The impact of prenatal vitamin A and zinc supplementation on growth of children up to 2 years of age in rural Java, Indonesia

Objective: To determine whether prenatal vitamin A and/or Zn supplementation affects postnatal growth. Design: Follow-up of a randomized controlled trial monitoring growth in children from birth up to 24 months of age. Setting: Central Java, Indonesia. Subjects: Children (n 343) of mothers participating in a double-blinded, randomized controlled study of vitamin A and/or Zn supplementation during pregnancy. We report the effects of prenatal supplementation on infant growth, measured as weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and weight-for-height Z-scores (WHZ), from 0 to 24 months, as well as differences in growth faltering among the supplementation groups. Results: For HAZ, the absolute differences between the vitamin A-only and vitamin A + Zn groups at 3 and 9 months were 0.34 SD and 0.37 SD, respectively, and the absolute difference between the vitamin A-only and Zn-only groups at 18 months was 0.31 SD. Compared with placebo, none of the supplements affected growth. Defining growth faltering as a downward crossing of two or more major percentile lines, 50-75% of the children were found to be growth faltering within 9 months of age, whereas 17% and 8% scored <-2 SD for WAZ and HAZ, respectively. Prenatal supplementation did not reduce the prevalence of growth faltering. Conclusions: Prenatal vitamin A supplementation had a small but significant effect on postnatal growth of children's length until 18 months of age compared with supplementation with either vitamin A + Zn or Zn alone, but not compared with placebo. It had no effects on other anthropometric measures and did not reduce the prevalence of growth faltering. Future studies should duplicate these findings before recommendations can be made.