부산대학교 도서관

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 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. Christopher R. Sudfeld and colleagues evaluate the benefit of multiple micronutrient supplementation and medium‐quantity lipid‐based nutrient supplementation in pregnancy on child development in rural Niger. Author summary Why was this study done? It is estimated that over 250 million children under 5 years of age do not reach their developmental potential in low- and middle-income country (LMIC) settings. Observational studies suggest that poor diet, anemia, and micronutrient deficiencies in pregnancy are associated with poor child development outcomes; however, the effect of macronutrient and micronutrient supplementation in pregnancy on child development outcomes remains inconclusive due to a limited number of randomized trials that have assessed developmental outcomes. What did the researchers do and find? We conducted a cluster-randomized controlled trial of prenatal multiple micronutrient supplementation (MMS) and lipid-based nutrient supplementation (LNS) as compared to routine iron–folic acid (IFA) supplementation among pregnant women in rural Niger and evaluated the effect on child development outcomes during the first 2 years of life. There was no benefit of prenatal MMS on child Bayley Scales of Infant and Toddler Development III (BSID-III) scores or on time to achievement of motor milestones as compared to IFA. There was no effect of prenatal LNS on BSID-III scores at 24 months of age as compared to IFA; however, the trajectory of child development differed between groups, with children in the prenatal LNS group having higher cognitive scores at 18 and 21 months of age as compared to IFA. Children whose mothers received prenatal LNS also had earlier achievement of sitting alone and walking alone as compared to children whose mothers received prenatal IFA. What do these findings mean? Prenatal supplementation with LNS appeared to support the achievement of selected motor milestones and improve cognitive development trajectory; however, there was no evidence of benefit of MMS over routine IFA on developmental outcomes in the context of rural Niger. Nevertheless, the apparent beneficial effects of prenatal LNS were limited, and, therefore, integrated interventions that consider maternal and child nutritional support along with parenting interventions and other components to support an enabling environment may provide larger effects on child development outcomes.