Prenatal supplementation with multiple micronutrient supplements or medium-quantity lipid-based nutrient supplements has limited effects on child growth up to 24 months in rural Niger: a secondary analysis of a cluster randomized trial.

Bliznashka L Sudfeld CR Garba S Guindo O Soumana I Adehossi I Langendorf C Grais RF Isanaka S
The American journal of clinical nutrition 2021 Dec 06; doi: 10.1093/ajcn/nqab404. Epub 2021 12 06
Niger child growth lipid-based nutrient supplements multiple micronutrient supplementation prenatal supplementation


BACKGROUND: Prenatal multiple micronutrient supplementation (MMS) and lipid-based nutrient supplementation (LNS) can improve birth outcomes relative to iron-folic acid supplementation (IFA); however, effects on child postnatal growth remain unclear.

OBJECTIVE: To compare the effect of prenatal MMS, medium-quantity LNS (MQ-LNS), and IFA on child growth up to 2 years of age.

DESIGN: We conducted a cluster-randomized controlled trial of prenatal nutritional supplementation in Madarounfa, Niger. Villages were randomly assigned for pregnant women to receive IFA (17 villages, 1105 women), MMS (18 villages, 1083 women) or MQ-LNS (18 villages, 1144 women). Pregnant women received nutritional supplements weekly until delivery, and children were followed up monthly from 6-8 weeks to 24 months of age. We assessed the effect of prenatal MMS and MQ-LNS compared to IFA and the effect of prenatal MMS compared to MQ-LNS on child length-for-age Z-scores (LAZ), weight-for-age Z-scores (WAZ), and weight-for-length Z-scores (WLZ) at 24 months of age using generalized linear models. In secondary analyses, we used mixed effects models to assess the trajectory of anthropometric Z-scores longitudinally from 6-8 weeks to 24 months.

RESULTS: Compared to IFA, MMS and MQ-LNS had no effect on child LAZ, WAZ, or WLZ at 24 months of age (P-values >0.05). Children in the MQ-LNS arm had significantly higher MUAC at 24 months than children in the MMS arm: mean difference 0.50 cm (95% CI 0.10, 0.91). WAZ and WLZ trajectories were more negative in the MQ-LNS arm compared to IFA and MMS, with lower Z-scores from 14 to 20 months of age. However, WAZ and WLZ trajectories converged after 20 months of age, and there were no differences by 24 months of age.

CONCLUSIONS: Prenatal MMS and MQ-LNS had limited effect on anthropometric measures of child growth up to 24 months of age as compared to IFA in rural Niger.

© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.