Supplementation of Maternal Diets during Pregnancy and for 6 Months Postpartum and Infant Diets Thereafter with Small-Quantity Lipid-Based Nutrient Supplements Does Not Promote Child Growth by 18 Months of Age in Rural Malawi: A Randomized Controlled Trial.
What this study found
Overall, the combined maternal and child SQ-LNS regimen did not improve child growth by 18 months. Mean length was similar across groups at 18 months: 76.8 cm in the LNS arm versus 77.0 cm with iron and folic acid and 76.9 cm with multiple micronutrients; mean LAZ was also similar at -1.69, -1.63, and -1.64, respectively. There were no meaningful differences in weight, head circumference, midupper arm circumference, or stunting prevalence. A slower postnatal length gain in the LNS group versus the iron and folic acid group was observed, but it attenuated after adjustment for birth size;…
- Study & population
- Randomized controlled trial in rural Malawi among pregnant women and their singleton children, followed from pregnancy through 18 months of age.
- Intervention
- In the active LNS arm, mothers received small-quantity lipid-based nutrient supplements during pregnancy and for 6 months postpartum as 1 daily 20 g sachet taken orally, providing 118 kcal and 21 micronutrients plus additional minerals, protein, and fat.
- Key limitation
- Single-site rural Malawi trial with a high-burden setting of food insecurity and maternal undernutrition, which may limit generalizability.
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Open PDFOriginal abstract
BACKGROUND Intrauterine growth restriction may be reduced by supplementing maternal diets during pregnancy, but few studies have assessed the impact of combined prenatal and postnatal interventions on child growth. OBJECTIVE We tested a hypothesis that provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) to mothers in pregnancy and 6 mo postpartum and to their infants from 6 to 18 mo of age would promote infant and child growth in the study area in rural Malawi. METHODS We enrolled 869 pregnant women in a randomized trial in Malawi. During pregnancy and 6 mo thereafter, the women received daily 1 capsule of iron-folic acid (IFA), 1 capsule containing 18 micronutrients (MMN), or one 20-g sachet of SQ-LNS [lipid-based nutrient supplements (LNS), containing 21 MMN, protein, carbohydrates, essential fatty acids, and 118 kcal]. Children in the IFA and MMN groups received no supplementation; children in the LNS group received SQ-LNSs from 6 to 18 mo. Primary outcome was child length at 18 mo. RESULTS At 18 mo, the mean length in the IFA, MMN, and LNS groups was 77.0, 76.9, and 76.8 cm (P = 0.90), respectively, and the prevalence of stunting was 32.7%, 35.6%, and 37.9% (P = 0.54), respectively. No intergroup differences were found in the mean weight, head circumference, or midupper arm circumference or the proportions with low z scores for these variables (P > 0.05). Covariate adjustment did not change the analysis results, and the associations between the intervention and child length were not modified by maternal parity, age, or nutritional status (P > 0.10). CONCLUSIONS The findings do not support a hypothesis that provision of SQ-LNSs to women in pregnancy and postpartum and to children from 6 to 18 mo of age would promote child growth in this Malawian study area. This trial was registered at clinicaltrials.gov as NCT01239693.