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Objectives o examine the effects of prenatal Moringa oliefera extract (EG) or powder (PG), compared to iron-folic acid (IFA) supplementation during pregnancy on nutritional status of children aged 2–5 years in Indonesia. Methods Participants were children (2–5 y) born to pregnant women who participated in a randomized controlled trial. In the parent trial, pregnant women were randomized to receive Moringa oliefera extract (EG) or powder (PG), or iron-folic acid (IFA), twice weekly during pregnancy beginning in the third trimester. Capillary blood samples were collected in children lby a trained phlebotomist. Whole blood samples were analyzed for hemoglobin (Hb) via portable hemoglobinometer (HemoCue Hb 201 + analyser, Helsinborg, Sweden). Hepcidin concentrations were measured by ELISA (ELISA Technique, BT LAB, Shanghai, China) and lactic acid was measured via RT-PCR. Anemia was defined as hemoglobin concentrations of < 11.0 g/dL. Height-for-age (HAZ) Z-scores were calculated using the World Health Organization (WHO) Child Growth Standards and used to define stunting (HAZ < −2 SD). Multivariate analyses were conducted to determine the effect of a the interventions on outcomes. Results The prevalence of stunting at baseline in EG was 42 (28.8) lower than PG and IFA [59 (40.4) and 45 (30.8)]. The prevalence of stunting (HAZ < −2) was lower at each time point (i.e., 2–3 y; 3–4 y; 4–5 y) during follow-up in the EG group, compared to PG or IFA groups (P < 0.05), and the number of stunted cases significantly decreased during follow-up in the EG group, compared to the PG or IFA groups (P < 0.05). The quantity of lactobacillus lactic acid bacteria was significantly higher in the EG group compared to the other groups at 2–3 y (6.88 log CFU/gram vs. 6.57; 5.94 log CFU/gram; P < 0.05). Hepcidin concentrations were significantly higher in EG groups than PG or IFA (1.85 ng/mL vs 1.38; 0.9 ng/mL, although there were no differences in hemoglobin concentrations between intervention groups. Conclusions Findings suggest that Moringa oleifera extract supplementation during pregnancy was associated with lower prevalence of stunting in children in this population. Funding Sources Funding in research is supported by Directorate General of Higher Education, Research, and Technology, Ministry of Education, Culture, Research, and Technology of the Republic of Indonesia.

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