Sustained effects of combined maternal and child small-quantity lipid-based nutrient supplements in early life on growth and developmental outcomes at preschool age: an individual participant data analysis of randomized trials in Ghana and Bangladesh.
Dewey K, Arnold C, et al. • The American journal of clinical nutrition • 2026
We observed a sustained impact of maternal plus child SQ-LNS on growth and language development among female children, but not among males, with child sex being a significant effect modifier for several outcomes.
Key Findings
Results
Exposure to maternal plus child SQ-LNS was associated with higher weight-for-age z-scores at preschool age in the overall sample.
Overall sample size was n = 3565 preschool children reassessed at ages 40-78 months.
Mean difference in WAZ was +0.06 (95% CI: 0.01, 0.11) among children exposed compared with not exposed to maternal plus child SQ-LNS.
Body composition outcomes did not differ between groups.
Data came from a 2-stage individual participant data meta-analysis of randomized controlled trials in Ghana and Bangladesh.
SQ-LNS was provided to pregnant participants and their children aged 6 to 18-24 months.
Results
Child sex was a significant effect modifier for multiple outcomes, with positive effects observed among females but not males.
WAZ among females: +0.16 (95% CI: 0.08, 0.24); among males: -0.04 (95% CI: -0.14, 0.05); P-interaction < 0.01.
HAZ among females: +0.15 (95% CI: 0.06, 0.23); among males: -0.03 (95% CI: -0.3, 0.08); P-interaction < 0.01.
Language development z-score among females: +0.12 (95% CI: 0.02, 0.22); among males: -0.03 (95% CI: -0.13, 0.08); P-interaction < 0.01.
Sex was identified as a significant effect modifier for several outcomes including growth and language development.
Results
Overall developmental outcomes including visual-spatial, executive function, and preacademic skills did not differ between children exposed versus not exposed to maternal plus child SQ-LNS.
Development outcomes assessed included language, visual-spatial, executive function, and preacademic skills.
No significant overall differences in developmental outcomes were found between the exposed and unexposed groups.
Language development showed a sex-specific effect, with positive effects only among females (z-score +0.12, 95% CI: 0.02, 0.22).
Results
Outcomes did not differ overall between children exposed to both maternal plus child SQ-LNS compared with only child SQ-LNS, though sex-specific effects were observed.
The secondary comparison examined whether adding maternal SQ-LNS to child SQ-LNS provided additional benefit.
No significant overall difference was found between maternal plus child SQ-LNS versus child SQ-LNS alone.
Among females, the addition of maternal SQ-LNS positively affected growth.
Among males, the opposite pattern was observed with addition of maternal SQ-LNS.
Methods
The study used a 2-stage individual participant data meta-analysis design pooling randomized controlled trial data from Ghana and Bangladesh.
Trials were conducted in Ghana (registered NCT00970866, 2009) and Bangladesh (registered NCT01715038, 2012).
SQ-LNS was provided during pregnancy and to children aged 6 to 18-24 months.
Follow-up assessments occurred at preschool ages 40-78 months.
Total pooled sample size at follow-up was n = 3565.
Growth outcomes included weight-for-age z-scores (WAZ), height-for-age z-scores (HAZ), and indicators of body composition.
What This Means
This research examined whether giving nutritional supplements called small-quantity lipid-based nutrient supplements (SQ-LNS) to mothers during pregnancy and to their children during early infancy (ages 6 to 18-24 months) had lasting effects on children's growth and development when the children reached preschool age (roughly 3 to 6 years old). The study pooled data from over 3,500 children from two large trials in Ghana and Bangladesh. Overall, children who had received the supplements weighed slightly more for their age at preschool age compared to children who had not received them, but differences in body composition and most developmental skills were not statistically significant across the whole group.
A striking finding was that the effects differed substantially by the child's sex. Among girls, exposure to the supplements was associated with meaningfully better weight-for-age, height-for-age, and language development scores at preschool age. Among boys, no such benefits were seen, and in some cases the pattern pointed in the opposite direction. This sex difference was statistically significant for several outcomes. When the researchers compared children who received both maternal and child supplements versus only child supplements, there was no overall additional benefit from the maternal supplementation, though again, girls appeared to benefit more from the combined approach than boys did.
This research suggests that nutritional supplementation during pregnancy and early childhood can have lasting positive effects on girls' growth and language development that persist into preschool age, even after supplementation has ended. The reasons why boys and girls respond so differently to the same nutritional intervention are not yet understood, and the authors call for further research to investigate these mechanisms. These findings have potential implications for how nutritional programs targeting early childhood development are designed and evaluated, particularly regarding whether sex-specific approaches might be warranted.
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Dewey K, Arnold C, Matias S, Adu-Afarwuah S, Demuyakor M, Kumordzie S, et al.. (2026). Sustained effects of combined maternal and child small-quantity lipid-based nutrient supplements in early life on growth and developmental outcomes at preschool age: an individual participant data analysis of randomized trials in Ghana and Bangladesh.. The American journal of clinical nutrition. https://doi.org/10.1016/j.ajcnut.2026.101310