Prenatal multiple micronutrient supplementation (MMS) and lipid-based nutrient supplementation (LNS) can improve birth outcomes relative to iron-folic acid supplementation (IFA); however, effects on child postnatal growth remain unclear. The aim was to compare the effect of prenatal MMS, medium-quantity LNS (MQ-LNS), and IFA on child growth up to 2 y of age. We conducted a cluster randomized controlled trial of prenatal nutritional supplementation in Madarounfa, Niger. Villages were randomly assigned for pregnant women to receive IFA (17 villages, 1105 women), MMS (18 villages, 1083 women) or MQ-LNS (18 villages, 1144 women). Pregnant women received nutritional supplements weekly until delivery, and children were followed up monthly from 6-8 weeks to 24 months of age. We assessed the effect of prenatal MMS and MQ-LNS compared with IFA and the effect of prenatal MMS compared with MQ-LNS on child length for-age z scores (LAZ), weight-for-age z scores (WAZ), and weight-for-length z scores (WLZ) at 24 months of age using generalized linear models. In secondary analyses, we used mixed-effects models to assess the trajectories of anthropometric z scores longitudinally from 6-8 weeks to 24 mo. Compared with IFA, MMS and MQ-LNS had no effect on child LAZ, WAZ, or WLZ at 24 months of age (P>0.05). Children in the MQ-LNS arm had significantly higher mid-upper arm circumference at 24 months than children in the MMS arm: mean difference 0.50cm (95% CI 0.10, 0.91cm). WAZ and WLZ trajectories were more negative in the MQ-LNS arm compared with IFA and MMS, with lower z scores from 14 to 20 months of age. However, WAZ and WLZ trajectories converged after 20 months of age, and there were no differences by 24 months of age. Prenatal MMS and MQ-LNS had limited effect on anthropometric measures of child growth up to 24 months of age as compared with IFA in rural Niger.
