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

Abstract

Background: 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.

Methods: In 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.

Results: There 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.

Conclusions: Early 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 number: ISRCTN: ISRCTN16581394.

Figure 1

Flow diagram of women and infants participating in the MINIMat trial. E = Early invitation food supplementation, U = Usual invitation food supplementation, FU = Follow-up; Fe30F = 30 mg iron and 400 μg of folic acid; Fe60F = 60 mg iron and 400 μg of folic acid; MMS = multiple micronutrients, 15 micronutrients including 30 mg iron and 400 μg of folic acid;

Figure 2

Repeated measures analyses showing effects of prenatal food and micronutrient supplementations on linear growth (16 anthropometric assessments) by sex, from birth to 54 months of age. Dots represent mean%. p-values for the contrasts from the repeated-measures analysis. E Boy vs. U Boy, p = 0.01; Fe60F Boy vs. MMS Boy, p = 0.01. E Girl vs. U Girl, p = 0.31; Fe60F Girl vs. MMS Girl, p = 0.53. E = Early invitation to food supplementation, U = Usual invitation to food supplementation, Fe30F = 30 mg iron and 400 μg of folic acid; Fe60F = 60 mg iron and 400 μg of folic acid; MMS = multiple micronutrients, 15 micronutrients including 30 mg iron and 400 μg of folic acid.

Figure 3

Repeated measures analysis highlighting the effects of prenatal food and micronutrient supplementations on linear growth (16 anthropometric assessments) by maternal BMI (median) from birth to 54 months of age. Dots represent mean%. p-values for the contrasts from the repeated-measures analysis E BMI < 19.7 vs. U BMI < 19.7, p = 0.09; Fe60 BMI < 19.7 vs. MMS BMI < 19.7, p = 0.05 E BMI > 19.7 vs. U BMI > 19.7, p = 0.05; Fe60 BMI > 19.7 vs. MMS BMI > 19.7, p = 0.13 E = Early invitation to food supplementation, U = Usual invitation to food supplementation, BMI = body mass index; Fe30F = 30 mg iron and 400 μg of folic acid; Fe60F = 60 mg iron and 400 μg of folic acid; MMS = multiple micronutrients, 15 micronutrients including 30 mg iron and 400 μg of folic acid.