Effect of Multiple Micronutrient Supplementation on Pregnancy and Infant Outcomes: A Systematic Review

Abstract

Supplementation with multiple micronutrients (MM) during pregnancy may result in improved pregnancy and infant outcomes. We conducted meta-analyses of randomised controlled trials that evaluated the effects of prenatal supplementation with MM (defined as containing at least five micronutrients and typically included iron or iron and folic acid). The outcomes of interest were low birthweight (<2500 g), birthweight, small-for-gestational age (SGA), gestational age, preterm birth (<37 weeks' gestation), stillbirth and neonatal death, maternal morbidity and mortality. We identified eligible studies through PubMed and EMBASE database searches. Meta-analyses were performed by pooling results for outcomes that were reported from more than one trial and sub-analyses were conducted to evaluate the effect of timing of intervention and amount of iron. We included published results from 16 trials in this review. Compared with control supplementation that was usually iron plus folic acid in most studies, MM supplementation resulted in a significant reduction in the incidence of low birthweight [pooled risk ratio ( There was no significant difference in the overall risk of preterm birth, stillbirth, and maternal or neonatal mortality, but we found an increased risk of neonatal death for the MM group compared with iron-folate in the subgroup of five trials that began the intervention after the first trimester (RR 1.38 [95% CI 1.05, 1.81]). None of the studies evaluated maternal morbidity. Compared with iron plus folic acid supplementation alone, prenatal maternal supplementation with MM resulted in a reduction in the incidence of low birthweight and SGA but increased risk of neonatal death in the subgroup of studies that began the intervention after the first trimester.

Is it Time to Replace Iron Folate Supplements in Pregnancy with Multiple Micronutrients?

“…Birth outcomes have been assessed in another paper in this supplement. 33 Continuous data were pooled to get a standard mean difference. Dichotomous data were pooled to get a relative risk, which was reported along with 95% CI.…”

“…27 Some MMN supplementation studies have also suggested benefits on infant 28 and newborn mortality 29 and growth in later infancy. 30 Others have cautioned against the use of these supplements on the basis of an increased risk of perinatal mortality observed in some settings [31][32][33] although this has been disputed given the overall variation in context. 18,26 In the current conundrum an evaluation of the potential benefits and risks of replacing iron folate supplements with MMN is necessary and must in the first instance be based on a factual evaluation of the scientific benefits and risks.…”

Correction of Micronutrient Status of the Population of the Irkutsk Region as a Means of Lowering Infant Mortality

“…Особенно неблагоприятны дефициты микро-нутриентов для беременных женщин, поскольку отсутствие или недостаток микронутриентов имеют программирующее воздействие на здоровье ребёнка и будущего поколения [9]. Ещё в 1932 г. Ф. Хэйл опу-бликовал исследования по дефицитному по витамину А рациону питания свиней на ранних сроках зачатия.…”

Bagaimana Gizi Sejak Massa Konsepsi Dapat Mempengaruhi Kesehatan Biologis Anak?

“…Folic acid has long been acknowledged as influential nutrient pre and during pregnancy to prevent neural tube defect 7,11 . Inadequate intrauterine nutrient supply brings information of adverse life conditions in the extra-uterine environment; it may enable to re-program metabolic pathways of the growing conceptus to prepare it to the shortage of food in later life.…”