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Effects of prenatal food and micronutrient supplementation on child growth from birth to 54 months of age: a randomized trial in Bangladesh
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell barnhälsa och nutrition/Persson)
International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Bangladesh.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell kvinno- & mödrahälsovård/Essén)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell barnhälsa och nutrition/Persson)
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2011 (English)In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 10, 134- p.Article in journal (Refereed) Published
Abstract [en]

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 ug folic acid (Fe30F), 60 mg Fe and 400 ug 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. The study is registered as an International Standard Randomized Controlled Trial, number ISRCTN16581394.

Place, publisher, year, edition, pages
2011. Vol. 10, 134- p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-164145DOI: 10.1186/1475-2891-10-134ISI: 000300369000001PubMedID: 22152147OAI: oai:DiVA.org:uu-164145DiVA: diva2:466665
Available from: 2011-12-16 Created: 2011-12-16 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Effects of Pre- and Postnatal Nutrition Interventions on Child Growth and Body Composition: The MINIMat Trial in Rural Bangladesh
Open this publication in new window or tab >>Effects of Pre- and Postnatal Nutrition Interventions on Child Growth and Body Composition: The MINIMat Trial in Rural Bangladesh
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Nutritional insults and conditions in fetal life and infancy may influence later growth and body composition as well as the development of chronic diseases in adult life. We studied the effects of maternal food and micronutrient supplementation and exclusive breast-feeding counseling on offspring growth 0-54 months and body composition at 54 months of age. We also validated and developed equations for a leg-to-leg bioimpedance analyzer in order to assess body composition of Bangladeshi children aged 4-10 years.

In the MINIMat trial in Matlab, Bangladesh, pregnant women were randomized to Early (around 9 weeks) or a Usual invitation (around 20 weeks) to food supplementation and to one of three daily micronutrient supplementations with capsules of either 30 mg Fe and 400 µg folic acid, or 60 mg Fe and 400 µg folic acid, or multiple micronutrient supplements (MMS) (15 micronutrients including 30 mg Fe and 400 µg folic acid). They were also randomized to exclusive breastfeeding counseling (EBC) or to usual health messages (UHM). Growth of their children was measured from birth to 54 months, when body composition also was assessed.

There were no differences in background characteristics across the different intervention groups. There was no differential effect by prenatal interventions on birth weight or length. Early invitation to food supplementation reduced stunting from early infancy up to 54 months for boys (average difference 6.5 percent units, 95% CI=1.7 to 11.3, p=0.01), but not for girls (average difference 2.4 percent units, 95% CI=-2.2 to 7.0, p=0.31). MMS resulted in more stunting than standard Fe60F (average difference 4.8 percent units, 95% CI=0.8 to 8.9, p=0.02). Breast-feeding counseling prolonged the duration of exclusive breastfeeding (difference 35.0 days, 95% CI 30.6-39.5, p<0.001). Neither the pregnancy interventions nor the breast-feeding counseling influenced body composition at 54 months.

Early food supplementation in pregnancy reduced the occurrence of stunting in boys 0-54 months, while prenatal MMS increased the proportion of stunting. Early food and multiple micronutrient supplementation or exclusive breastfeeding intervention provided to rural Bangladeshi women during pregnancy did not affect offspring body composition at 54 months of age. The effects on postnatal growth suggest programming effects in early fetal life.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 63 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 811
Keyword
body composition, child growth, exclusive breast feeding, food supplementation, multiple micronutrients, pregnancy, programming
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-180479 (URN)978-91-554-8467-5 (ISBN)
Public defence
2012-10-17, Rosensalen, Akademiska sjukhuset, Entrance 95/96 nbv, Akademiska sjukhuset, Uppsala, 09:15 (English)
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Supervisors
Available from: 2012-09-25 Created: 2012-09-07 Last updated: 2014-08-18

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