Previous research on the topic has focused on standalone or partially integrated interventions and produced mixed findings. In contrast, this trial tested an integrated intervention package and showed consistent benefits in terms of growth, anemia, and neurodevelopmental outcomes for SGA babies.
Every year, about 23 million babies (17%) are born SGA globally, with a prevalence of 40% in South Asia alone, which may be due to persistent maternal nutritional, health, and socioeconomic constraints in the region. SGA babies have higher risks of poor growth, developmental delay, illness, and death during early childhood. In the first six months of life, optimal weight and length trajectories are strongly associated with better neurodevelopmental outcomes in later childhood, and early weight gain is a strong determinant of survival in low-resource settings.
The study is a collaboration between scientists from the Society for Applied Studies in New Delhi, India, and from the University of Bergen, Norway. First authors are Ranadip Chowdhury and Rukman Manapurath and the last author is Sunita Taneja from the Society for Applied Studies, New Delhi, India, and co-authors include Ingvild Fossgard Sandøy, Director of the Bergen Centre for Ethics and Priority Setting in Health (BCEPS) at the University of Bergen, as well as Tor Strand and Jose Martines affiliated with the Centre for International Health and the Centre for Intervention Science in Maternal and Child Health (CISMAC) at the University of Bergen.
The clinical trial was conducted in low-resource neighborhoods of South Delhi, India, between January 2023 and August 2025. Term SGA infants were enrolled in the study within 14 days of birth, and 1300 infants were randomized and followed up to 12 months of age. The infants were randomized in a 1:1 ratio to receive either the integrated intervention package, which included health, nutrition, early child stimulation, and psychosocial support, delivered through regular home visits to mothers and infants (n = 647) or the usual care provided through Indian government programs (n = 653).
The researchers found that babies in the intervention group had a lower prevalence of underweight, stunting, wasting, and anemia. The prevalence of anemia was reduced by more than half among infants receiving the intervention. In addition, they had higher cognitive scores, language scores, and motor composite scores. Fewer babies died in the intervention group than in the control group during the trial period.
These strong results underscore the importance of integrated interventions to improve the survival and healthy growth of SGA infants, not only in India or South Asia, where the prevalence of babies born SGA is particularly high, but also globally.
JAMA
Randomized controlled/clinical trial
People
Multidomain Intervention for Growth in Term Small-for-Gestational-Age Infants
27-Jul-2026