Effects of antenatal multiple micronutrient supplementation on birthweight and gestational duration in Nepal:
David Osrin1, Anjana Vaidya, Yagya Shrestha
1International Perinatal Care Unit, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
Insights
Antenatal multiple micronutrient supplementation in Nepal significantly increased infant birthweight, reducing low birthweight by 25%. This intervention did not affect gestational duration, infant length, or head circumference.
Area of Science:
- Maternal and child health
- Nutritional science
- Global public health
Background:
- Neonatal mortality is a leading cause of under-5 deaths globally.
- Low birthweight is a critical factor contributing to neonatal mortality.
- Antenatal supplementation is a key strategy to improve infant outcomes.
Purpose of the Study:
- To evaluate the effect of antenatal multiple micronutrient supplementation on infant birthweight and gestational duration.
- To test the hypothesis that improved maternal nutrition enhances fetal growth.
Main Methods:
- A double-blind, randomized controlled trial was conducted in Nepal.
- Pregnant women received either standard iron/folic acid or a 15-micronutrient supplement.
- Primary outcomes were birthweight and gestational duration; intention-to-treat analysis was used.
Main Results:
- Multiple micronutrient supplementation resulted in a mean birthweight increase of 77g (p=0.004).
- The proportion of low birthweight infants decreased by 25% in the intervention group.
- No significant differences were observed in gestational duration, infant length, or head circumference.
Conclusions:
- Daily 15-micronutrient supplementation during pregnancy in a low-income Nepalese community is associated with improved infant birthweight.
- The intervention showed a significant reduction in low birthweight incidence.
- Further research is needed to assess impacts on perinatal morbidity and mortality.
Background:
Neonatal mortality is the biggest contributor to global mortality of children younger than 5 years, and low birthweight is a crucial underlying factor. We tested the hypotheses that antenatal multiple micronutrient supplementation would increase infant birthweight and gestational duration.
Methods:
We did a double-blind, randomised controlled trial in Dhanusha district, Nepal. Women attending for antenatal care with singleton pregnancies at up to 20 weeks' gestation were invited to participate. Participants were randomly allocated either routine iron and folic acid supplements (control; n=600) or a multiple micronutrient supplement providing a recommended daily allowance of 15 vitamins and minerals (intervention; n=600). Supplementation began at a minimum of 12 weeks' gestation and continued until delivery. Primary outcome measures were birthweight and gestational duration. Analysis was by intention to treat. The study is registered as an International Standard Randomised Controlled Trial, number ISRCTN88625934.
Findings:
Birthweight was available for 523/600 infants in the control group and 529/600 in the intervention group. Mean birthweight was 2733 g (SD 422) in the control group and 2810 g (453) in the intervention group, representing a mean difference of 77 g (95% CI 24-130; p=0.004) and a relative fall in the proportion of low birthweight by 25%. No difference was recorded in the duration of gestation (0.2 weeks [-0.1 to 0.4]; p=0.12), infant length (0.3 cm [-0.1 to 0.6]; p=0.16), or head circumference (0.2 cm [-0.1 to 0.4]; p=0.18).
Interpretation:
In a poor community in Nepal, consumption of a daily supplement containing a recommended daily allowance of 15 micronutrients in the second and third trimesters of pregnancy was associated with increased birthweight when compared with a standard iron and folic acid preparation. The effects on perinatal morbidity and mortality need further comparisons between studies. Published online March 3, 2005 http://image.thelancet.com/extras/04art11045web.pdf.
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