Effect of Maternal Multiple Micronutrient vs Iron–Folic Acid Supplementation on Infant Mortality and Adverse Birth Outcomes in Rural Bangladesh

West, Keith P.; Shamim, Abu Ahmed; Mehra, Sucheta; Labrique, Alain; Ali, Hasmot; Shaikh, Saijuddin; Klemm, Rolf; Wu, Lee; Mitra, Madhumi; Haque, Rezwanul; Hanif, Abu Abdullah Mohammad; Massie, Allan B.; Merrill, Rebecca D.; Schulze, Kerry; Christian, Parul

doi:10.1001/jama.2014.16819

Cited by 124 publications

(177 citation statements)

References 46 publications

(21 reference statements)

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“…115 In Bangladesh, antenatal multiple micronutrient with the same formulation as used in Indonesia versus IFA supplementation had no effect on all-cause infant mortality in boys but lowered mortality in girls by 16%. 87 In this study, the investigators suggested that a larger birth size for boys might have differentially increased the risk of dying from asphyxia in the first few days after birth, which was not seen in girls. 87 Consequently, antenatal micronutrient supplementation might improve survival among offspring but the effect is likely to be modulated by local nutrition, disease and health care conditions.…”

Section: Antenatal Effects Across the Lifespanmentioning

confidence: 68%

“…87 In this study, the investigators suggested that a larger birth size for boys might have differentially increased the risk of dying from asphyxia in the first few days after birth, which was not seen in girls. 87 Consequently, antenatal micronutrient supplementation might improve survival among offspring but the effect is likely to be modulated by local nutrition, disease and health care conditions. Unknown at present is the potential for preconceptional micronutrient interventions to affect survival of offspring during gestation and postnatally, which are effects requiring adequately sized population-based randomized trials with extended postnatal follow-up.…”

Section: Antenatal Effects Across the Lifespanmentioning

confidence: 68%

“…85, 86 In a trial comparing multiple micronutrient versus iron and folic acid (IFA) in Bangladesh (starting supplementation at ~9 weeks’ gestation), which was designed to evaluate stillbirth, multiple micronutrients reduced the incidence of stillbirth by 11% (95% CI 1–19%). 87 Moreover, in a Cochrane systematic review of all randomized multiple micronutrient supplementation trials that combined effect estimates from 15 studies in low-income and middle-income countries, a 9% reduction in stillbirth (RR 0.91; 95% CI 0.85–0.98) was found compared with iron supplementation both with or without folic acid. 9 Collectively, these data suggest that sustained and adequate antenatal micronutrient supplementation might indeed improve late fetal survival rates.…”

Section: Antenatal Effects Across the Lifespanmentioning

confidence: 99%

“…While the results of meta-analyses suggest the effect is associated with a reduction in SGA (by 10%, 95% CI: 3–17%), 9 implying increased intrauterine growth, a comparable reduction in LBW in a large trial in rural Bangladesh (by 12%, 95% CI: 9–15%) was associated with prolonged gestation rather than accelerated fetal growth and a lower risk of SGA. 87 …”

Section: Antenatal Effects Across the Lifespanmentioning

confidence: 99%

“…9 By contrast, in a large, adequately powered trial in Bangladesh investigators reported a 2–3 day longer gestation and 15% reduction in preterm birth (95% CI 9–20%) following daily antenatal multiple micronutrient versus IFA from the first trimester onward. 87 These differing results suggest that pre-existing nutritional, disease and other environmental conditions might modify the public health impact of any given nutrition intervention.…”

Section: Antenatal Effects Across the Lifespanmentioning

confidence: 99%

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Micronutrient deficiencies in pregnancy worldwide: health effects and prevention

et al. 2016

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Micronutrients, vitamins and minerals accessible from the diet, are essential for biologic activity. Micronutrient status varies widely throughout pregnancy and across populations. Women in low-income countries often enter pregnancy malnourished, and the demands of gestation can exacerbate micronutrient deficiencies with health consequences to the fetus. Examples of efficacious single micronutrient interventions include folic acid to prevent neural tube defects, iodine to prevent cretinism, zinc to reduce of preterm birth, and iron to reduce the risk of low birth weight. Folic acid and vitamin D might also increase birth weight. While extensive mechanism and association research links antenatal multiple micronutrients to plausible materno-fetal health advantages, hypothesized benefits have often been absent, minimal or unexpected in trials. These findings suggest a role for population context in determining health responses and extensive gaps in knowledge. Multiple micronutrient supplements reduce risks of being born low birth weight, small for gestational age or stillborn in undernourished settings, and justify micronutrient interventions with antenatal care. Measurable health effects of gestational micronutrient exposure may persist into childhood but few data exists on potential long-term benefits. In this Review, we discuss micronutrient intake recommendations, risks and consequences of deficiencies, and the effects of interventions with a particular emphasis on offspring.

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Section: Antenatal Effects Across the Lifespanmentioning

confidence: 68%

Section: Antenatal Effects Across the Lifespanmentioning

confidence: 68%

Section: Antenatal Effects Across the Lifespanmentioning

confidence: 99%

Section: Antenatal Effects Across the Lifespanmentioning

confidence: 99%

Section: Antenatal Effects Across the Lifespanmentioning

confidence: 99%

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Micronutrient deficiencies in pregnancy worldwide: health effects and prevention

et al. 2016

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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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Vitamin supplementation for preventing miscarriage

Balogun

Lopes

Ota

et al. 2016

Cochrane Database of Systematic Reviews

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Effect of Maternal Multiple Micronutrient vs Iron–Folic Acid Supplementation on Infant Mortality and Adverse Birth Outcomes in Rural Bangladesh

Abstract: clinicaltrials.gov Identifier: NCT00860470.

Cited by 124 publications

References 46 publications

Micronutrient deficiencies in pregnancy worldwide: health effects and prevention

Micronutrient deficiencies in pregnancy worldwide: health effects and prevention

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

Vitamin supplementation for preventing miscarriage

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