PMID- 35500028
OWN - NLM
STAT- MEDLINE
DCOM- 20220504
LR  - 20220716
IS  - 1549-1676 (Electronic)
IS  - 1549-1277 (Print)
IS  - 1549-1277 (Linking)
VI  - 19
IP  - 5
DP  - 2022 May
TI  - Evaluation of multiple micronutrient supplementation and medium-quantity 
      lipid-based nutrient supplementation in pregnancy on child development in rural 
      Niger: A secondary analysis of a cluster randomized controlled trial.
PG  - e1003984
LID - 10.1371/journal.pmed.1003984 [doi]
LID - e1003984
AB  - BACKGROUND: It is estimated that over 250 million children under 5 years of age 
      in low- and middle-income countries (LMICs) do not reach their full developmental 
      potential. Poor maternal diet, anemia, and micronutrient deficiencies during 
      pregnancy are associated with suboptimal neurodevelopmental outcomes in children. 
      However, the effect of prenatal macronutrient and micronutrient supplementation 
      on child development in LMIC settings remains unclear due to limited evidence 
      from randomized trials. METHODS AND FINDINGS: We conducted a 3-arm 
      cluster-randomized trial (n = 53 clusters) that evaluated the efficacy of (1) 
      prenatal multiple micronutrient supplementation (MMS; n = 18 clusters) and (2) 
      lipid-based nutrient supplementation (LNS; n = 18 clusters) as compared to (3) 
      routine iron-folic acid (IFA) supplementation (n = 17 clusters) among pregnant 
      women in the rural district of Madarounfa, Niger, from March 2015 to August 2019 
      (ClinicalTrials.gov identifier NCT02145000). Children were followed until 2 years 
      of age, and the Bayley Scales of Infant and Toddler Development III (BSID-III) 
      were administered to children every 3 months from 6 to 24 months of age. Maternal 
      report of WHO gross motor milestone achievement was assessed monthly from 3 to 24 
      months of age. An intention-to-treat analysis was followed. Child BSID-III data 
      were available for 559, 492, and 581 singleton children in the MMS, LNS, and IFA 
      groups, respectively. Child WHO motor milestone data were available for 691, 781, 
      and 753 singleton children in the MMS, LNS, and IFA groups, respectively. 
      Prenatal MMS had no effect on child BSID-III cognitive (standardized mean 
      difference [SMD]: 0.21; 95% CI: -0.20, 0.62; p = 0.32), language (SMD: 0.16; 95% 
      CI: -0.30, 0.61; p = 0.50) or motor scores (SMD: 0.18; 95% CI: -0.39, 0.74; p = 
      0.54) or on time to achievement of the WHO gross motor milestones as compared to 
      IFA. Prenatal LNS had no effect on child BSID-III cognitive (SMD: 0.17; 95% CI: 
      -0.15, 0.49; p = 0.29), language (SMD: 0.11; 95% CI: -0.22, 0.44; p = 0.53) or 
      motor scores (SMD: -0.04; 95% CI: -0.46, 0.37; p = 0.85) at the 24-month endline 
      visit as compared to IFA. However, the trajectory of BSID-III cognitive scores 
      during the first 2 years of life differed between the groups with children in the 
      LNS group having higher cognitive scores at 18 and 21 months (approximately 0.35 
      SD) as compared to the IFA group (p-value for difference in trajectory <0.001). 
      Children whose mothers received LNS also had earlier achievement of sitting alone 
      (hazard ratio [HR]: 1.57; 95% CI: 1.10 to 2.24; p = 0.01) and walking alone 
      (1.52; 95% CI: 1.14 to 2.03; p = 0.004) as compared to IFA, but there was no 
      effect on time to achievement of other motor milestones. A limitation of our 
      study is that we assessed child development up to 2 years of age, and, therefore, 
      we may have not captured effects that are easier to detect or emerge at older 
      ages. CONCLUSIONS: There was no benefit of prenatal MMS on child development 
      outcomes up to 2 years of age as compared to IFA. There was evidence of an 
      apparent positive effect of prenatal LNS on cognitive development trajectory and 
      time to achievement of selected gross motor milestones. TRIAL REGISTRATION: 
      ClinicalTrials.gov NCT02145000.
FAU - Sudfeld, Christopher R
AU  - Sudfeld CR
AUID- ORCID: 0000-0002-3203-3638
AD  - Department of Global Health and Population, Harvard T.H. Chan School of Public 
      Health, Boston, Massachusetts, United States of America.
AD  - Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, 
      Massachusetts, United States of America.
FAU - Bliznashka, Lilia
AU  - Bliznashka L
AUID- ORCID: 0000-0003-2084-1141
AD  - Department of Global Health and Population, Harvard T.H. Chan School of Public 
      Health, Boston, Massachusetts, United States of America.
FAU - Salifou, Aichatou
AU  - Salifou A
AD  - Epicentre, Niamey, Niger.
FAU - Guindo, Ousmane
AU  - Guindo O
AD  - Epicentre, Niamey, Niger.
FAU - Soumana, Issaka
AU  - Soumana I
AUID- ORCID: 0000-0002-7268-4005
AD  - Epicentre, Niamey, Niger.
FAU - Adehossi, Irene
AU  - Adehossi I
AD  - National Pediatric Hospital of Niamey, Niamey, Niger.
FAU - Langendorf, Celine
AU  - Langendorf C
AUID- ORCID: 0000-0002-0811-7540
AD  - Department of Research, Epicentre, Paris, France.
FAU - Grais, Rebecca F
AU  - Grais RF
AUID- ORCID: 0000-0002-5037-8218
AD  - Department of Research, Epicentre, Paris, France.
FAU - Isanaka, Sheila
AU  - Isanaka S
AUID- ORCID: 0000-0002-4503-2861
AD  - Department of Global Health and Population, Harvard T.H. Chan School of Public 
      Health, Boston, Massachusetts, United States of America.
AD  - Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, 
      Massachusetts, United States of America.
AD  - Department of Research, Epicentre, Paris, France.
LA  - eng
SI  - ClinicalTrials.gov/NCT02145000
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20220502
PL  - United States
TA  - PLoS Med
JT  - PLoS medicine
JID - 101231360
RN  - 0 (Lipids)
RN  - 0 (Micronutrients)
RN  - 935E97BOY8 (Folic Acid)
RN  - E1UOL152H7 (Iron)
SB  - IM
MH  - *Child Development
MH  - Child, Preschool
MH  - Dietary Supplements
MH  - Female
MH  - Folic Acid
MH  - Humans
MH  - Infant
MH  - Iron
MH  - Lipids/pharmacology
MH  - *Micronutrients/pharmacology
MH  - Niger
MH  - Pregnancy
PMC - PMC9060361
COIS- I have read the journal's policy and the authors of this manuscript have the 
      following competing interests: RFG is an Academic Editor on PLOS Medicine's 
      editorial board.
EDAT- 2022/05/03 06:00
MHDA- 2022/05/06 06:00
PMCR- 2022/05/02
CRDT- 2022/05/02 13:43
PHST- 2021/11/07 00:00 [received]
PHST- 2022/04/08 00:00 [accepted]
PHST- 2022/05/02 13:43 [entrez]
PHST- 2022/05/03 06:00 [pubmed]
PHST- 2022/05/06 06:00 [medline]
PHST- 2022/05/02 00:00 [pmc-release]
AID - PMEDICINE-D-21-04627 [pii]
AID - 10.1371/journal.pmed.1003984 [doi]
PST - epublish
SO  - PLoS Med. 2022 May 2;19(5):e1003984. doi: 10.1371/journal.pmed.1003984. 
      eCollection 2022 May.