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Effects of prenatal food and micronutrient supplementation on infant development: a randomized trial from the Maternal and Infant Nutrition Interventions, Matlab (MINIMat) study^1,2,3

¹ From the International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh (FT, SEA, JDH, and FM); International Maternal and Child Health, Uppsala University, Uppsala, Sweden (LAP and E-CE); the Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh (SNH); and the Centres for International Child Health and the Centre for Paediatric Epidemiology and Biostatistics (DR), Institute of Child Health, University College London, London, United Kingdom (SMG-M)

Background: Few data exist for the effects of multiple micronutrient (MM) or food supplementation to undernourished pregnant women on their offsprings’ development.

Objective: We aimed to compare the effects on infant development of early (8–10 wk gestation) or usual (17 wk gestation) supplementation with food and MM, 30 mg Fe + 400 µg folate, or 60 mg Fe + 400 µg folate.

Design: A large, randomized, controlled trial of pregnancy supplementation was conducted in Bangladesh. A subsample of infants (n = 2853) were assessed on 2 problem-solving tests (support and cover tests), the motor index of the Bayley Scales of Infant Development, and Wolke's behavior ratings at 7 mo of age.

Results: There were no significant effects of any intervention in the group as a whole. However, infants of undernourished mothers [body mass index (BMI; in kg/m²) < 18.5] who received early food supplementation performed slightly but significantly (P = 0.035) better on the support test than did infants of mothers who received usual food supplementation (z score: 0.17; 95% CI: 0.01, 0.33). There were no benefits in infants of higher-BMI mothers (P = 0.024 for BMI x food interaction). Children of low-BMI mothers who received MMs had slightly better motor scores (z score: 0.28; 95% CI: 0.08, 0.48) and activity ratings (z score: 0.24; 95% CI: 0.037, 0.45) than did those who received 30 mg Fe + 400 µg folate, whereas other children did not benefit (P = 0.05 for both motor scores and BMI x micronutrients and for activity and BMI x micronutrients).

Conclusions: Small benefits from early food and MM supplementation were found in infants of low-BMI but not of high-BMI mothers. However, the benefits were of doubtful functional importance, and longer follow-up is required to determine programmatic implications.

Key Words: Maternal nutrition • pregnancy • food and micronutrient supplementation • problem-solving test • psychomotor development • Bangladesh • infants • body mass index