Ashorn 2015.

Methods	A randomised, outcome‐assessor‐blinded, community‐based clinical trial in Malawi
Participants	Sample size: 1391 pregnant women enrolled; 84 women lost to follow‐up Mean age: 25 years Inclusion/exclusion criteria: eligible women had an ultrasound confirmed pregnancy of no more than 20 completed gestation weeks, residence in the defined catchment area, availability during the period of the study, and signed or thumb‐printed informed consent. The study excluded those: younger than 15 years of age; in need for frequent medical attention due to a chronic health condition; diagnosed asthma treated with regular medication; severe illness warranting hospital referral; history of peanut allergy; history of anaphylaxis or serious allergic reaction to any substance; requiring emergency medical care; pregnancy complications evident at enrolment visit (moderate to severe oedema, blood haemoglobin concentration 50 g/L, systolic blood pressure of 160 mmHg or more, or diastolic blood pressure 100 mmHg or more); earlier participation in the iLiNS‐DYAD‐M trial (during a previous pregnancy); or concurrent participation in any other clinical trial.
Interventions	Interventions Pregnant women were allocated to 3 groups Group 1 (n = 463) received iron (60 mg) and folic acid (400 mg) tablets Group 2 (n = 466) received MMN capsule Group 3 (n = 462) received 20 g/day LNS sachets Delivery/administration Data collectors made home visits, biweekly, to deliver the supplements and to collect information on the participant's adherence to the study intervention. LNS composition Total energy: 118 kcal Protein: 2.6 g Fat: 10 g Linoleic acid: 4.59 g α‐Linolenic acid: 0.59 g Vitamin A: 800 mg RE Vitamin C: 100 mg Vitamin B1: 2.8 mg Vitamin B2: 2.8 mg Niacin: 36 mg Folic acid: 400 mg Pantothenic acid: 7 mg Vitamin B6: 3.8 mg Vitamin B12: 5.2 mg Vitamin D: 10 mg Vitamin E: 20 mg Vitamin K: 45 mg Iron: 20 mg Zinc: 30 mg Copper: 4 mg Calcium: 280 mg Phosphorus: 190 mg Potassium: 200 mg Magnesium: 65 mg Selenium: 130 mg Iodine: 250 mg Manganese: 2.6 mg
Outcomes	Primary outcomes Birth weight Birth length Secondary outcomes Length at 18 months Weight at 18 months Stunting at 18 months Head circumference at 18 months MUAC at 18 months Pregnancy duration
Notes	Study duration: February 2011 to December 2015 Conflict of interest: one of the authors, Mamane Zeilani, works as a Drector of Research for Nutriset SAS, a company that produces and sells LNS supplements and also prepared the LNS supplements purchased for the current trial. The other authors declared no conflicts of interest related to this study. Source of funding: supported, in part, by a grant from the Bill & Melinda Gates Foundation, with additional funding from the Office of Health, Infectious Diseases, and Nutrition, Bureau for Global Health, US Agency for International Development (USAID) under terms of Cooperative Agreement No. AID‐OAA‐A‐12‐00005, through the Food and Nutrition Technical Assistance III Project (FANTA), managed by FHI 360. For data management and statistical analysis, the team received additional support in grants from the Academy of Finland (grant 252075) and the Medical Research Fund of Tampere University Hospital (grant 9M004). The author Yin Bun Cheung was supported by the Singapore Ministry of Health's National Medical Research Council under its Clinician Scientist Award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "A study statistician not involved in data collection generated 4 randomization code lists in blocks of 9." Comment: adequately done
Allocation concealment (selection bias)	Low risk	Quote: "In the randomisation process, each participant number was allocated one of 9 possible letter codes (A, B, C, D,E, H, J, K, or M). Each letter code corresponded to one of the 3 interventions (i.e., each intervention matched with 3 separate letter codes)." Comment: adequately done
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Quote: "The IFA and MMN interventions were provided by using double‐masked procedures—that is, the capsules looked identical,and neither the participants nor the research team members were aware of the nutrient contents of the supplement capsules. For the LNS group, we used single‐masked procedures—that is field workers who delivered the supplements knew which mothers were receiving LNS (but not a difference between IFA and MMN), and the participants were advised not to disclose information about their supplements to anyone other than an iLiNS team member." Comment: it was not possible to blind field workers due to the nature of the intervention.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "The data collectors who performed the anthropometric measurements or assessed other outcomes were not aware of group allocation." Comment: adequately done
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: overall 6.04% similar between groups; adequately done
Selective reporting (reporting bias)	Low risk	Comment: all presented analyses were prespecified either in the trial protocol or in the statistical analysis plan. Registered at clinicaltrials.gov as NCT01239693. Adequately done
Other bias	Low risk	Comment: no other sources of bias were identified. The study was supported, in part, by a grant to the University of California, Davis, from the Bill & Melinda Gates Foundation, with additional funding from the Office of Health, Infectious Diseases, and Nutrition, Bureau for Global Health, US Agency for International Development (USAID).