) in children born to mothers who received twice-weekly IFA or MMN compared with those who received daily IFA. Children born to mothers who received twice-weekly MMN had lower composite motor scores compared with those who received daily IFA (MD –2.07, 95% CI –4.11 to –0.03). There were no differences in composite cognitive scores in the twice-weekly compared with daily regimens.ConclusionsLow-dose antenatal IFA supplementation (120 mg elemental iron per week) resulted in lower HAZ and motor composite scores in children compared with higher-dose antenatal IFA supplementation (420 mg elemental iron per week). This highlights the importance of adequate iron stores during pregnancy and the need for careful monitoring when lower-dose antenatal iron regimens are used.Trial registration numberAustralia New Zealand Clinical Trials Registry: 12610000944033.

show abstract

Antenatal supplementation with folic acid + iron + zinc improves linear growth and reduces peripheral adiposity in school-age children in rural Nepal

Abstract: Antenatal supplementation with zinc may benefit child growth, particularly in areas where a deficiency of this nutrient is common.

Cited by 89 publications

References 40 publications

Prenatal Nutrient Supplementation and Postnatal Growth in a Developing Nation: An RCT

Prenatal Nutrient Supplementation and Postnatal Growth in a Developing Nation: An RCT

Low Maternal Vitamin B-12 Status Is Associated with Offspring Insulin Resistance Regardless of Antenatal Micronutrient Supplementation in Rural Nepal,

Effect of low-dose versus higher-dose antenatal iron supplementation on child health outcomes at 36 months of age in Viet Nam: longitudinal follow-up of a cluster randomised controlled trial

Contact Info

Product

Resources

About