title: Effects of maternal and child lipid-based nutrient supplements on infant development: a randomized trial in Malawi.
abstract: Maternal and infant undernutrition is associated with poor infant development; however, few studies have examined the impact of combined pre- and postnatal dietary supplementation on infant development.
  
  
  
  Our objective was to determine whether provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) to mothers during pregnancy and the first 6 mo postpartum, and to children aged 6-18 mo, improves infant development in Malawi.
  
  
  
  We randomly assigned 869 pregnant women to receive one of the following daily: an iron and folic acid (IFA) capsule, a multiple micronutrient (MMN) capsule containing 18 micronutrients, or a 20-g sachet of SQ-LNSs containing 22 vitamins and minerals, protein, carbohydrates, essential fatty acids, and 118 kcal. Children in the lipid-based nutrient supplement (LNS) group only received SQ-LNSs from 6 to 18 mo of age. We monitored the acquisition of 11 developmental milestones monthly by maternal report; observed the attainment of 7 motor milestones at 6, 12, and 18 mo of age; and conducted a comprehensive assessment of motor, language, and socioemotional development and executive function at 18 mo of age. The primary analysis was by intention-to-treat.
  
  
  
  By maternal report, children in the LNS group achieved walking alone (B = 0.53; 95% CI: 0.11, 0.94; P = 0.034) and waving goodbye (B = 0.60; 95% CI: 0.12, 1.08; P = 0.040) earlier than the IFA group and standing with assistance earlier than the MMN group (B = 0.51; 95% CI: 0.12, 0.89; P = 0.029). By researcher observation, there was a trend (P = 0.052) for a greater percentage of children in the LNS group (58%) to walk alone at age 12 mo than in the IFA (49%) and MMN (49%) groups. At age 18 mo, there were no significant differences between groups in any scores.
  
  
  
  Although provision of SQ-LNSs to pregnant women and infants in Malawi may affect the age of acquisition of certain developmental milestones, it did not affect our assessments of motor, language, socioemotional, or executive function skills at 18 mo of age. This trial was registered at clinicaltrials.gov as NCT01239693.
authors: Department of Nutrition, University of California Davis, Davis, CA; elprado@ucdavis.edu.
authors: Elizabeth L
authors: http://orcid.org/0000-0002-5388-081X
authors: EL
authors: Prado
authors: School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi;
authors: Kenneth
authors: http://orcid.org/0000-0002-2536-3938
authors: K
authors: Maleta
authors: Department for International Health, University of Tampere School of Medicine, Tampere, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland; and.
authors: Per
authors: http://orcid.org/0000-0003-2311-2593
authors: P
authors: Ashorn
authors: Department for International Health, University of Tampere School of Medicine, Tampere, Finland;
authors: Ulla
authors: http://orcid.org/0000-0002-1720-868X
authors: U
authors: Ashorn
authors: Department of Agricultural and Resource Economics, University of California Davis, Davis, CA.
authors: Steve A
authors: SA
authors: Vosti
authors: School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi;
authors: John
authors: J
authors: Sadalaki
authors: Department of Nutrition, University of California Davis, Davis, CA;
authors: Kathryn G
authors: KG
authors: Dewey
mesh_terms: D000328:Adult; D000367:Age Factors; D002657:Child Development / Q000187:drug effects*; D003071:Cognition; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008055:Lipids / Q000494:pharmacology*; D008295:Malawi; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000494:pharmacology*; D009048:Motor Skills; D009752:Nutritional Status; D011247:Pregnancy; D016138:Walking; D055815:Young Adult
chemical_list: D008055:Lipids; D018977:Micronutrients
keywords: cognitive development; iLiNS project; infant development; lipid-based nutrient supplements; maternal micronutrient supplements