Lipid-based nutrient supplements for pregnant women reduce newborn stunting in a cluster-randomized controlled effectiveness trial in Bangladesh

Mridha, Malay K; Matias, Susana L; Chaparro, C; Paul, Rina Rani; Hussain, Sohrab; Vosti, Stephen A.; Harding, Kassandra; Cummins, Joseph; Day, Louise; Saha, Stacy L.; Peerson, Janet M; Dewey, Kathryn G.

doi:10.3945/ajcn.115.111336

Cited by 111 publications

(276 citation statements)

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“…The overall hypothesis of the study was that the provision of LNS-PL to women and/or LNS-C to their offspring would result in larger positive changes in maternal and child nutrition outcomes than would the provision of iron and folic acid (IFA) to women and MNP or no supplementation for their children. We previously reported that LNS-PL reduced stunting and small head size at birth in the RDNS sample (12). This report describes the effects of the RDNS intervention on child development (secondary) outcomes during the first 24 mo.…”

Section: Introductionmentioning

confidence: 84%

“…Other regular services provided by CHDP included maternity services at a safe delivery unit (SDU) in each union; home visits for antenatal, postnatal, and primary child care by community health workers (CHWs) and village health volunteers; and educational group sessions to promote maternal and child health. A further description of the study setting is reported elsewhere (12).…”

Section: Study Setting and Designmentioning

confidence: 99%

“…The study was implemented in 64 clusters (defined as the supervision area of a CHW), with 16 clusters randomly assigned to each of the 4 arms by the study statistician, after stratification by subdistrict and union, as previously described (12).…”

Section: Study Setting and Designmentioning

confidence: 99%

“…The distribution format and the use messages for LNS-PL are described elsewhere (12). Child supplementation started at 6 mo of age with a first month's supply of either LNS-C or MNP given at the SDU along with the use messages.…”

Section: Study Supplementsmentioning

confidence: 99%

“…Further details on participant enrollment are reported elsewhere (12). Data collection was conducted in 2 settings, by 2 different teams, as follows: at the participant's home (e.g., sociodemographic characteristics; nutrition-related knowledge, attitudes, and practices; food security; infant and young feeding practices; medical expenditures) and at the SDU [e.g., anthropometric measurements (except for measurements at birth and at 42 d), bio-specimens, clinical data, and developmental assessments].…”

Section: Enrollment and Data Collectionmentioning

confidence: 99%

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Home fortification during the first 1000 d improves child development in Bangladesh: a cluster-randomized effectiveness trial

Matias

Mridha

Tofail³

et al. 2017

The American Journal of Clinical Nutrition

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Background: Nutrition during the first 1000 d is critical for brain development. Objective: We evaluated the effects on child development of home fortification with lipid-based nutrient supplements (LNSs) for mothers and/or children or micronutrient powder (MNP) for children. Design: We conducted a cluster-randomized effectiveness trial with 4 arms: 1) LNSs during pregnancy and the first 6 mo postpartum and LNSs for the offspring from 6 to 24 mo (LNS-LNS), 2) iron and folic acid (IFA) during pregnancy and the first 3 mo postpartum and LNSs for the children from 6 to 24 mo (IFA-LNS), 3) IFA (as above) and MNP for the offspring from 6 to 24 mo (IFA-MNP), and 4) IFA (as above) and no child supplement (IFA-Control). Women were enrolled at #20 wk of gestation; children were assessed at 12 (n = 3331), 18 (n = 3364), and 24 (n = 3379) mo. Results: Compared with the IFA-Control group, motor development scores were higher in the LNS-LNS (P = 0.016) and IFA-LNS groups (P = 0.006) at 18 mo and in the IFA-MNP group (P = 0.048) at 24 mo. Receptive language scores were higher for the LNS-LNS group (P = 0.028) at 18 mo and for all 3 groups at 24 mo (P = 0.008 for LNS-LNS, P = 0.022 for IFA-LNS, and P = 0.009 for IFA-MNP compared with IFA-Control). Expressive language scores did not differ at 18 mo (P = 0.236) but were higher in the LNS-LNS (P = 0.035) and IFA-MNP (P = 0.002) groups than in the IFA-Control group at 24 mo. Groups did not differ in personal-social scores at 18 (P = 0.233) or 24 (P = 0.146) mo or in executive function score at 24 mo (P = 0.467). Conclusion: Prenatal LNSs, postnatal LNSs, or both, or postnatal MNP had a positive effect on motor and language development in Bangladeshi children. This trial was registered at clinicaltrials.gov as NCT01715038.Am J Clin Nutr

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Section: Introductionmentioning

confidence: 84%

Section: Study Setting and Designmentioning

confidence: 99%

Section: Study Setting and Designmentioning

confidence: 99%

Section: Study Supplementsmentioning

confidence: 99%

Section: Enrollment and Data Collectionmentioning

confidence: 99%

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Home fortification during the first 1000 d improves child development in Bangladesh: a cluster-randomized effectiveness trial

Matias

Mridha

Tofail³

et al. 2017

The American Journal of Clinical Nutrition

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Association of Early Interventions With Birth Outcomes and Child Linear Growth in Low-Income and Middle-Income Countries

Park

Fang

Harari³

et al. 2019

JAMA Netw Open

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IMPORTANCE The first 1000 days of life represent a critical window for child development. Pregnancy, exclusive breastfeeding (EBF) period (0-6 months), and complementary feeding (CF) period (6-24 months) have different growth requirements, so separate considerations for intervention strategies are needed. No synthesis to date has attempted to quantify the associations of interventions under multiple domains of micronutrient and balanced energy protein and food supplements, deworming, maternal education, water sanitation, and hygiene across these 3 life periods with birth and growth outcomes. OBJECTIVE To determine the magnitude of association of interventions with birth and growth outcomes based on randomized clinical trials (RCTs) conducted in low-income and middle-income countries (LMICs) using Bayesian network meta-analyses. DATA SOURCES MEDLINE, Embase, and Cochrane databases were searched from their inception up to August 14, 2018. STUDY SELECTION Included were LMIC-based RCTs of interventions provided to pregnant women, infants (0-6 months), and children (6-24 months). DATA EXTRACTION AND SYNTHESIS Two independent reviewers used a standardized data extraction and quality assessment form. Random-effects network meta-analyses were performed for each life period. Effect sizes are reported as odds ratios (ORs) and mean differences (MeanDiffs) for dichotomous and continuous outcomes, with 95% credible intervals (CrIs). This study calculated probabilities of interventions being superior to standard of care by at least a minimal clinically important difference. MAIN OUTCOMES AND MEASURES The study compared ORs on preterm birth and MeanDiffs on birth weight for pregnancy, length for age (LAZ) for EBF, and height for age (HAZ) for CF. RESULTS Among 302 061 participants in 169 randomized clinical trials, the network meta-analyses found several nutritional interventions that demonstrated greater association with improved birth and growth outcomes compared with standard of care. For instance, compared with standard of care, maternal supplements of multiple micronutrients showed reduced odds for preterm birth (OR, 0.54; 95% CrI, 0.27-0.97) and improved mean birth weight (MeanDiff, 0.08 kg; 95% CrI, 0.00-0.17 kg) but not LAZ during EBF (MeanDiff, −0.02; 95% CrI, −0.18 to 0.14). Supplementing infants and children with multiple micronutrients showed improved LAZ (MeanDiff, 0.20; 95% CrI, 0.03-0.35) and HAZ (MeanDiff, 0.14; 95% CrI, 0.02-0.25). The study found that pregnancy interventions (continued) Key Points Question Which interventions under the domains of nutrition, deworming, maternal education, and water, sanitation, and hygiene can improve birth and linear growth outcomes during the first 1000 days of life in low-income and middle-income countries (LMICs)? Findings This study used Bayesian network meta-analyses of 169 randomized clinical trials including 302 061 participants and showed that several nutritional interventions demonstrating greater associations with improved outcomes compared with standard of care, whi...

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Multiple-micronutrient supplementation for women during pregnancy

Haider

Bhutta

2015

Cochrane Database of Systematic Reviews

176

204

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Analysis 1.13. Comparison 1 Multiple micronutrients vs control, Outcome 13 Mode of delivery: caesarean section. . Analysis 1.14. Comparison 1 Multiple micronutrients vs control, Outcome 14 Pre-eclampsia. . . . . . . . . Analysis 2.1. Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 1 Preterm births: mean maternal BMI. . . . . . . . . . . . . . . Analysis 2.2. Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 2 Preterm births: mean maternal height. . . . . . . . . . . . . . . Analysis 2.3. Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 3 Preterm births: timing of supplementation. . . . . . . . . . . . . Analysis 2.4. Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 4 Preterm births: dose of iron. . . . . . . . . . . . . . . . . . Analysis 2.5. Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 5 Small-for-gestational age: mean maternal BMI. . . . . . . . . . . . Analysis 2.6. Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 6 Small-for-gestational age: dose of iron. . . . . . . . . . . . . . . Analysis 2.7. Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 7 Small-for-gestational age: timing of supplementation. . . . . . . . . . Analysis 2.8. Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 8 Small-for-gestational age: mean maternal height. . . . . . . . . . . Analysis 2.9. Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 9

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Lipid-based nutrient supplements for pregnant women reduce newborn stunting in a cluster-randomized controlled effectiveness trial in Bangladesh

Abstract: Prenatal lipid-based nutrient supplements can improve birth outcomes in Bangladeshi women, especially those at higher risk of fetal growth restriction. This trial was registered at clinicaltrials.gov as NCT01715038.

Cited by 111 publications

References 30 publications

Home fortification during the first 1000 d improves child development in Bangladesh: a cluster-randomized effectiveness trial

Home fortification during the first 1000 d improves child development in Bangladesh: a cluster-randomized effectiveness trial

Association of Early Interventions With Birth Outcomes and Child Linear Growth in Low-Income and Middle-Income Countries

Multiple-micronutrient supplementation for women during pregnancy

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