Supplementation with fortified balanced energy–protein during pregnancy and lactation and infant growth outcomes in southern Nepal: a community-based 2×2 factorial randomized trial

Small-for-gestational age birth and infant linear growth faltering are prevalent in South Asia. The World Health Organization recommends balanced energy–protein (BEP) supplementation in pregnancy for undernourished populations, but evidence on the extension of supplementation through lactation to improve infant growth remains limited. This study examined the effect of daily fortified BEP supplementation during pregnancy and lactation on infant mean length-for-age z-score (LAZ) and secondary growth outcomes at 6 months of age. Findings showed that in rural Nepal, daily fortified BEP supplementation during pregnancy or early lactation did not improve linear or ponderal growth of infants at 6- or 12-months. To reduce the burden of early infant growth faltering, alternative strategies should be considered.