| Abstrakt: |
Background: Optimal nutrition is crucial during the critical period of the first 1,000 days from conception to 2 years after birth. Prenatal and postnatal supplementation of mothers with multimicronutrient-fortified balanced energy–protein (BEP) supplements is a potential nutritional intervention. However, evidence on the long-term effects of BEP supplementation on child growth is inconsistent. We evaluated the efficacy of daily fortified BEP supplementation during pregnancy and lactation on infant growth in rural Burkina Faso. Methods and findings: A 2 × 2 factorial individually randomized controlled trial (MISAME-III) was implemented in 6 health center catchment areas in Houndé district under the Hauts-Bassins region. From October 2019 to December 2020, 1,897 pregnant women aged 15 to 40 years with gestational age <21 completed weeks were enrolled. Women were randomly assigned to the prenatal intervention arms receiving either fortified BEP supplements and iron–folic acid (IFA) tablets (i.e., intervention) or IFA alone (i.e., control), which is the standard of care during pregnancy. The same women were concurrently randomized to receive either of the postnatal intervention, which comprised fortified BEP supplementation during the first 6 months postpartum in combination with IFA for the first 6 weeks (i.e., intervention), or the postnatal control, which comprised IFA alone for 6 weeks postpartum (i.e., control). Supplements were provided by trained village-based project workers under direct observation during daily home visits. We previously reported the effect of prenatal BEP supplementation on birth outcomes. The primary postnatal study outcome was length-for-age z-score (LAZ) at 6 months of age. Secondary outcomes were anthropometric indices of growth (weight-for length and weight-for-age z-scores, and arm and head circumferences) and nutritional status (prevalence rates of stunting, wasting, underweight, anemia, and hemoglobin concentration) at 6 months. Additionally, the longitudinal prevalence of common childhood morbidities, incidence of wasting, number of months of exclusive breastfeeding, and trajectories of anthropometric indices from birth to 12 months were evaluated. Prenatal BEP supplementation resulted in a significantly higher LAZ (0.11 standard deviation (SD), 95% confidence interval (CI) [0.01 to 0.21], p = 0.032) and lower stunting prevalence (−3.18 percentage points (pp), 95% CI [−5.86 to −0.51], p = 0.020) at 6 months of age, whereas the postnatal BEP supplementation did not have statistically significant effects on LAZ or stunting at 6 months. On the other hand, postnatal BEP supplementation did modestly improve the rate of monthly LAZ increment during the first 12 months postpartum (0.01 z-score/month, 95% CI [0.00 to 0.02], p = 0.030), whereas no differences in growth trajectories were detected between the prenatal study arms. Furthermore, except for the trend towards a lower prevalence of underweight found for the prenatal BEP intervention at 6 months (−2.74 pp, 95% CI [−5.65 to 1.17], p = 0.065), no other secondary outcome was significantly affected by the pre- or postnatal BEP supplementation. Conclusions: This study provides evidence that the benefits obtained from prenatal BEP supplementation on size at birth are sustained during infancy in terms of linear growth. Maternal BEP supplementation during lactation may lead to a slightly better linear growth towards the second half of infancy. These findings suggest that BEP supplementation during pregnancy can contribute to the efforts to reduce the high burden of child growth faltering in low- and middle-income countries. Trial registration: ClinicalTrials.gov: NCT03533712. Carl Lachat and colleagues report a a 2×2 factorial individually randomized controlled trial conducted in rural Burkina Faso which investigates the impact of fortified balanced energy-protein supplementation during pregnancy and lactation on infant growth. Author summary: Why was this study done?: Growth faltering during the first 1,000 days is a global public health problem, which is strongly associated with an increased risk of child mortality and poor developmental outcomes, as well as poor school performance and lower earning in later life. Prenatal and postnatal supplementation of mothers with multiple micronutrient-fortified balanced energy–protein (BEP) supplements is a potential nutritional intervention to prevent the high burden of growth retardation during this window of opportunity in low- and middle-income countries. However, the effect of providing pregnant and lactating women with BEP supplements on child growth is inconsistent to date. Hence, there is a critical need for high-quality experimental studies to assess the efficacy of BEP supplements on fetal and infant growth outcomes. What did the researchers do and find?: We conducted an individually randomised controlled efficacy trial in rural Burkina Faso (MISAME-III) to assess the effect of supplementing mothers with fortified BEP during pregnancy and lactation on the growth of their infants. Our trial indicates that the improvements in size at birth accrued from prenatal BEP supplementation are sustained in terms of linear growth at the age of 6 months. In addition, we provide evidence that maternal BEP supplementation for 6 months postpartum might lead to a slightly better linear growth towards the second half of infancy. What do these findings mean?: Our findings suggest that the benefits of BEP supplementation on linear growth might be fully exploited by extending the intervention to cover the first 1,000 days of life, which includes supplementation of infants and young children during the complementary feeding period. Future research in MISAME-III will assess additional maternal and child biochemical parameters to provide further insights into the clinical relevance of BEP supplementation, including the potential impacts on breast milk composition. [ABSTRACT FROM AUTHOR] |
