Effects of prenatal food and micronutrient supplementation on child growth from birth to 54 months of age: a randomized trial in Bangladesh

Nutrition Journal

Lars-Åke Persson²  Shams Arifeen³  Md Yunus³  Edward A Frongillo¹  Dewan Shamsul Alam³  Kajsa Åsling-Monemi²  Eva-Charlotte Ekström²  Iqbal Kabir³  Ashraful Islam Khan³ 

[1] Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA;International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Sweden;International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Bangladesh

关键词: stunting;    programming;    pregnancy;    multiple micronutrients;    food supplementation;    Child growth;   

Others  :  828378
DOI  :  10.1186/1475-2891-10-134

 received in 2011-08-11, accepted in 2011-12-08,  发布年份 2011

【 摘 要 】

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

【 授权许可】

   
2011 Khan et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Barker DJ, Clark PM: Fetal undernutrition and disease in later life. Rev Reprod 1997, 2:105-12.
• [2]Yajnik CS, Deshmukh US: Maternal nutrition, intrauterine programming and consequential risks in the offspring. Rev Endocr Metab Disord 2008, 9:203-11.
• [3]Yajnik C: Nutritional control of fetal growth. Nutr Rev 2006, 64:S50-1. discussion S72-91
• [4]Fall CH, Yajnik CS, Rao S, Davies AA, Brown N, Farrant HJ: Micronutrients and fetal growth. J Nutr 2003, 133:1747S-1756S.
• [5]Kontic-Vucinic O, Sulovic N, Radunovic N: Micronutrients in women's reproductive health: I. Vitamins. Int J Fertil Womens Med 2006, 51:106-15.
• [6]Hassan NHN, Ahmad K: Seasonal patterns of food intake in rural Bangladesh: its impact on nutritional status. Ecol Food Nutr 1985, 17:175-86.
• [7]Alam DS, Van Raaij JM, Hautvast JG, Yunus M, Fuchs GJ: Energy stress during pregnancy and lactation: consequences for maternal nutrition in rural Bangladesh. Eur J Clin Nutr 2003, 57:151-6.
• [8]Kramer MS, Kakuma R: Energy and protein intake in pregnancy. Cochrane Database Syst Rev 2003, CD000032.
• [9]Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J: Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008, 371:243-60.
• [10]UNICEF/UNU/WHO: Composition of a multiple micronutrient supplement to be used in pilot programmes among pregnant women in developing countries. In Report of a workshop held at UNICEF Headquarters. New York: UNICEF; 1999.
• [11]Fall CH, Fisher DJ, Osmond C, Margetts BM: Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on birth size and length of gestation. Food Nutr Bull 2009, 30:S533-46.
• [12]Kusin JA, Kardjati S, Houtkooper JM, Renqvist UH: Energy supplementation during pregnancy and postnatal growth. Lancet 1992, 340:623-6.
• [13]Vaidya A, Saville N, Shrestha BP, Costello AM, Manandhar DS, Osrin D: Effects of antenatal multiple micronutrient supplementation on children's weight and size at 2 years of age in Nepal: follow-up of a double-blind randomised controlled trial. Lancet 2008, 371:492-9.
• [14]Huy ND, Le Hop T, Shrimpton R, Hoa CV: An effectiveness trial of multiple micronutrient supplementation during pregnancy in Vietnam: impact on birthweight and on stunting in children at around 2 years of age. Food Nutr Bull 2009, 30:S506-16.
• [15]Hoet JJ, Hanson MA: Intrauterine nutrition: its importance during critical periods for cardiovascular and endocrine development. J Physiol 1999, 514(Pt 3):617-27.
• [16]Ramakrishnan U: Nutrition and low birth weight: from research to practice. Am J Clin Nutr 2004, 79:17-21.
• [17]Cetin I, Berti C, Calabrese S: Role of micronutrients in the periconceptional period. Hum Reprod Update 2010, 16:80-95.
• [18]Huybregts L, Roberfroid D, Lanou H, Menten J, Meda N, Van Camp J, Kolsteren P: Prenatal food supplementation fortified with multiple micronutrients increases birth length: a randomized controlled trial in rural Burkina Faso. Am J Clin Nutr 2009, 90:1593-600.
• [19]Tofail F, Persson LA, El Arifeen S, Hamadani JD, Mehrin F, Ridout D, Ekström EC, Huda SN, Grantham-McGregor SM: Effects of prenatal food and micronutrient supplementation on infant development: a randomized trial from the Maternal and Infant Nutrition Interventions, Matlab (MINIMat) study. Am J Clin Nutr 2008, 87:704-11.
• [20]Jasti S, Siega-Riz AM, Cogswell ME, Hartzema AG: Correction for errors in measuring adherence to prenatal multivitamin/mineral supplement use among low-income women. J Nutr 2006, 136:479-83.
• [21]World Health Organization M-cGRSG: WHO Child Growth Standards: methods and development: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. [http://www.who.int/childgrowth/standards/technical_report/en/index.html] webciteGeneva, Switzerland: World Health Organization; 2006.
• [22]Lampl M, Gotsch F, Kusanovic JP, Gomez R, Nien JK, Frongillo EA, Romero R: Sex differences in fetal growth responses to maternal height and weight. Am J Hum Biol 2010, 22:431-43.
• [23]Mittwoch U: Blastocysts prepare for the race to be male. Hum Reprod 1993, 8:1550-5.
• [24]Chen LC, Huq Emdadul, D'Souza Stan: Sex bias in the family allocation of food and health care in rural Bangladesh. Pop Dev Rev 1981, 1:55-69.
• [25]Kapil U: Multiple Micronutrient Supplements will not Reduce Incidence of Low Birthweight. Indian J Community Med 2009, 34:85-6.
• [26]Lind T, Lönnerdal B, Stenlund H, Gamayanti IL, Ismail D, Seswandhana R, Persson LA: A community-based randomized controlled trial of iron and zinc supplementation in Indonesian infants: effects on growth and development. Am J Clin Nutr 2004, 80:729-36.
• [27]Frith AL, Naved RT, Ekstrom EC, Rasmussen KM, Frongillo EA: Micronutrient supplementation affects maternal-infant feeding interactions and maternal distress in Bangladesh. Am J Clin Nutr 2009, 90:141-8.
• [28]Ninomiya-Alarcon JG, Hudson R, Reyes-Guerrero G, Barrera-Mera B, Guevara-Guzman R: Effect of photoperiod on the mechanical response of the pregnant rabbit uterus to oxytocin. Am J Physiol Regul Integr Comp Physiol 2004, 287:R174-80.
• [29]Ciosek J, Drobnik J: Vasopressin and oxytocin release and the thyroid function. J Physiol Pharmacol 2004, 55:423-41.
• [30]Allen LH, Peerson JM: Impact of multiple micronutrient versus iron-folic acid supplements on maternal anemia and micronutrient status in pregnancy. Food Nutr Bull 2009, 30:S527-32.
• [31]Waterland RA, Jirtle RL: Early nutrition, epigenetic changes at transposons and imprinted genes, and enhanced susceptibility to adult chronic diseases. Nutrition 2004, 20:63-8.
• [32]Keen CL, Clegg MS, Hanna LA, Lanoue L, Rogers JM, Daston GP, Oteiza P, Uriu-Adams JY: The plausibility of micronutrient deficiencies being a significant contributing factor to the occurrence of pregnancy complications. J Nutr 2003, 133:1597S-1605S.
• [33]Shankar AH, Jahari AB, Sebayang SK, Apriatni M, Harefa B, Muadz H, Soesbandoro SD, Tjiong R, Fachry A, Shankar AV, Prihatini S, Sofia G: Effect of maternal multiple micronutrient supplementation on fetal loss and infant death in Indonesia: a double-blind cluster-randomised trial. Lancet 2008, 371:215-27.
• [34]Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HP, Shekar M: Maternal and Child Undernutrition Study Group. What works? Interventions for maternal and child undernutrition and survival. Lancet 2008, 371:417-40.
• [35]Arifeen SE, Hoque DM, Akter T, Rahman M, Hoque ME, Begum K, Chowdhury EK, Khan R, Blum LS, Ahmed S, Hossain MA, Siddik A, Begum N, Sadeq-ur Rahman Q, Haque TM, Billah SM, Islam M, Rumi RA, Law E, Al-Helal ZA, Baqui AH, Schellenberg J, Adam T, Moulton LH, Habicht JP, Scherpbier RW, Victora CG, Bryce J, Black RE: Effect of the Integrated Management of Childhood Illness strategy on childhood mortality and nutrition in a rural area in Bangladesh: a cluster randomised trial. Lancet 2009, 374:393-403.