Authors: F. Tofail (1), L.A. Persson (2), S.E. Arifeen (1), J.D. Hamadani (1), S.N. Huda (3), F. Mehrin (1), S. Yesmin (1), A. Hilaly (1), and Sally M. Grantham-McGregor (4)
(1)ICDDR,B: Centre for Health and Population Research, GPO Box 128, Dhaka 1000, Bangladesh, (2)IMCH, Uppsala University, Sweden, (3)Institute of Nutrition and Food Science, University of Dhaka, Ramna, Dhaka 1000, Bangladesh, and (4)CICH, Institute of Child Health, London, UK
Maternal under-nutrition and low birth-weight are highly prevalent in developing countries. Many countries have nutritional supplementation programmes during pregnancy to improve the situation. However, the impact of prenatal supplementations on infants’ developmental outcome has not been adequately studied.
The study was conducted to determine the effect of early (8-10-week pregnancy) versus late (19-week pregnancy) food supplementation along with multiple micronutrients (UNICEF/WHO/UNU formulation, 15 micronutrients) or 30 mg iron+400 µg folate or 60 mg iron+400 µg folate during pregnancy on development of their infants.
A large randomized trial examined the effect of food and multiple-micronutrient supplementation to pregnant women on birth outcomes (n=5,000) in the Matlab field site of ICDDR,B. Development and behaviour of a sub-sample of infants (n=2,853) born to these women were assessed at 7 months of age using 2 problem-solving tests (PSTs: cover and support), Bayley motor-scale, and Wolke’s behaviour ratings. Seventy-four percent of eligible infants were tested. Baseline characteristics of lost children were similar across the groups. Treatment effects were examined using intention-to-treat analyses with micronutrient interventions (3 levels) and food (2 levels) as factors.
There was no main effect of prenatal supplementations on the development of the infants. However, infants of thin mothers (body mass index [BMI] <18.5 kg/m2 on enrollment) demonstrated significant benefits from early food supplementation on two PSTs and behaviour ratings, whereas those of other mothers did not. They had higher scores on the support (BMI x early food p<0.03) and cover (BMI x early food p<0.05) tests, were less fussy, more cooperative during tests, and vocalised more (BMI x early food p<0.04 for all) than children of similar mothers given late food supplementation. Significant benefits on motor development (BMI x micronutrients p=0.05) and activity (BMI x micronutrients p<0.05) were also observed among infants of thin mothers who received multipl- micronutrient supplements. BMI of mothers had an independent effect on children's development.
Infants of thin mothers showed small but statistically significant benefits in child development from multiple micronutrient and early-food supplementations. The findings support the current practices of targeting thin mothers. However, the effect sizes were small, and their public-health importance is not clear. This can only be determined with longer follow-up. The relationship between BMI of mothers and children's development emphasizes the importance of maternal nutrition.
The support of UNICEF, DFID, USAID, CHNRI, Sida, ICDDR,B, World Bank, and others is acknowledged.