Public Health Nutrition


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

Endy P Prawirohartonoa1 c1, Lennarth Nyströma2, Anneli Ivarssona2, Hans Stenlunda2 and Torbjörn Linda3

a1 Department of Child Health, Medical School, Gadjah Mada University, Sardjito Hospital, Jalan Kesehatan no. 1, Sekip, Yogyakarta 55284, Indonesia

a2 Division of Epidemiology and Global Health Sciences, Department of Public Health and Clinical Medicine, Umeå University, Sweden

a3 Division of Pediatrics, Department of Clinical Sciences, Umeå University, Sweden


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.

(Received April 16 2010)

(Accepted March 31 2011)

(Online publication June 23 2011)


c1 Corresponding author: Email