Effects of prenatal small-quantity lipid-based nutrient supplements on pregnancy, birth and infant outcomes: a systematic review and meta-analysis of individual participant data from randomized controlled trials in low- and middle-income countries

Author:

Dewey Kathryn G.ORCID,Wessells K. RyanORCID,Arnold Charles D.ORCID,Adu-Afarwuah SethORCID,Arnold Benjamin F.ORCID,Ashorn UllaORCID,Ashorn PerORCID,Garcés AnaORCID,Huybregts LievenORCID,Krebs Nancy F.ORCID,Lartey AnnaORCID,Leroy Jef L.ORCID,Maleta KennethORCID,Matias Susana L.ORCID,Moore Sophie E.ORCID,Mridha Malay K.,Okronipa HarrietORCID,Stewart Christine P.ORCID

Abstract

AbstractBackgroundUndernutrition during pregnancy increases the risk of giving birth to a small vulnerable newborn. Small-quantity lipid-based nutrient supplements (SQ-LNS) contain both macro- and micronutrients and can help prevent nutritional deficiencies during pregnancy and lactation.ObjectivesWe examined effects of SQ-LNS provided to pregnant women, compared to a) iron and folic acid or standard of care (IFA/SOC) or b) multiple micronutrient supplements (MMS), and identified characteristics that modified effects of SQ-LNS on birth outcomes.MethodsWe conducted a 2-stage meta-analysis of individual participant data from 4 randomized controlled trials of SQ-LNS provided to pregnant women (n = 5,273). We generated study-specific and subgroup estimates of SQ-LNS compared with IFA/SOC or MMS and pooled the estimates. In sensitivity analyses, we examined whether results differed depending on methods for gestational age dating, birth anthropometry, or study design.ResultsSQ-LNS (vs IFA/SOC) increased birth weight (mean difference: +49g; 95% CI: 26, 71g), duration of gestation (+0.12 wk; 95% CI: 0.01, 0.24 wk), and all birth anthropometric z-scores (+0.10-0.13 SD); it reduced risk of low birthweight by 11%, newborn stunting by 17%, newborn wasting by 11%, and small head size by 11%. Only 2 trials compared SQ-LNS and MMS; birth outcomes did not differ except for a marginal increase in head circumference for gestational age (+0.11; 95% CI: -0.01, 0.23). Effect estimates for SQ-LNS vs IFA/SOC were greater among female infants and among women with body mass index < 20 kg/m2, inflammation, malaria, or household food insecurity. Effect estimates for SQ-LNS vs MMS were greater among female infants, first-born infants, and women < 25 y.ConclusionsSQ-LNS had positive impacts on multiple outcomes compared to IFA/SOC, but further research directly comparing SQ-LNS and MMS is needed. Targeting SQ-LNS to vulnerable subgroups may be worth considering. Analysis registered atwww.crd.york.ac.uk/PROSPERO(CRD42021283391).

Publisher

Cold Spring Harbor Laboratory

Reference60 articles.

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5. Women in Resource-Poor Settings Are at Risk of Inadequate Intakes of Multiple Micronutrients

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