In Malawi, FANTA partners University of California, Davis, and the University of Tampere, along with the University of Malawi College of Medicine, conducted a randomized, controlled clinical trial to investigate the extent to which adverse birth outcomes, such as preterm births and infants with low birth weight (both of which are associated with linear growth faltering in early childhood and beyond), can be reduced through the provision of a small-quantity lipid-based nutrient supplement (LNS) or multiple micronutrient supplementation—in comparison to the standard iron/folic acid supplementation. 

The trial had a large sample size and collected a wide range of biological samples, including data on maternal plasma concentration of cholesterol, composition of fatty acids, malaria, maternal periodontitis and dental caries, infections of the reproductive tract, placenta and amniotic membranes, and maternal stress. Hence, the trial provided a unique opportunity not only to study the impact of the intervention on adverse birth outcomes, and on various indicators of maternal nutrition, stress, infection, inflammation and health, but also to provide clues on other potential pregnancy interventions by carefully analyzing the multiple determinants of preterm birth and small birth size in the same dataset.

The complete results of the trial are available in the reports here. 

The Impact of Dietary Supplementation with Lipid-Based Nutrient Supplements on Maternal Health and Pregnancy Outcomes in Rural

This report describes the impact of the trial intervention on adverse birth outcomes and various indicators of maternal nutrition, stress, infection, inflammation, and health. 

The Associations between Nutrition, Stress, Infection, and Inflammation and Maternal Health and Pregnancy Outcomes in Rural Malawi 

This report describes the association of maternal nutrition, stress, infection, inflammation, and health with adverse birth outcomes; and provides a pathway analysis of the determinants of pre-term birth and small birth size. 

Pathways Leading to Adverse Birth Outcomes in Rural Malawi

This report is a summary report to highlight the findings specifically from the pathway analysis undertaken to identify determinants of pre-term birth and small birth size.

Additionally, several peer-reviewed journal articles have also been published to report on the trial findings. 

Collaborating Organizations: University of College London, University of Melbourne, University of North Carolina

Journal articles

• Klevor, Adu-Afarwuah et al.  A mixed method study exploring adherence to and acceptability of small quantity lipid-based nutrient supplements (SQ-LNS) among pregnant and lactating women in Ghana and Malawi, BMC Pregnancy and Childbirth (BMC Pregnancy and Childbirth, 2016)
• Shaw, L et al.  Distinguishing the signals of gingivitis and periodontitis in supragingival plaque: a cross-sectional cohort study in Malawi. Applied and Evnironmental Microbiology (Applied and Environmental Biology, 2016)
• Maternal cortisol and stress are associated with birth outcomes, but are not affected by lipid-based nutrient supplements during pregnancy: an analysis of data from a randomized controlled trial in rural Malawi (BMC Pregnancy Childbirth, 2015)
• The impact of lipid-based nutrient supplement provision to pregnant women on newborn size in rural Malawi: A randomised controlled trial (The American Journal of Clinical Nutrition, 2015)
• Supplementation of maternal diets during pregnancy and for six months post-partum and infant diets thereafter with small-quantity lipid-based nutrient supplements does not promote child growth by 18 months of age in rural Malawi (The Journal of Nutrition, 2015)
• The impact of lipid-based nutrient supplementation on anti-malarial antibodies in pregnant women in a randomized controlled trial (Malaria Journal, 2015)
• Nutrient supplementation may adversely affect maternal oral health - a randomised controlled trial in rural Malawi (Maternal & Child Nutrition, 2015)
• Association between maternal dental periapical infections and pregnancy outcomes: results from a cross-sectional study in Malawi (Tropical Medicine & International Health, 2015)