Nutrient supplementation during the first 1000 days and growth of infants born to pregnant adolescents

Abstract

Few studies have evaluated the impact of nutritional supplementation among pregnant adolescents. We examined the effects of the Rang Din Nutrition Study (RDNS) interventions on children born to mothers <20 years of age. The RDNS was a cluster-randomized effectiveness trial with four arms: (1) women and children both received small-quantity lipid-based nutrient supplements (LNS-LNS), (2) women received iron and folic acid (IFA) and children received LNS (IFA-LNS), (3) women received IFA and children received micronutrient powder (MNP) (IFA-MNP), and (4) women received IFA and children received no supplements (IFA-Control). We enrolled 4011 women at <20 weeks gestation; 1552 were adolescents. Among adolescents, prenatal LNS reduced newborn stunting by 25% and small head size by 28% and had a marginally significant effect on newborn wasting, compared with IFA. Low birth weight and preterm birth were reduced only among adolescents with lower food security. Effects on subsequent growth status were observed only among female children in the LNS-LNS group: less stunting at 18 months (versus IFA-MNP) and lower prevalence of small head circumference and wasting at 24 months (versus IFA-Control). Initiatives targeting pregnant adolescents in similar settings should consider inclusion of small-quantity LNS, particularly for adolescents living in food-insecure households.

Keywords: child growth; lipid-based nutrient supplements; low birth weight; prenatal nutrition; stunting.

Figure 1

Participation flow diagram.

Figure 2

Percentages of low birth weight (A), stunting at birth (B), and preterm birth (C), by food security and intervention group, among children of adolescent mothers. IFA = light gray; LNS = dark gray. Sample sizes: moderate or severe insecurity, IFA = 338 and LNS = 105; mild insecurity, IFA = 127 and LNS = 60; food secure, IFA = 509 and LNS = 195. For % low birth weight, P for interaction with continuous food security = 0.0173; within those with moderate or severe food insecurity, LNS versus IFA, P = 0.0276, OR = 0.60 (0.38–0.95). For % stunting at birth, P for interaction with continuous food security = 0.003; within those with moderate or severe food insecurity, LNS versus IFA, P = 0.001, OR = 0.39 (0.22–0.68); within those with mild food insecurity, P = 0.074, OR = 0.46 (0.20–1.08). For preterm birth, P for interaction with continuous food security = 0.069; within those with moderate or severe food insecurity, LNS versus IFA, P = 0.062, OR = 0.50 (0.25–1.04). P values account for the random effects of union (nested within subdistrict) and cluster, but are not adjusted for other covariates, as further adjustment did not alter these results.

Figure 3

Stunting at 18 months (A), stunting at 24 months (B), small head size at 24 months (C), and wasting at 24 months (D), by sex and intervention group, among children of adolescent mothers. IFA‐Control = light gray; IFA‐MNP = medium‐light gray; IFA‐LNS = medium gray; LNS‐LNS = dark gray. Sample sizes: (A) females: IFA‐Control = 155, IFA‐MNP = 176, IFA‐LNS = 151, and LNS‐LNS = 165; males: IFA‐Control = 155, IFA‐MNP = 152, IFA‐LNS = 152, and LNS‐LNS = 182; (B) females: IFA‐Control = 156, IFA‐MNP = 179, IFA‐LNS = 152, and LNS‐LNS = 170; males: IFA‐Control = 155, IFA‐MNP = 154, IFA‐LNS = 153, LNS‐LNS = 190; (C) females: IFA‐Control = 156, IFA‐MNP = 179, IFA‐LNS = 152, and LNS‐LNS = 170; males: IFA‐Control = 155, IFA‐MNP = 154, IFA‐LNS = 153, and LNS‐LNS = 190; (D) females: IFA‐Control = 156, IFA‐MNP = 179, IFA‐LNS = 151, and LNS‐LNS = 170; males: IFA‐Control = 155, IFA‐MNP = 154, IFA‐LNS = 153, and LNS‐LNS = 190. For (A), P for interaction = 0.033; within females, LNS‐LNS versus IFA‐MNP, P = 0.014, OR = 0.48 (0.26–0.89). For (B), P for interaction = 0.799; within females, LNS‐LNS versus IFA‐MNP, P = 0.086, OR = 0.68 (0.38, 1.22). For (C), P for interaction = 0.002; within females, LNS‐LNS versus IFA‐MNP, P = 0.015, OR = 0.49 (0.27–0.90); LNS‐LNS versus IFA‐Control, P = 0.007, OR = 0.28 (0.24–0.84). For (D), P for interaction = 0.030; within females, LNS‐LNS versus IFA‐Control, P = 0.064, OR = 0.36 (0.12–1.04). P values account for the random effects of union (nested within subdistrict) and cluster, but are not adjusted for other covariates, as further adjustment did not alter these results.