Effects of prenatal food and micronutrient supplementation on child growth from birth to54 months of age: a randomized trial in Bangladesh

Background: There is a lack of information on the optimal timing of food supplementation to malnourished
pregnant women and possible combined effects of food and multiple micronutrient supplementations (MMS) on
their offspring’s growth. We evaluated the effects of prenatal food and micronutrient interventions on postnatal
child growth. The hypothesis was that prenatal MMS and early invitation to food supplementation would increase
physical growth in the offspring during 0-54 months and a combination of these interventions would further
improve these outcomes.
Methods: In the large, randomized MINIMat trial (Maternal and Infant Nutrition Interventions in Matlab),
Bangladesh, 4436 pregnant women were enrolled between November 2001 and October 2003 and their children
were followed until March 2009. Participants were randomized into six groups comprising 30 mg Fe and 400 μg
folic acid (Fe30F), 60 mg Fe and 400 μg folic acid (Fe60F) or MMS combined with either an early (immediately
after identification of pregnancy) or a later usual (at the time of their choosing, i.e., usual care in this community)
program invitation to food supplementation. The anthropometry of 3267 children was followed from birth to 54
months, and 2735 children were available for analysis at 54 months.
Results: There were no differences in characteristics of mothers and households among the different intervention
groups. The average birth weight was 2694 g and birth length was 47.7 cm, with no difference among
intervention groups. Early invitation to food supplementation (in comparison with usual invitation) reduced the
proportion of stunting from early infancy up to 54 months for boys (p = 0.01), but not for girls (p = 0.31). MMS
resulted in more stunting than standard Fe60F (p = 0.02). There was no interaction between the food and
micronutrient supplementation on the growth outcome.
Conclusions: Early food supplementation in pregnancy reduced the occurrence of stunting during 0-54 months in
boys, but not in girls, and prenatal MMS increased the proportion of stunting in boys. These effects on postnatal
growth suggest programming effects in early fetal life.
Trial registration number: ISRCTN: ISRCTN16581394
Keywords: Child growth, food supplementation, multiple micronutrients, pregnancy, programming, stunting