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

Abstract

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 ...

PROCOMIDA, a Food-Assisted Maternal and Child Health and Nutrition Program, Reduces Child Stunting in Guatemala: A Cluster-Randomized Controlled Intervention Trial

“…To date, impacts of LNSs on children's linear growth have been mixed. Our null results are in line with those from studies conducted in Malawi (13, 34) and Burkina Faso (35) which also did not find an effect of LNSs on linear growth outcomes, and in Ghana where the impact of LNSs on birth length was limited to primiparous women (36). Thus, we cannot exclude the possibility that the lack of impact could be due to limitations of the efficacy of LNSs in the Guatemalan context.…”

Supplementation of Maternal Diets during Pregnancy and for 6 Months Postpartum and Infant Diets Thereafter with Small-Quantity Lipid-Based Nutrient Supplements Does Not Promote Child Growth by 18 Months of Age in Rural Malawi: A Randomized Controlled Trial

“…Similar results were recently obtained in 2 trials in Burkina Faso. In those studies, a prenatal maternal supplementation with MMN or a larger daily dose (72 g) of LNS was associated with increased birth weight and length, but these gains in growth were lost by the time children reached 12-30 mo of age (29,30).…”

Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: a randomized controlled trial,

“…Two studies (20, 21, 33, 34) involved the use of LNSs in prenatal supplementation followed by postnatal supplementation or follow-up, with which we can compare our results. First is the iLiNS-DYAD trial in Malawi referred to above (20, 21), in which SQ-LNSs, evaluated by using the same design as this study, did not increase linear growth of children by 18 mo of age.…”

“…Further, ∼11−15% of women across the 3 groups in the Malawi study (20) were HIV positive at baseline, compared with no documented HIV infection in the present study. In Burkina Faso, prenatal supplementation with medium-quantity LNSs, compared with MMNs, increased birth length (33), but the increase was not sustained during the ensuing 12 mo postpartum, when there was no LNS supplementation of mothers or infants (34). Our results are somewhat consistent with those from Burkina Faso (33, 34), in that prenatal LNS supplementation increased fetal growth in both cases, albeit primarily among primiparous women in our study (22).…”

“…In Burkina Faso, prenatal supplementation with medium-quantity LNSs, compared with MMNs, increased birth length (33), but the increase was not sustained during the ensuing 12 mo postpartum, when there was no LNS supplementation of mothers or infants (34). Our results are somewhat consistent with those from Burkina Faso (33, 34), in that prenatal LNS supplementation increased fetal growth in both cases, albeit primarily among primiparous women in our study (22). However, in Ghana the growth differences at birth were sustained through 18 mo of age, although there was no widening of the growth difference between groups after birth.…”