Impact of Prenatal Nutrition Interventions on Infant Longitudinal Growth: A Secondary Analysis of the Mumta Pregnant Women Trial in Pakistan

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Objective: To evaluate the effect of antenatal interventions on infant growth from birth till 12 months of age. Patients and Methods: In the Mumta Pregnant Women (PW) trial conducted from July 22, 2019, to February 1, 2022, PW were randomly assigned (1:1:1:1) to one of 4 groups: control (standard antenatal care), balanced energy protein supplementation (BEP alone), BEP/azithromycin (AZ), or BEP/nicotinamide/choline. Infant growth trajectories were modeled using the broken stick method and k-means clustering for weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length z-scores. Random effect models assessed the impact of interventions and covariates (maternal age, height, parity, and mode of delivery) on growth outcomes. Results: From 1884 PW randomized, 1678 infants were born alive and included in this analysis (control n=410, BEP only n=418, BEP/AZ n=428, and BEP/choline/nicotinamide n=422). The mean growth trajectories revealed that the BEP/AZ arm had higher mean WAZ, LAZ, and weight-for-length scores compared with control. BEP/AZ arm had the highest proportion of infants in the thriving cluster across WAZ (control 34.4 % and BEP/AZ 35.5 %), and LAZ (control 31.7%, BEP/AZ 33.4%) measures. The odds of membership to the faltering cluster were reduced in the BEP/AZ arm based on WAZ (control 22.3%, BEP/AZ 15.7%), and LAZ measures (control 22.1%, BEP/AZ 17.7%) as compared with control. Across all measures, faltering was 4-fold higher in small-for-gestational-age infants and 2-fold higher among infants born to undernourished mothers. Conclusion: Antenatal interventions, such as BEP and prophylactic AZ, may have the potential to support and sustain infant growth outcomes in low-resource settings. Trial Registration: Clinicaltrials.gov Identifier: NCT04012177.

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