Background: Early childhood growth failure including stunting is associated with suboptimal health and cognitive development outcomes. Despite progress, the prevalence of childhood stunting in India remains amongst the highest globally. Objective: We aimed to evaluate the impact of a systems strengthening interventional package, including body-mass-index measurement at pregnancy registration, monthly weight monitoring, on-the-spot supplementary nutrition, iron-folic acid supplementation, and targeted dietary counselling provided to women during their antenatal care on childhood stunting. Methods: This is a prospective follow-up comparison study. Women from three districts in West Bengal, India in their first trimester of pregnancy between May 2018 and May 2019 were enrolled into the study. Pregnancy, birth and infant characteristics were collected, and anthropometric indices measured. The relative risk of stunting in children in intervention and comparison groups were compared using generalized linear model to adjust for clustering effect. Results: A total of 809 mother-child dyads (406 intervention; 403 comparison) were followed between May 2018 and May 2021. The median age of women in the intervention and comparison group was 23 (IQR 20-25) and 25 (IQR 24-27) years respectively. Median gestational weight gain was higher amongst women in the intervention group (9 vs. 8 kilograms, p=0.04). Low-birth-weight prevalence was 29.3% (119/406) and 32.0% (129/403) in the intervention and comparison group respectively. At 12-35 months of age, children born to women in the intervention group had significantly reduced risk of stunting (RR=0.58, 95% CI 0.45-0.75, p<0.001). The odds of stunting amongst children born with low birthweight to women in the comparison group were statistically significant [OR 2.44 (1.44-4.14)], unlike those amongst children born to women in the intervention group [1.19 (0.58-2.46)]. Conclusions: These results indicate that strengthening of routine antenatal care including targeted nutritional counselling to expectant mothers can have distal beneficial effects on childhood stunting beyond the immediate post-natal period.

The authors have declared no competing interest.

The authors acknowledge funding provided by the Johns Hopkins Maternal and Child Health Center - India. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Ethics approval was obtained from the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (No. 18366) and the Institutional Ethics Committee at the Child in Need Institute, Kolkata, India (No. 01/2021-22).

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