Supplementation with fortified balanced energy-protein during pregnancy and lactation and infant growth outcomes in southern Nepal: a community-based 2×2 factorial randomized trial

Why clinicians should know about it

• Picked for Pediatrics and Child Health (paper of the day, 1 November 2026): Randomized trial evaluates infant growth after maternal supplementation

Abstract

BACKGROUND: Small-for-gestational age birth and infant linear growth faltering are prevalent in South Asia. The World Health Organization recommends balanced energy-protein (BEP) supplementation in pregnancy for undernourished populations, but evidence on the extension of supplementation through lactation to improve infant growth remains limited. OBJECTIVE: To examine the effect of daily fortified BEP supplementation during pregnancy and lactation on infant mean length-for-age z-score (LAZ) and secondary growth outcomes at 6 months of age. METHODS: MINT (Maternal Infant Nutrition Trial) was a 2x2 factorial, household randomized, unblinded efficacy trial to assess a daily fortified BEP supplement during pregnancy and/or lactation compared to no supplement on birth and infant growth outcomes in Sarlahi, Nepal. A modified intention-to-treat analysis estimated the effects of supplementation on infant growth outcomes using linear and Poisson regression models. Models without and with adjustment for birth size were used to estimate the overall effect and the effect independent of birth size, respectively. RESULTS: Among 1,554 mothers and 1,568 infants randomized after delivery, there was no interaction between pregnancy and lactation supplementation on the primary infant growth outcome. Neither BEP supplementation during pregnancy nor lactation had an effect on mean infant LAZ at 6 months (unadjusted mean difference for pregnancy: 0.01 [95% CI: -0.10, 0.12]; for lactation -0.02 [95% CI: -0.13, 0.09]). Significant differences were not observed for any secondary outcomes: mean weight-for-length z-scores, weight-for-age z-scores, infant weight, length, head circumference, mid-upper arm circumference or prevalence of stunting, wasting, and underweight at 6-months or for a subset of infants at 12-months. Null effects persisted after adjustment for birth size. CONCLUSIONS: In rural Nepal, daily fortified BEP supplementation during pregnancy or early lactation did not improve linear or ponderal growth of infants at 6- or 12-months. To reduce the burden of early infant growth faltering, alternative strategies should be considered. TRIAL REGISTRATION NUMBER: NCT03668977. https://clinicaltrials.gov/study/NCT03668977?term=nct03668977&rank=1.

Abstract as published, via PubMed.