Energy supplementation during pregnancy and postnatal growth

Abstract

The effect of improving maternal nutrition during pregnancy on growth of the child has not been assessed, since previous studies supplemented the diets of children as well as mothers. In a controlled randomised trial in Madura, East Java, pregnant women received a high (HE) or low (LE) energy supplement that provided 1950 kJ (465 kcal) or 218 kJ (52 kcal), respectively, in the last trimester of pregnancy. The effect of this intervention on the children's growth was assessed longitudinally for the first 5 years of life. Only the children of mothers who had complied for at least 90 days were included. Infants entered the study at birth and their growth was measured at 4-week intervals until 12 months old; thereafter they were measured every 3 months. Growth curves were calculated from a mathematical model, based on the best fit of actual measurements and the age-related growth velocity. Up to the age of 24 months, HE children were significantly heavier than LE children (p less than 0.05). HE children were also taller throughout the first 5 years (p less than 0.005 from 15 to 48 months, p less than 0.05 at both 3-12 and 60 months). Weight-for-height by age was similar in both groups, but stunting (height-for-age) was less prevalent in HE children. In a community characterised by chronic energy deficiency among women of reproductive age, energy supplementation of women for the last 90 days of pregnancy was effective in the promotion of postnatal growth and reduction in malnutrition of preschool children.

PIP: In 1982-84, health workers randomly assigned 542 women in the last trimester of pregnancy who lived in 3 villages in East Java, Indonesia to either the low energy (LE) or high energy (HE) supplement group (52 kcal vs. 465 kcal). They followed the children for 5 years to determine the association between prenatal nutrition and postnatal growth. No difference in infant and child mortality (mean=116 and 32, respectively) existed between the HE and LE children. The supplement had no effect on growth of children whose mothers took it for 45 days. HE children weighed more and were taller than those of LE children during the entire 5 years. The weight differences were significant only until 24 months (p.05), but height differences were significant during the entire 60 months (p.005 from 15-48 months; p.05 from 3-12 and 60 months). Weight differences peaked at 9 months (463 gm). Height differences rose with age (0.9 cm at 3 months and 1.7 cm at 60 months). Growth rates were always more rapid in HE children, and differences in height gain were only significant at 2-3 months (p.01) and in weight gain from 1-6 months (p.05). Thus improved growth was realized early in life. 38% of the HE children had a satisfactory nutritional status based on height for age at 12 months compared with 16% for LE children (p.01). These corresponding figures for weight for age were 28% and 14%. At 24 months, however, the weights were similar for both groups. 23% of HE children at 24 months had a satisfactory height compared with only 8% of LE children. After 24 months, the differences no longer existed for either weight or height. No significant differences existed for weight for height thus showing that both groups of children were stunted. Prevalence of stunting was lower among HE children, however. These results indicated that high energy supplementation during the 3rd trimester boosted postnatal growth and reduced malnutrition in 1-60 month old children.