Effects of prenatal food and micronutrient supplementation on child growth from birth to 54 months of age: a randomized trial in Bangladesh

Ashraful Islam Khan,Kajsa Åsling-Monemi,Edward A Frongillo,Eva-Charlotte Ekström,Dewan Shamsul Alam,Shams Arifeen,Md Yunus,Lars-Åke Persson,Iqbal Kabir

doi:10.1186/1475-2891-10-134

Abstract

BackgroundThere is a lack of information on the optimal timing of food supplementation to malnourished pregnant women and possible combined effects of food and multiple micronutrient supplementations (MMS) on their offspring's growth. We evaluated the effects of prenatal food and micronutrient interventions on postnatal child growth. The hypothesis was that prenatal MMS and early invitation to food supplementation would increase physical growth in the offspring during 0-54 months and a combination of these interventions would further improve these outcomes.MethodsIn the large, randomized MINIMat trial (Maternal and Infant Nutrition Interventions in Matlab), Bangladesh, 4436 pregnant women were enrolled between November 2001 and October 2003 and their children were followed until March 2009. Participants were randomized into six groups comprising 30 mg Fe and 400 μg folic acid (Fe30F), 60 mg Fe and 400 μg folic acid (Fe60F) or MMS combined with either an early (immediately after identification of pregnancy) or a later usual (at the time of their choosing, i.e., usual care in this community) program invitation to food supplementation. The anthropometry of 3267 children was followed from birth to 54 months, and 2735 children were available for analysis at 54 months.ResultsThere were no differences in characteristics of mothers and households among the different intervention groups. The average birth weight was 2694 g and birth length was 47.7 cm, with no difference among intervention groups. Early invitation to food supplementation (in comparison with usual invitation) reduced the proportion of stunting from early infancy up to 54 months for boys (p = 0.01), but not for girls (p = 0.31). MMS resulted in more stunting than standard Fe60F (p = 0.02). There was no interaction between the food and micronutrient supplementation on the growth outcome.ConclusionsEarly food supplementation in pregnancy reduced the occurrence of stunting during 0-54 months in boys, but not in girls, and prenatal MMS increased the proportion of stunting in boys. These effects on postnatal growth suggest programming effects in early fetal life.Trial registration numberISRCTN: ISRCTN16581394

Highlights

There is a lack of information on the optimal timing of food supplementation to malnourished pregnant women and possible combined effects of food and multiple micronutrient supplementations (MMS) on their offspring’s growth
She was enrolled in the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) study if the following eligibility criteria had been met: fetus was viable, gestational age was < 14 weeks confirmed by ultrasound examination, no severe illness, and consent to participate
There were 3267 singleton infants with birth anthropometry born by the 4436 women enrolled into the MINIMat trial

Summary

Introduction

There is a lack of information on the optimal timing of food supplementation to malnourished pregnant women and possible combined effects of food and multiple micronutrient supplementations (MMS) on their offspring’s growth. We evaluated the effects of prenatal food and micronutrient interventions on postnatal child growth. The hypothesis was that prenatal MMS and early invitation to food supplementation would increase physical growth in the offspring during 0-54 months and a combination of these interventions would further improve these outcomes. Studies in India have shown that maternal nutrition is an important determinant of fetal growth, size at birth, and post natal growth [3], and highlight the need for improving maternal diet through micronutrient rich foods [4]. The diets of women in low- and middle-income countries are frequently deficient in energy, protein, and different micronutrients [5]. The usual diet in rural Bangladesh is monotonous and low in energy calories [6]. Maternal energy intake at 5 to 7 months of pregnancy is reportedly only 1464 kcal/day [7]

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Conclusion