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Maternal and Child Nutrition: The First 1,000 Days

74th Nestlé Nutrition Institute Workshop, Goa, March 2012

Editor(s): Bhatia J. (Augusta, Ga.) 
Bhutta Z.A. (Karachi) 
Kalhan S.C. (Cleveland, Ohio) 
Table of Contents
Vol. 74, 2013
Section title: Prevention of Low Birthweight, Epidemiology
Bhatia J, Bhutta ZA, Kalhan SC (eds): Maternal and Child Nutrition: The First 1,000 Days. Nestlé Nutr Inst Workshop Ser. Nestec Ltd. Vevey/S. Karger AG Basel, 2013, vol 74, pp 53-62
(DOI:10.1159/000348401)

Effect of Multiple Micronutrient versus Iron-Folate Supplementation during Pregnancy on Intrauterine Growth

Ramakrishnan U. · Grant F.K. · Imdad A. · Bhutta Z.A. · Martorell R.
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Abstract

This review examines the effects of prenatal multiple micronutrient (MM) supplementation (≥5 micronutrients) on intrauterine growth. We identified publications from 16 randomized controlled trials through PubMed and EMBASE database searches. Meta-analyses were performed by pooling results, and sub-analyses by timing of intervention and amount of iron were also done. The primary outcome measures were birthweight, low birthweight (LBW; <2,500 g) and small for gestational age (SGA). Prenatal MM supplementation significantly reduced the incidence of LBW (risk ratio, RR: 0.86; 95% CI: 0.81-0.92) and SGA (RR: 0.83; 95% CI: 0.73-0.95) compared to iron-folate supplementation; mean birthweight was significantly higher by 55 g for MM with borderline increases in gestational age. MM supplementation was associated with larger decreases in the risk of LBW and SGA in the subgroup of trials that used supplements containing 60 mg of iron, but were not statistically significantly different from those for trials that used 30 mg iron. Prenatal MM supplementation improved intrauterine growth and can be recommended instead of prenatal IFA supplements in settings where micronutrient deficiencies are common.



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References

  1. Osrin D, Costello AM: Maternal nutrition and fetal growth: practical issues in international health. Semin Neonatol 2000;5:209-219.
  2. Ramakrishnan U, Huffman S: Multiple micronutrient malnutrition - What can be done? in Semba RD, Bloem M (eds): Nutrition and Health in Developing Countries, ed 2. Totowa, Humana Press, 2008.

    External Resources

  3. Ramakrishnan U: A review of the benefits of nutrient supplements during pregnancy: From iron-folic acid (IFA) to long chain polyunsaturated fatty acids (LCPUFAs) to probiotics. Ann Nestlé 2010;68:29-40.

    External Resources

  4. Imdad A, Bhutta ZA: Routine iron/folate supplementation during pregnancy: effect on maternal anemia and birth outcomes. Paediatr Perinat Epidemiol 2012;26(suppl 1):168-177.
  5. Imdad A, Bhutta ZA: Maternal nutrition and birth outcomes: effect of balanced protein energy supplementation. Paediatr Perinat Epidemiol 2012;26(suppl 1):178-190.
  6. Ramakrishnan U, Grant FK, Goldenberg T, et al: Effect of multiple micronutrient supplementation on pregnancy and infant outcomes: a systematic review. Paediatr Perinat Epidemiol 2012;26(suppl 1):153-167.
  7. Bhutta ZA, Imdad A, Ramakrishnan U, Martorell R: Is it time to replace iron folate supplements in pregnancy with multiple micronutrients? Paediatr Perinat Epidemiol 2012;26(suppl 1):27-35.
  8. Haider BA, Yakoob MY, Bhutta ZA: Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes. BMC Public Health 2011;11(suppl 3):S19.
  9. Higgins JPT, Green S: Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration, 2011.

    External Resources

  10. Sterne J: Investigating and dealing with publication and other biases in meta-analysis; in Egger M, Davey Smith G, Altman DG (eds): Systematic Reviews in Health Care. London, BMJ Books, 2001, pp 189-208.

    External Resources

  11. Rothstein H, Sutton AJ, Borenstein M: Publication Bias in Meta-Analysis: Prevention, Assessment and Adjustment. New York, John Wiley & Sons, 2005, pp 99-110.
  12. Bhutta ZA, Rizvi A, Raza F, et al: A comparative evaluation of multiple micronutrient and iron-folic acid supplementation during pregnancy in Pakistan: impact on pregnancy outcomes. Food Nutr Bull 2009;30:S496-S505.

    External Resources

  13. Christian P, Khatry SK, Katz J, et al: Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial. BMJ 2003;326:571.
  14. Christian P, West KP, Khatry SK, et al: Effects of maternal micronutrient supplementation on fetal loss and infant mortality: a cluster-randomized trial in Nepal. Am J Clin Nutr 2003;78:1194-1202.

    External Resources

  15. Eneroth H, El Arifeen S, Persson LA, et al: Maternal multiple micronutrient supplementation has limited impact on micronutrient status of Bangladeshi infants compared with standard iron and folic acid supplementation. J Nutr 2010;140:618-624.
  16. Gupta P, Ray M, Dua T, et al: Multimicronutrient supplementation for undernourished pregnant women and the birth size of their offspring: a double-blind, randomized, placebo-controlled trial. Arch Pediatr Adolesc Med 2007;161:58-64.
  17. Osrin D, Vaidya A, Shrestha Y, et al: Effects of antenatal multiple micronutrient supplementation on birthweight and gestational duration in Nepal: double-blind, randomised controlled trial. Lancet 2005;365:955-962.
  18. Shankar AH, Jahari AB, Sebayang SK, et al: Effect of maternal multiple micronutrient supplementation on fetal loss and infant death in Indonesia: a double-blind cluster-randomised trial. Lancet 2008;371:215-227.
  19. Sunawang, Utomo B, Hidayat A, et al: Preventing low birthweight through maternal multiple micronutrient supplementation: a cluster-randomized, controlled trial in Indramayu, West Java. Food Nutr Bull 2009;30:S488-S495.

    External Resources

  20. Zeng L, Dibley MJ, Cheng Y, et al: Impact of micronutrient supplementation during pregnancy on birth weight, duration of gestation, and perinatal mortality in rural western China: double blind cluster randomised controlled trial. BMJ 2008;337:a2001.
  21. Fawzi WW, Msamanga GI, Spiegelman D, et al: Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet 1998;351:1477-1482.
  22. Fawzi WW, Msamanga GI, Urassa W, et al: Vitamins and perinatal outcomes among HIV-negative women in Tanzania. N Engl J Med 2007;356:1423-1431.
  23. Friis H, Gomo E, Nyazema N, et al: Effect of multimicronutrient supplementation on gestational length and birth size: a randomized, placebo-controlled, double-blind effectiveness trial in Zimbabwe. Am J Clin Nutr 2004;80:178-184.

    External Resources

  24. Kaestel P, Michaelsen KF, Aaby P, Friis H: Effects of prenatal multimicronutrient supplements on birth weight and perinatal mortality: a randomised, controlled trial in Guinea-Bissau. Eur J Clin Nutr 2005;59:1081-1089.
  25. Zagre NM, Desplats G, Adou P, et al: Prenatal multiple micronutrient supplementation has greater impact on birthweight than supplementation with iron and folic acid: a cluster-randomized, double-blind, controlled programmatic study in rural Niger. Food Nutr Bull 2007;28:317-327.

    External Resources

  26. Roberfroid D, Huybregts L, Lanou H, et al: Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso. Am J Clin Nutr 2008;88:1330-1340.

    External Resources

  27. Hininger I, Favier M, Arnaud J, et al: Effects of a combined micronutrient supplementation on maternal biological status and newborn anthropometrics measurements: a randomized double-blind, placebo-controlled trial in apparently healthy pregnant women. Eur J Clin Nutr 2004;58:52-59.
  28. Ramakrishnan U, Gonzalez-Cossio T, Neufeld LM, et al: Multiple micronutrient supplementation during pregnancy does not lead to greater infant birth size than does iron-only supplementation: a randomized controlled trial in a semirural community in Mexico. Am J Clin Nutr 2003;77:720-725.

    External Resources

  29. Fall CH, Fisher DJ, Osmond C, Margetts BM: Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on birth size and length of gestation. Food Nutr Bull 2009;30:S533-S546.

    External Resources

  30. Shah PS, Ohlsson A: Effects of prenatal multimicronutrient supplementation on pregnancy outcomes: a meta-analysis. CMAJ 2009;180:E99-E108.


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