Abstract
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.
