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Modifying Levels of Maternal Dietary Folic Acid or Choline to Study the Impact of Deficiencies on Offspring Health Outcomes
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Preventing low birthweight through maternal multiple micronutrient supplementation: a cluster-randomized, controlled

Sunawang1, Budi Utomo, Adi Hidayat

  • 1Center for Health Research, School of Public Health, University of Indonesia, Depok, Indonesia. snw@cbn.net.id

Food and Nutrition Bulletin
|February 4, 2010
PubMed
Summary

Prenatal multiple micronutrient supplements showed a trend toward reducing low birthweight (LBW) and improved pregnancy outcomes when adherence was high. This multivitamin approach is as effective as iron-folic acid for anemia.

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Area of Science:

  • Maternal and Child Health
  • Nutritional Epidemiology
  • Public Health Interventions

Background:

  • Micronutrient deficiencies are linked to increased low birthweight (LBW) incidence.
  • A WHO/UNU/UNICEF-recommended multiple micronutrient supplement (MMS) formulation for pregnant women has been evaluated in effectiveness trials.

Purpose of the Study:

  • To compare the efficacy of prenatal multiple micronutrient supplementation (MMS) versus standard iron-folic acid (IFA) supplementation.
  • To assess impacts on birth size, pregnancy outcomes, and maternal micronutrient status.

Main Methods:

  • A cluster-randomized controlled trial was conducted in Indramayu, Indonesia, with 843 pregnant women.
  • Participants were assigned to receive either MMS (n=432) or IFA (n=411).
  • Daily observation of supplement intake and monitoring of fetal loss/mortality were performed.

Main Results:

  • High adherence was observed for both MMS and IFA groups (average 5 days/week).
  • A trend towards lower LBW incidence (6.3% vs 7.3%) and higher mean birthweight (+40g) was noted with MMS, though not statistically significant.
  • Among women with high adherence (≥90 supplements), MMS significantly reduced the combined rate of miscarriage, stillbirth, or neonatal death (3.3% vs 6.9%, p < .049).
  • Anemia rates were similar between groups, despite lower iron content in MMS.
  • Serum retinol levels were higher in the MMS group.

Conclusions:

  • Prenatal multivitamin supplementation is as effective as iron-folic acid for improving anemia status.
  • MMS supplementation appears to offer additional benefits for maternal and child nutritional status, particularly with high adherence.