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

Abstract

Background: Maternal undernutrition and newborn stunting [birth length-for-age z score (LAZ) <-2] are common in Bangladesh.

Objective: The objective was to evaluate the effect of lipid-based nutrient supplements for pregnant and lactating women (LNS-PLs) on birth outcomes.

Design: We conducted a cluster-randomized effectiveness trial (the Rang-Din Nutrition Study) within a community health program in rural Bangladesh. We enrolled 4011 pregnant women at ≤20 gestational weeks; 48 clusters received iron and folic acid (IFA; 60 mg Fe + 400 μg folic acid) and 16 clusters received LNS-PLs (20 g/d, 118 kcal) containing essential fatty acids and 22 vitamins and minerals. Both of the supplements were intended for daily consumption until delivery. Primary outcomes were birth weight and length.

Results: Infants in the LNS-PL group had higher birth weights (2629 ± 408 compared with 2588 ± 413 g; P = 0.007), weight-for-age z scores (-1.48 ± 1.01 compared with -1.59 ± 1.02; P = 0.006), head-circumference-for-age z scores (HCZs; -1.26 ± 1.08 compared with -1.34 ± 1.12; P = 0.028), and body mass index z scores (-1.57 ± 1.05 compared with -1.66 ± 1.03; P = 0.005) than those in the IFA group; in adjusted models, the differences in length (47.6 ± 0.07 compared with 47.4 ± 0.04 cm; P = 0.043) and LAZ (-1.15 ± 0.04 compared with -1.24 ± 0.02; P = 0.035) were also significant. LNS-PLs reduced the risk of newborn stunting (18.7% compared with 22.6%; RR: 0.83; 95% CI: 0.71, 0.97) and small head size (HCZ <-2) (20.7% compared with 24.9%; RR: 0.85; 95% CI: 0.73, 0.98). The effects of LNS-PL on newborn stunting were greatest in infants born before a 10-wk interruption in LNS-PL distribution (n = 1301; 15.7% compared with 23.6%; adjusted RR: 0.69; 95% CI: 0.53, 0.89) and in infants born to women ≤24 y of age or with household food insecurity.

Conclusion: 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.

Keywords: head circumference; iron and folic acid; lipid-based nutrient supplements; low birth weight; newborn stunting.

FIGURE 1

Trial profile. IFA, iron and folic acid; LNS-PL, lipid-based nutrient supplement for pregnant and lactating women.

FIGURE 2

Prevalence (±1 SE) of stunting at birth by intervention group and food-security category. Groups were compared by using mixed-model logistic regression. P = 0.043 for group by food-security interaction. *Difference between LNS-PL and IFA groups, P <0.05. IFA, iron and folic acid; LNS-PL, lipid-based nutrient supplement for pregnant and lactating women.

FIGURE 3

Mean (±1 SE) duration of gestation by intervention group and food-security category. Groups were compared by using mixed-model ANCOVA. P = 0.085 for group by food-security interaction. *Difference between LNS-PL and IFA groups, P <0.05. IFA, iron and folic acid; LNS-PL, lipid-based nutrient supplement for pregnant and lactating women.

FIGURE 4

Distribution of length-for-age z scores by group and food security. IFA, iron and folic acid; LNS-PL, lipid-based nutrient supplement for pregnant and lactating women.

FIGURE 5

Prevalence (±1 SE) of stunting at birth by intervention group and age category. Groups were compared by using mixed-model logistic regression. P = 0.068 for group by age interaction. *^,†Difference between LNS-PL and IFA groups: *P <0.05, ^†P < 0.10. IFA, iron and folic acid; LNS-PL, lipid-based nutrient supplement for pregnant and lactating women.

FIGURE 6

Prevalence (±1 SE) of stunting at birth by intervention group and period of birth: 20 January 2012 to 8 August 2012, infants born before the LNS-PL supply disruption; 9 August 2012 to 20 October 2012, infants born during the suspension of LNS-PL distribution whose mothers were in the last 1–10 wk of pregnancy at that time; 21 October 2012 to 4 May 2013, infants born after the disruption but whose mothers experienced a 10-wk gap in LNS-PL distribution during pregnancy (at 7–33 wk of gestation) if they had been assigned to the LNS-PL group. Groups were compared by using mixed-model logistic regression. Difference between LNS-PL and IFA groups, *P <0.05. IFA, iron and folic acid; LNS-PL, lipid-based nutrient supplement for pregnant and lactating women.