Association of prenatal lipid‐based nutritional supplementation with fetal growth in rural Gambia

Abstract

Prenatal supplementation with protein‐energy (PE) and/or multiple‐micronutrients (MMNs) may improve fetal growth, but trials of lipid‐based nutritional supplements (LNSs) have reported inconsistent results. We conducted a post‐hoc analysis of non‐primary outcomes in a trial in Gambia, with the aim to test the associations of LNS with fetal growth and explore how efficacy varies depending on nutritional status. The sample comprised 620 pregnant women in an individually randomized, partially blinded trial with four arms: (a) iron and folic acid (FeFol) tablet (usual care, referent group), (b) MMN tablet, (c) PE LNS, and (d) PE + MMN LNS. Analysis of variance examined unadjusted differences in fetal biometry z‐scores at 20 and 30 weeks and neonatal anthropometry z‐scores, while regression tested for modification of intervention‐outcome associations by season and maternal height, body mass index, and weight gain. Despite evidence of between‐arm differences in some fetal biometry, z‐scores at birth were not greater in the intervention arms than the FeFol arm (e.g., birth weight z‐scores: FeFol −0.71, MMN −0.63, PE −0.64, PE + MMN −0.62; group‐wise p = .796). In regression analyses, intervention associations with birth weight and head circumference were modified by maternal weight gain between booking and 30 weeks gestation (e.g., PE + MMN associations with birth weight were +0.462 z‐scores (95% CI [0.097, 0.826]) in the highest quartile of weight gain but –0.099 z‐scores (−0.459, 0.260) in the lowest). In conclusion, we found no strong evidence that a prenatal LNS intervention was associated with better fetal growth in the whole sample.

Impact of Dietary Interventions during Pregnancy on Maternal, Neonatal, and Child Outcomes in Low- and Middle-Income Countries

“…On abstract screening, 61 articles were selected for full-text screening and, at the same time, eight articles were included through cross-referencing. Fifteen studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] were included for data extraction ( Figure S1). All included trials studied healthy pregnant women at varying gestational ages in LMIC settings.…”

“…Studies included both urban [26,28,32,35] and rural [21,[23][24][25]29,31,33,34] settings, with three studies not specifying their setting [22,27,30]. The characteristics of included studies are briefly mentioned in Table S3.…”

“…We included five trials, providing food to pregnant women (Table S3) [24,27,29,31,34]. Out of five studies, three were conducted in Africa [27,29,34], and two in Asia [24,31]. Three of these were cRCTs [24,27,34], and two were RCTs [29,31].…”

“…Out of five studies, three were conducted in Africa [27,29,34], and two in Asia [24,31]. Three of these were cRCTs [24,27,34], and two were RCTs [29,31]. The food programs provided nutritional supplement along with food rations [27], free medical care, such as antenatal/postnatal care [31], maternity services or obstetrical care [24], malaria treatment [34], and HIV counseling [34], to all pregnant women.…”

Effect of a micronutrient‐rich snack taken preconceptionally and throughout pregnancy on ultrasound measures of fetal growth: The Mumbai Maternal Nutrition Project (MMNP)

“…Numerous trials have examined the effect of multiple micronutrient supplementation during pregnancy on birth outcomes (Brough, Rees, Crawford, Morton, & Dorman, 2010;Osrin et al, 2005;Zagré, Desplats, Adou, Mamadoultaibou, & Aguayo, 2007), but literature on the effect of supplementation on fetal biometry is scarce. A randomised controlled trial in The Gambia showed that a prenatal lipid-based nutritional supplement had no effect on fetal growth overall, but that fetal measurements at 30-week gestation were larger in the dry season among women receiving protein and energy compared with those receiving multiple micronutrients alone or with protein and energy and multiple micronutrients combined (Johnson et al, 2016). A trial in Peru showed a positive effect of prenatal zinc supplementation on FL (Merialdi et al, 2004); however, the quantity of zinc used (25 mg) was more than 27 times higher than that in our food-based supplement (0.9 mg).…”