Maternal-Infant Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Does Not Affect Child Blood Pressure at 4-6 Y in Ghana: Follow-up of a Randomized Trial

Abstract

Background: In the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana trial, prenatal small-quantity lipid-based nutrient supplements (LNSs) had a positive effect on birth weight. Birth weight may be inversely related to blood pressure (BP) later in life.

Objectives: We examined the effect of the intervention on BP at 4-6 y of age, and maternal and child factors related to BP.

Methods: The iLiNS-DYAD-Ghana study was a partially double-blind, randomized controlled trial which assigned women (n = 1320) ≤20 weeks of gestation to daily supplementation with: 1) iron and folic acid during pregnancy and 200 mg Ca for 6 mo postpartum , 2) multiple micronutrients during pregnancy and postpartum, or 3) LNSs during pregnancy and postpartum plus LNSs for infants from 6 to 18 mo of age. At 4-6 y of age (n = 858, 70% of live births), we compared BP, a secondary outcome, between non-LNS and LNS groups and examined whether BP was related to several factors including maternal BP, child weight-for-age z score (WAZ), and physical activity.

Results: Non-LNS and LNS groups did not differ in systolic (99.2 ± 0.4 compared with 98.5 ± 0.6 mm Hg; P = 0.317) or diastolic (60.1 ± 0.3 compared with 60.0 ± 0.4 mm Hg; P = 0.805) BP, or prevalence of high BP (systolic or diastolic BP ≥90th percentile of the US National Heart, Lung, and Blood Institute reference: 31% compared with 28%; P = 0.251). BP at 4-6 y of age was positively related to birth weight; this relation was largely mediated through concurrent WAZ in a path model. Concurrent WAZ and maternal BP were the factors most strongly related to child BP.

Conclusions: Despite greater birth weight in the LNS group, there was no intervention group difference in BP at 4-6 y. In this preschool population at high risk of adult hypertension based on BP at 4-6 y, high maternal BP and child WAZ were key factors related to BP. This trial was registered at clinicaltrials.gov as NCT00970866.

Keywords: Ghanaian children; prenatal; infant nutrition; blood pressure; lipid-based nutrient supplements; supplementation.

FIGURE 1

Study profile. IFA, iron and folic acid; LNS, lipid-based nutrient supplement; MMN, multiple micronutrients.

FIGURE 2

Conceptual model of maternal and child factors related to child blood pressure. WAZ, weight-for-age z score.

FIGURE 3

Final path model of the maternal and child factors related to child systolic blood pressure at 4–6 y. Numbers in the model are standardized β-coefficients. **P  > 0.0001 but P < 0.001; ***P < 0.0001. SBP, systolic blood pressure; WAZ, weight-for-age z score.

FIGURE 4

Path diagrams representing mediation analysis within the final path model. (A) Mediation between birth WAZ and SBP at 4–6 y by WAZ at 4–6 y. Parameter estimates of mediation: 0.08 (0.02)***; proportion mediated 97.2%. (B) Mediation between postnatal weight gain (0–6 mo) and SBP at 4–6 y by WAZ at 4–6 y. Parameter estimates of mediation: 0.13 (0.03)***; proportion mediated 75.6%. (C) Mediation between maternal prepregnancy BMI and WAZ at 4–6 y by birth WAZ. Parameter estimates of mediation: 0.07 (0.02)***; proportion mediated 25.9%. Numbers in the model were obtained from mediation analysis in STATA software version 15.0 and represent parameter estimates (SEs). ***P < 0.0001. SBP, systolic blood pressure; WAZ, weight-for-age z score.