Effect of low-dose versus higher-dose antenatal iron supplementation on child health outcomes at 36 months of age in Viet Nam: longitudinal follow-up of a cluster randomised controlled trial

Hanieh, Sarah; Hà, Trần Thị Thu; Simpson, Julie A.; Braat, Sabine; Thuy, Tran T; Tran, Thach; King, Janet C.; Tran, Thanh; Fisher, Jane; Biggs, Beverley‐Ann

doi:10.1136/bmjgh-2017-000368

Cited by 9 publications

(10 citation statements)

References 23 publications

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“… 44 In a follow-up cohort study of the infants born to women in the trial, we found that lower dose antenatal iron supplementation led to impaired growth (Adjusted MD in HAZ were –0.14 (95% CI –0.28 to –0.01) and motor development (MD –2.07, 95% CI –4.11 to –0.03) in children at 3 years of age. 45 …”

Section: Introductionmentioning

confidence: 99%

Addressing multiple modifiable risks through structured community-based Learning Clubs to improve maternal and infant health and infant development in rural Vietnam: protocol for a parallel group cluster randomised controlled trial

et al. 2018

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IntroductionOptimal early childhood development is an international priority. Risks during pregnancy and early childhood have lasting effects because growth is rapid. We will test whether a complex intervention addressing multiple modifiable risks: maternal nutrition, mental health, parenting capabilities, infant health and development and gender-based violence, is effective in reducing deficient cognitive development among children aged two in rural Vietnam.Methods and analysisThe Learning Clubs intervention is a structured programme combining perinatal stage-specific information, learning activities and social support. It comprises 20 modules, in 19 accessible, facilitated groups for women at a community centre and one home visit. Evidence-informed content is from interventions to address each risk tested in randomised controlled trials in other resource-constrained settings. Content has been translated and culturally adapted for Vietnam and acceptability and feasibility established in pilot testing.We will conduct a two-arm parallel-group cluster-randomised controlled trial, with the commune as clustering unit. An independent statistician will select 84/112 communes in Ha Nam Province and randomly assign 42 to the control arm providing usual care and 42 to the intervention arm. In total, 1008 pregnant women (12 per commune) from 84 clusters are needed to detect a difference in the primary outcome (Bayley Scales of Infant and Toddler Development Cognitive Score <1 SD below standardised norm for 2 years of age) of 15% in the control and 8% in the intervention arms, with 80% power, significance 0.05 and intracluster correlation coefficient 0.03.Ethics and disseminationMonash University Human Research Ethics Committee (Certificate Number 20160683), Melbourne, Victoria, Australia and the Institutional Review Board of the Hanoi School of Public Health (Certificate Number 017-377IDD- YTCC), Hanoi, Vietnam have approved the trial. Results will be disseminated through a comprehensive multistranded dissemination strategy including peer-reviewed publications, national and international conference presentations, seminars and technical and lay language reports.Trial registration numberACTRN12617000442303; Pre-results.

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Section: Introductionmentioning

confidence: 99%

Addressing multiple modifiable risks through structured community-based Learning Clubs to improve maternal and infant health and infant development in rural Vietnam: protocol for a parallel group cluster randomised controlled trial

et al. 2018

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“…There is some evidence from case–control studies that iron deficient children (assessed in early childhood) perform worse in both mental development tests and motor development tests compared with iron‐replete children . Some preventive trials with iron supplementation favor a beneficial effect of iron on motor development . Despite heterogeneity between studies, meta‐analyses indicate that antenatal micronutrient supplementation is beneficial for fluid intelligence and that especially iron supplementation is beneficial for a range of cognitive outcomes .…”

Section: Discussionmentioning

confidence: 99%

“…15 Some preventive trials with iron supplementation favor a beneficial effect of iron on motor development. [24][25][26][27] Despite heterogeneity between studies, meta-analyses indicate that antenatal micronutrient supplementation is beneficial for fluid intelligence and that especially iron supplementation is beneficial for a range of cognitive outcomes. 28 Results from newer and larger randomized trials will update evidence on short-term effects of antenatal iron supplementation on cognitive, mental, and motor development.…”

Section: Discussionmentioning

confidence: 99%

Frequent blood donation and offspring scholastic attainment: an assessment of long‐term consequences of prenatal iron deficiency

et al. 2019

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BACKGROUND Due to physiological demands, children and premenopausal women are at risk of developing iron deficiency. In premenopausal women, the risk may be further increased by repeated whole blood donations. Short‐term consequences of iron deficiency in infancy include impaired cognitive development and lower IQ scores. This prompts concern that maternal iron deficiency before or during pregnancy may have long‐term consequences for the offspring, for example, by affecting scholastic attainment. The aim of this study was to evaluate if prepregnancy donation intensity is associated with offspring scholastic attainment measured as grade averages in standardized national written examinations in Denmark. STUDY DESIGN AND METHODS By using the Danish personal identification number as key, we obtained information on donation intensity before pregnancy, school grade, year of graduation, age of the students, students' sex, and parental length of education and income from various nationwide registers. Linear regression analyses were performed, with grade average as outcome and maternal donation status as explanatory variable (nondonor, n = 177,078; low‐frequency donor, n = 4995 [one to five donations in the 3 years before pregnancy]; high‐frequency donor, n = 414 [six or more donations in the 3 years before pregnancy), and further adjusted for the covariates listed above. RESULTS Adjusted normalized (mean, 0; standard deviation [SD], 1) test scores were statistically significantly higher for children of active female donors compared with children of nondonors (SD, 0.104; 95% confidence interval, 0.079–0.129). We observed no differences in scholastic attainment between children of low‐frequency donors and high‐frequency donors. CONCLUSION Prepregnancy donation intensity, as a proxy of iron stores, is not associated with subsequent offspring scholastic attainment.

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“…These MCID thresholds have previously been used in the sample size calculations of several MNCH trials. 25,26,27,28,29,30,31,32,33,34…”

Section: Methodsmentioning

confidence: 99%

Association of Early Interventions With Birth Outcomes and Child Linear Growth in Low-Income and Middle-Income Countries

Park

Fang

Harari³

et al. 2019

JAMA Netw Open

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IMPORTANCE The first 1000 days of life represent a critical window for child development. Pregnancy, exclusive breastfeeding (EBF) period (0-6 months), and complementary feeding (CF) period (6-24 months) have different growth requirements, so separate considerations for intervention strategies are needed. No synthesis to date has attempted to quantify the associations of interventions under multiple domains of micronutrient and balanced energy protein and food supplements, deworming, maternal education, water sanitation, and hygiene across these 3 life periods with birth and growth outcomes. OBJECTIVE To determine the magnitude of association of interventions with birth and growth outcomes based on randomized clinical trials (RCTs) conducted in low-income and middle-income countries (LMICs) using Bayesian network meta-analyses. DATA SOURCES MEDLINE, Embase, and Cochrane databases were searched from their inception up to August 14, 2018. STUDY SELECTION Included were LMIC-based RCTs of interventions provided to pregnant women, infants (0-6 months), and children (6-24 months). DATA EXTRACTION AND SYNTHESIS Two independent reviewers used a standardized data extraction and quality assessment form. Random-effects network meta-analyses were performed for each life period. Effect sizes are reported as odds ratios (ORs) and mean differences (MeanDiffs) for dichotomous and continuous outcomes, with 95% credible intervals (CrIs). This study calculated probabilities of interventions being superior to standard of care by at least a minimal clinically important difference. MAIN OUTCOMES AND MEASURES The study compared ORs on preterm birth and MeanDiffs on birth weight for pregnancy, length for age (LAZ) for EBF, and height for age (HAZ) for CF. RESULTS Among 302 061 participants in 169 randomized clinical trials, the network meta-analyses found several nutritional interventions that demonstrated greater association with improved birth and growth outcomes compared with standard of care. For instance, compared with standard of care, maternal supplements of multiple micronutrients showed reduced odds for preterm birth (OR, 0.54; 95% CrI, 0.27-0.97) and improved mean birth weight (MeanDiff, 0.08 kg; 95% CrI, 0.00-0.17 kg) but not LAZ during EBF (MeanDiff, −0.02; 95% CrI, −0.18 to 0.14). Supplementing infants and children with multiple micronutrients showed improved LAZ (MeanDiff, 0.20; 95% CrI, 0.03-0.35) and HAZ (MeanDiff, 0.14; 95% CrI, 0.02-0.25). The study found that pregnancy interventions (continued) Key Points Question Which interventions under the domains of nutrition, deworming, maternal education, and water, sanitation, and hygiene can improve birth and linear growth outcomes during the first 1000 days of life in low-income and middle-income countries (LMICs)? Findings This study used Bayesian network meta-analyses of 169 randomized clinical trials including 302 061 participants and showed that several nutritional interventions demonstrating greater associations with improved outcomes compared with standard of care, whi...

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Effect of low-dose versus higher-dose antenatal iron supplementation on child health outcomes at 36 months of age in Viet Nam: longitudinal follow-up of a cluster randomised controlled trial

Cited by 9 publications

References 23 publications

Addressing multiple modifiable risks through structured community-based Learning Clubs to improve maternal and infant health and infant development in rural Vietnam: protocol for a parallel group cluster randomised controlled trial

Addressing multiple modifiable risks through structured community-based Learning Clubs to improve maternal and infant health and infant development in rural Vietnam: protocol for a parallel group cluster randomised controlled trial

Frequent blood donation and offspring scholastic attainment: an assessment of long‐term consequences of prenatal iron deficiency

Association of Early Interventions With Birth Outcomes and Child Linear Growth in Low-Income and Middle-Income Countries

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