Suchergebnisse

OBJECTIVES: Newborn size, including length, has been associated with later growth. Preconception nutrition supplementation in Women First (WF) trial (clinicaltrials.gov NCT01883193) was associated with higher newborn length and lower rates of stunting. The objective was to examine postnatal growth outcomes through 6 mo in the WF offspring. METHODS: Subjects were 2450 infants from the WF sites in Democratic Republic of Congo (DRC), Guatemala, India, and Pakistan with the 3 WF arms maintained: Arm 1 started a lipid-based nutrition supplement ≥ 3 mo prior to conception; Arm 2 started same supplement at ∼11 wk gestation; and Arm 3 received no trial supplements. Maternal supplementation was discontinued at delivery. Anthropometric measurements were obtained at birth, 0.5, 1, 3, and 6 mo; Z-scores were calculated from WHO Child Growth Standards. Primary and secondary outcomes were analyzed using longitudinal generalized estimating equations accounting for the correlation of repeated measures over time and study cluster. Intervention effects were evaluated within each site as well as overall, adjusting for site and baseline maternal covariates that differed by arm. Statistical interaction between arm and infant sex was evaluated and included if significant. RESULTS: Longitudinal growth (length and weight) curves from 0–6 mo demonstrated differences by intervention arm, with Arms 1 and 2 more favorable compared to Arm 3 (Table + LAZ in Figure). Relative risks (RR) for stunting were significantly lower for Arms 1 and 2 (vs. Arm 3) (Table). Site-specific analyses revealed some site differences warranting further exploration. CONCLUSIONS: Without any postnatal intervention, differences in fetal growth evident at birth persisted at 6 months. FUNDING SOURCES: Bill & Melinda Gates Foundation; NIH, NICHD & ODS. SUPPORTING TABLES, IMAGES AND/OR GRAPHS:

OBJECTIVES: Nutrition during fetal and early postnatal life impacts brain development, however evidence from randomized trials from low-and-middle-income countries (LMIC) is limited. We evaluated effects of maternal nutrition supplementation before and during pregnancy on neurodevelopment and vision in children from 4 LMIC with high rates of stunting, using a simplified assessment tool. METHODS: Women First was an individually randomized trial comparing the impact of maternal nutrition supplementation initiated preconception vs at ∼12 wk gestation vs no supplement; interventions were discontinued at delivery in trial sites in Democratic Republic of the Congo, Guatemala, India, and Pakistan. Neurodevelopment and visual acuity and visual contrast sensitivity were assessed at 24 mo using the INTER-NDA and the Cardiff tests, respectively, in a random sub-set, representing ∼1/3 of infants with valid birth measurements from the WF trial. Anthropometry and Family Care Indicators (FCI) were also obtained at 24 mo. RESULTS: 667 and 634 children (91% and 86% of sub-set) were included in INTER-NDA and vision analyses. Arm-proportionate contribution was 32.2–32.8%. Overall, we observed the following percentage of children with delays: 66.6% cognitive; 87.4% fine motor; 91.3% gross motor; and 11.7% language; 25.9% had positive behavior problems; and 26.0% and 21.0% had low acuity and contrast sensitivity scores, respectively. WF intervention arm was not significant for INTER-NDA scores, rates of mild-to-moderate or severe delay (F = 0.004–1.518, p = 0.28–0.99; X(2 )= 3.81–5.92, p = 0.18–0.42; X(2 )= 3.81–6.33, p = 0.18–0.43); or for low acuity and contrast sensitivity (X(2 )= 0.91, p = 0.63 and X(2 )= 1.64, p = 0.44). LAZ(24mo) was significantly associated with cognitive, motor, language, and behavior scores; maternal education predicted cognitive, language, and vision; and FCI was significantly associated with fine motor, language, and behavior after adjusting for other covariates (R(2) 0.33 cognitive; 0.40 language; 0.12 ...