TABLE 2.
Unadjusted continuous anthropometric outcomes of women who participated in a randomized trial of IFA (pregnancy only), MMN (pregnancy and lactation), and LNS (pregnancy and lactation) supplementation in a semi-urban setting in Ghana, by intervention group based on intended supplement at enrollment1
| Comparison of |
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| Group2 |
MMNs and IFA |
LNSs and IFA |
LNSs and MMNs |
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| Outcome variable | IFA (n = 441) | MMN (n = 439) | LNS (n = 440) | P3 | Difference (95% CI) | P | Difference (95% CI) | P | Difference (95% CI) | P |
| 36 wk of gestation4 | ||||||||||
| Total GWG, kg | 7.3 ± 3.9 (331) | 7.2 ± 3.6 (351) | 7.7 ± 3.7 (331) | 0.18 | −0.2 (−0.9, 0.5) | 0.79 | 0.3 (−0.3, 1.0) | 0.48 | 0.5 (−0.1, 1.2) | 0.16 |
| Rate of GWG, kg/wk | 0.2 ± 0.11 (331) | 0.2 ± 0.10 (351) | 0.2 ± 0.10 (331) | 0.19 | −0.0 (−0.0, 0.0) | 0.76 | 0.0 (−0.0, 0.0) | 0.51 | 0.0 (−0.0, 0.0) | 0.16 |
| Percentage of adequacy of GWG | 76.1 ± 43.6 (331) | 73.7 ± 41.0 (351) | 80.8 ± 44.2 (331) | 0.09 | −2.4 (−10, 5.4) | 0.75 | 4.7 (−3.1, 13) | 0.33 | 7.1 (−0.6, 15) | 0.08 |
| Total MUAC change, cm | −1.1 ± 1.8 (331) | −1.1 ± 1.6 (352) | −0.9 ± 1.6 (332) | 0.40 | −0.0 (−0.3, 0.3) | 0.98 | 0.1 (−0.2, 0.4) | 0.54 | 0.2 (−0.1, 0.5) | 0.41 |
| Total TSF thickness change, mm | −2.7 ± 4.2 (331) | −2.9 ± 3.9 (351) | −2.7 ± 4.1 (332) | 0.76 | −0.2 (−1.0, 0.5) | 0.76 | −0.0 (−0.8, 0.7) | 0.99 | 0.2 (−0.6, 0.9) | 0.84 |
| 6 mo postpartum | ||||||||||
| Weight, kg | 63.6 ± 12.7 (355) | 63.0 ± 13.1 (362) | 64.2 ± 13.2 (356) | 0.52 | −0.6 (−2.9, 1.7) | 0.81 | 0.5 (−1.8, 2.8) | 0.85 | 1.1 (−1.2, 3.4) | 0.48 |
| MUAC, cm | 29.1 ± 4.2 (355) | 29.0 ± 4.3 (362) | 29.2 ± 4.6 (356) | 0.84 | −0.1 (−0.9, 0.6) | 0.92 | 0.1 (−0.7, 0.8) | 0.98 | 0.2 (−0.6, 1.0) | 0.83 |
| TSF thickness, mm | 20.9 ± 7. 6 (355) | 20.8 ± 7.8 (362) | 21.0 ± 7.8 (356) | 0.95 | −0.1 (−1.5, 1.3) | 0.98 | 0.1 (−1.3, 1.4) | 0.99 | 0.2 (−1.2, 1.5) | 0.95 |
| BMI, kg/m2 | 25.2 ± 4.7 (355) | 25.0 ± 4.7 (362) | 25.4 ± 4.8 (356) | 0.67 | −0.2 (−1.0, 0.7) | 0.90 | 0.2 (−0.7, 1.0) | 0.89 | 0.3 (−0.5, 1.2) | 0.64 |
| Change from prepregnancy5 | ||||||||||
| Weight, kg | 1.9 ± 4.7 (348) | 1.40 ± 5.1 (356) | 1.4 ± 4.8 (351) | 0.33 | −0.5 (−1.4, 0.4) | 0.39 | −0.5 (−1.3, 0.4) | 0.40 | 0.0 (−0.9, 0.9) | 1.00 |
| MUAC, cm | 0.6 ± 2.0 (348) | 0.3 ± 2.0 (357) | 0.3 ± 2.1 (351) | 0.12 | −0.2 (−0.6, 0.1) | 0.24 | −0.3 (−0.6, 0.1) | 0.14 | −0.0 (−0.4, 0.3) | 0.95 |
| TSF thickness, mm | 0.9 ± 4.9 (348) | 0.5 ± 5.0 (356) | 0.4 ± 5.0 (351) | 0.30 | −0.5 (−1.3, 0.4) | 0.43 | −0.5 (−1.4, 0.3) | 0.33 | −0.1 (−1.0, 0.8) | 0.98 |
| BMI, kg/m2 | 0.7 ± 1.9 (348) | 0.6 ± 2.0 (356) | 0.5 ± 1.9 (351) | 0.36 | −0.2 (−0.5, 0.2) | 0.45 | −0.2 (−0.5, 0.2) | 0.41 | −0.0 (−0.4, 0.3) | 1.00 |
n = 1320. IFA group: women were assigned to receive 60 mg Fe + 400 mg folic acid/d during pregnancy and placebo (200 mg Ca/d) during the first 6 mo postpartum; MMN group: women were assigned to receive 18 vitamins and minerals (including 20 mg Fe)/d during pregnancy and the first 6 mo postpartum; LNS group: women were assigned to receive 20 g SQ-LNS/d with the same micronutrients as the MMN group + calcium, phosphorus, potassium, and magnesium as well as macronutrients during pregnancy and the first 6 mo postpartum. Results are based on ANOVA (SAS PROC GLM). GWG, gestational weight gain; IFA, iron and folic acid; LNS, lipid-based nutrient supplement; MMN, multiple micronutrient; MUAC, midupper arm circumference; SQ-LNS, small-quantity lipid-based nutrient supplement; TSF, triceps skinfold.
Values are means ± SDs (n). Except for weight, MUAC, TSF thickness, and BMI at 6 mo postpartum, mean ± SD values are based on prepregnancy values estimated from those measured at enrollment by using third-order polynomial regression with gestational age at enrollment as the predictor variable.
P values for comparison of means ± SDs between the 3 groups, with Tukey-Kramer adjustment for pairwise comparisons.
Observed total GWG and MUAC and TSF thickness changes were calculated by subtracting the estimated prepregnancy weight, MUAC, and TSF thickness, respectively, from the weight, MUAC, and TSF thickness measured at the last prenatal visit (21). Estimated prepregnancy weight, MUAC, and TSF thickness were calculated from baseline values by using third-order polynomial regression with gestational age at enrollment as the predictor variable. Rate of GWG was calculated as total GWG at the last prenatal measurement divided by completed weeks of gestation. Percentage of adequacy of GWG [continuous: percentage of weight-gain recommendations met (26)] was calculated by dividing the observed total GWG by the expected GWG according to the Institute of Medicine’s recommended ranges (25) up to the woman’s last prenatal measurement. Expected GWG = expected first-trimester total weight gain + [(gestational age at the time of last weight measurement − 13 wk) × recommended rate of GWG for the second and third trimesters] (21, 23, 24).
Change from prepregnancy to 6 mo postpartum was calculated by subtracting the estimated prepregnancy values from the values measured at 6 mo postpartum.