Effects of Multimicronutrient Supplementation during Pregnancy on Postnatal Growth of Children under 5 Years of Age: A Meta-Analysis of Randomized Controlled Trials

Abstract

BackgroundThe beneficial effect of antenatal multiple micronutrients supplementation on infant birth outcomes has been proposed by previous meta-analyses. However, their benefits on postnatal health of children have not been summarized. A meta-analysis of randomized controlled trials was conducted to evaluate the effect of maternal multimicronutrient supplementation on postnatal growth of children under 5 years of age.MethodsWe searched both published and ongoing trials through the PubMed, EMBASE, CENTRAL (OVID platform), Web of Science, BIOSIS Previews, Chinese Science Citation Database, Scopus, ProQuest, ClinicalTrials.gov, Chinese Biomedical Database, and WANFANG database for randomized controlled trials. Reference lists of included studies and relevant reviews were also reviewed for eligible studies. Standard mean difference (SMD) was employed as the index for continuous variables by using fixed effects models. Trend analysis by visual inspection was applied to evaluate the change of mean difference of weight and height between the groups over time.ResultsNine trials (12 titles) from nine different countries were retrieved for analysis. Pooled results showed that antenatal multimicronutrient supplementation increased child head circumference (SMD = 0.08, 95% CI: 0.00–0.15) compared with supplementation with two micronutrient or less. No evidence was found for the benefits of antenatal multimicronutrient supplementation on weight (P = 0.11), height (P = 0.66), weight-for-age z scores (WAZ) (P = 0.34), height-for-age z scores (HAZ) (P = 0.81) and weight-for-height z scores (WHZ) (P = 0.22). A positive effect was found on chest circumference based on two included studies.ConclusionsAntenatal multimicronutrient supplementation has a significant positive effect on head circumference of children under 5 years. No impact of the supplementation was found on weight, height, WAZ, HAZ and WHZ.

Micronutrient deficiencies in pregnancy worldwide: health effects and prevention

“…This finding is evident across nine trials that included children aged up to 5 years who had comparable distributions of weight, height and age-standardized indicators (weight-for-age, height-for-age, and weight-for-height z-scores). 117 However, potentially important, is a sustained increment of 0.08 cm (95% CI: 0.00–0.15 cm) in head circumference that was larger in those exposed to multiple micronutrients as compared to the controls. 117 By contrast, in Nepal, children aged 6–8 years and born to mothers who received folic acid, iron and zinc supplementation were taller by 0.64 cm (95% CI 0.04–1.25 cm) than children of mothers who received placebo.…”

“…117 However, potentially important, is a sustained increment of 0.08 cm (95% CI: 0.00–0.15 cm) in head circumference that was larger in those exposed to multiple micronutrients as compared to the controls. 117 By contrast, in Nepal, children aged 6–8 years and born to mothers who received folic acid, iron and zinc supplementation were taller by 0.64 cm (95% CI 0.04–1.25 cm) than children of mothers who received placebo. 118 The increment was accompanied by smaller skinfold thicknesses, consistent with improved linear growth amidst comparable energy intakes.…”

Maternal Diet and Nutrient Requirements in Pregnancy and Breastfeeding. An Italian Consensus Document

“…Supplementation with a mix of vitamins and minerals effectively reduces the risk of preterm delivery and infants of low weight at birth in developing countries, especially in women with a high body mass index [81]. …”

Is dietary macronutrient composition during pregnancy associated with offspring birth weight? An observational study

“…Maternal diet in pregnancy is suggested to contribute in the alteration of fetal outcomes ( 4 ) , including birth weight ( 5 ) , preterm delivery ( 6 ) , low birth weight infants (<2500 g) ( 7 ) and small-for-gestational-age (SGA) births ( 8 ) . Meta-analyses ( 9 – 11 ) have examined the role of micronutrients in the maternal diet, including vitamin C ( 9 ) , iron ( 12 ) and folate ( 13 , 14 ) in the development of adverse birth outcomes. Amongst dietary macronutrients, evidence has been restricted to exploring the use of protein-energy supplementation in pregnancy for improving offspring birth weight amongst low-income countries ( 15 – 17 ) .…”